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ANNUAL REPORTS, WAR DEPARTMENT
FISCAL YEAR ENDED JUNE 30, 1919
REPORT OF THE
SURGEON GENERAL
U. S. ARMY
TO THE SECRETARY OF WAR
1919
IN TWO VOLUMES
VOL. II
WASHINGTCW
GON'ERN.MENT PRINTING OFFICE
1919
ANNUAL REPORTS, WAR DEPARTMENT
FISCAL YEAR ENDED JUNE 30. 1919
REPORT OF THE
SURGEON GENERAL
U. S. ARMY
TO THE SECRETARY OF WAR
1919
IN TWO VOLUMES
VOL. II
WASHINGTON
GOVERNMENT PRINTING OFFICE
1919
TABLE OF CONTENTS, VOLUMES 1 AND 2.
(Vol. I=pp. 1-1014, i-cccxxxii. Vol. II=pp. i-xxxvi, 1015-2167.)
A. Letter of transmittal 37
B. Health of the Army 53
I. Army 53
1. Admissions 53
2. Deaths 54
3. Discharges for disability 55
4. Noneffective rate 5g
II. United States 58
1. Admissions 58
2. Deaths 58
3. Discharges for disability 63
4. Noneffective rate 64
III. Europe 67
1. General remarks 67
2. Admissions 67
3. Deaths 68
4. Discharges for disability 68
5. Noneffective rate 71
IV. Other countries 74
1. Admissions 74
a. Philippine Islands, American and native troops. ... 74
b. Hawaiian Islands, American and native troops 75
c. Panama, American troops 76
d. Porto Rican troops in Porto Rico and Panama 76
e. Transports, American troops 79
f. Russia, Siberia, and other countries, American
troops 86
2. Deaths 86
a. Philippine Islands, American and native troops 86
b. Hawaiian Islands, American and native troops 86
c. Panama, American troops 87
d. Porto Ricau troops in Porto Rico and Panama 87
e. Transports, American troops 87
f. Russia, Siberia, and other countries, American
troops 95
3. Daj's lost and noneffective rate 95
a. Philippine Islands, American and native troops 95
b. Hawaiian Islands, American and native troops 96
c . Panama, American troops 96
d. Porto Rican troops in Porto Rico and Panama 97
e. Transports, American troops 97
f. Russia, Siberia, and other countries, American
troops 97
4. Discharges for disability 106
a. Philippine Islands, American and native troops 106
b. Hawaiian Islands, American and native troops 106
c. Panama, American troops 107
d. Porto Rican troops in Porto Rico and Panama 107
e. Transports. American troops 108
f. Russia, Siberia, and other coimtries, American
troops 108
C. Strength of the Army 117
D. Large Camps in United States 119
I. Camp Beauregard 127
II. Camp Bowie 142
III. Camp Cody 156
III
IV TABLE OF CONTENTS.
D. Large Camps in United States — Continued. Page.
IV. Camp Custer 170
V. Camp Devens 184
VI . Camp Dix 198
VII. Camp Dodge 212
VIII. Camp Doniphan 226
IX. Camp Eustis 238
X. Camp Fremont 252
XI. Camp Funston 264
XII. Camp Gordon 278
XIII. Camp Grant 292
XIV. Camp Greene 306
XV. Camp Hancock 327
XVI. Camp Humphreys 340
XVII. Camp Jackson. .' 350
XVIII. Camp Johnston 364
XIX. Camp Kearny 374
XX. Camp Lee 386
XXI. Camp Lewis 400
XXII. Camp Logan 414
XXIII. Camp MacArthur 426
XXIV. Camp McClellan 440
XXV. Camp Meade 452
XXVI. Camp Mills 466
XXVII. Camp Pike 478
XXVIII. Camp Se\'ier 492
XXIX. Camp Shelby 504
XXX. Camp Sheridan 516
XXXI. Camp Sherman 530
XXXII. Camp Syracuse 544
XXXIII. Camp Taylor 551
XXXIV. Camp Trayis 564
CXXV. Camp Upton 578
XXXVI. Camp Wadsworth 592
XXXVII. Camp Wheeler 604
E. Infectious diseases 618
I. General remarks 618
II. Influenza, pneumonia, and respiratory discuses 618
1. Statistical discussion, tables and illustrations 618
2. Extracts from reports, influenza, pneumonia, and respira-
tory diseases 740
a. Camp Funston. division surgeon 740
b. Fort Riley, base hospital 742
c. Camp Bo^vie, division surgeon 742
d . Camp Bo\\'ie, base hospital 743
e. Camp Travis, division surgeon 743
f . Cam}) Travis, base hospital 743
g. Camp Sherman, rlivision surgeon 745
h. Camp Kearny, division surgeon 746
i. Cam]) Kearny, base hospital 746
j . Camp MacArthur, di vision surgeon 747
k. Camp Greene, division surgeon 747
1. Camp Greene, base hospital 748
m. Camp Humphreys, di\'ision surgeon 748
n. Camp Hmnphreys, base hospital 748
o. Camp Grant, division surgeon 749
p. Camp Grant, base hospital 749
q. Camp Eustis, division surgeon 755
r. Camp Eustis, base hospital 755
8. Camp McClellan, diWsion surgeon 755
t. Camp McClellan, base hospital 756
u. Camp WTieeler, division surgeon 756
y. Camp Wheeler, base hospital 756
w. Camp Lee, division surgeon 756
X. Camp Lee, base hospital 758
y . Camp Custer, division surgeon 758
z. Camp Upton, division surgeon 759
TABLE OF CONTENTS. V
Infectious diseases — Continued.
II. Influenza, pneumonia, and respiratory diseases — Continued.
2. Extracts from reports, influenza, pneumonia, and respira-
tory diseases — Continued. Page.
al. Camp Upton, base hospital 759
bl. Camp Meade, di^sion surgeon 760
el. Camp Meade, l^ase hospital 761
dl. Camp Logan, division surgeon 762
el. Camp Logan, base hospital 762
fl. Camp Gordon, di^dsion surgeon 762
gl. Camp Gordon, base hospital 763
hi. Camp Pike, di\'ision surgeon 1 763
il. Camp Pike, base hospital 764
jl. Camp Jackson, di\T.sion surgeon 765
kl. Camp Fremont, division surgeon 765
11. Camp Dix, di\'ision surgeon 765
ml. Camp Beauregard, di\T.sion surgeon 766
nl. Camp Johnston, division siirgeon 766
01. Camp Dodge, division surgeon 767
pi. Camp Hancock, di\dsion surgeon 767
ql. Camp Hancock, base hospital 768
rl. Camp Sheridan, base hospital 769
si. Camp Wadsworth, base hospital 770
tl. Camp Lewis, base hospital 770
ul. Camp Sevier, base hospital 771
vl. Camp Mills, base hospital 772
wl. Fort Sill, base hospital 772
xl. Camp Shelby, base hospital 772
yl. Camp Devens, base hospital 773
zl. Camp Taylor, base hospital 773
a2. Camp Merritt, base hospital 774
b2. General Hospital No. 2 776
c2. General Hospital No. 3 776
d2. General Hospital No. 4 776
e2. General Hospital No. 6 777
f2. General Hospital No. 7 777
g2. General Hospital No. 8 777
h2. General Hospital No. 9 777
i2. GeneralHospitalNo.il 777
j2. General Hospital No. 13 777
k2. General Hospital No. 15 778
12. General Hospital No. 16 778
m2. General Hospital No. 17 778
n2. General Hospital No. 25 779
02. General Hospital No. 27 780
p2. General Hospital No. 29 780
q2. General Hospital No. 26 781
r2. Armv and Navy General Hospital, Hot Springs,
Ark 781
s2. Base hospital. Fort Sam Houston, Tex 781
t2. Letterman General Hospital, San Francisco, Calif. . 782
u2. Embarkation Hospital, Camp Stuart, Va 782
v2. Embarkation Hospital No. 1 782
w2. Debarkation Hospital No. 1 782
3. Extracts from reports, Pneumonia.
a. Camp Lee, di\ision surgeon 782
b. Pneumonia immunization 787
c. Camp Wheeler, base hospital 783
d. Camp Dodge, division surgeon 784
e. Camp Fremont, division surgeon 784
f . Camp Gordon, base hospital 785
g. Fort Sill, base hospital 785
h. Camp Upton, base hospital 785
i. Camp Hancock, base hospital 786
j. Camp Tra\ds, base hospital 786
k. Camp Custer, division surgeon 786
1. Camp Merritt, base hospital 786
Vni TABLE OF CONTENTS.
F. Special divisions, Surgeon General's Office — Continued.
VI. Hospital Division — Continued. Page.
2. Administration section 1152
a. Function 1152
b. Personnel 1153
c. Railwav tiansportation 1154
d. R6sum"^ 1156
e. Demolnlization of base hospital 1159
f . Demobilization of general hospitals 1159
3. Census section 1161
a. Distribution of overseas sick and wounded 1161
b. Transfer of patients from hospital to hospital 1162
c. Weekly hed report 1162
d. Compilation of daily telegrapliic bed reports 1162
e. ^Maintaining accurate record of patients arri^^.ng from
overseas and en route to various hospitals 1163
4. Statistical section 1168
a. Function 1168
b. Capacity of hospitals 1168
c. Turnover of patients 1168
d. Number of patients 1169
e. Reports 1169
5. Division of physical reconstruction 1171
a. Organization 1171
b . Section of education 1176
c. Section of physio- therapy 1177
d. Section of puiblicity 1178
6. Overseas mobile hospitals 1180
VII. Finance and Supplv Division 1184
VIII. The Veterinarv DiAdsion 1200
1. Personnel 1200
2. Service of the interior 1204
3. Service of the American Expeditionan,' Forces, France 1210
4. Service of the American Expeditionarj' Forces, Siberia 1213
5. Instruction and training 1213
6. Supplies 1216
7. Hospital construction 1216
8. Sanitation 1217
9. Communicable diseases 1220
10. Animal morbidity and mortality 1232
11. Incidence of special diseases at the larger camps 1239
12. Number of diseases reported 1248
IX. Army Medical School 1251
i. Orthopedic section 1251
2. Pathology section 1253
3. X-ray and photography 1254
4. Physical examinations 1255
5. ^Mimeographing 1255
6. Report on Wassermann tests 1256
7. Property department 1256
8. Civilian personnel 1256
9. Remarks and recommendation 1257
X. Library Surgeon General's Office 1257
XI. Providence Hospital 1258
XII. Port of embarkation, Hoboken, N. J 1258
XIII. Health and sanitary conditions of departments 1274
G . American Expeditionarj' Forces 1290
I. Chief surgeon's office and special activities 1290
1. Personnel division Medical Corps 1290
a. Organization 1290
b. Priority 1291
c. Promotions 1293
d. Difficulties 1297
2. Nursing department 1297
TABLE OF COISTTENTS. IX
American Expeditionary Forces — Continued.
I. Chief surgeon's office and special activities — Continued. Page.
3. Dental ser\'ice 1300
a. Organization 1300
b. Personnel 1301
c. Equipment and supplies 1302
d. Character of dental services rendered 1305
6. Summary of dental work 1305
f. Schools 1307
g. Army dental boards 1308
h. Casualties , 1308
4. Sanitation 1309
5. Division of laboratories and infectious diseases 1314
a. Section of laboratories, June-November, 1917 1314
a^. General plan of organization and develop-
ment 1314
b'. Personnel 131 5
c'. Equipment and supplies 1315
d'. The technical laboratory services 1315
b. Section of laboratories, November, 1917-November.
1918 1315
a^. General plan of organization and develop-
ment 1316
b^. Central medical department laboratory- 1317
(/. Base laboratories (sections of the Services of
Supply) 1319
d^. Base laboratories for hospital centers and
hospital laboratories for hospital units serv-
ing in centers 1320
e'. Base hospital laboratories for base hospitals
operating independently 1321
i\ Camp hospital laboratories 1321
g^. Evacuation hospital laboratories 1321
h^. ^Mobile hospital laboratories 1321
i\ Army laboratories 1322
i^. Divisional laboratories 1323
a^^. Organization 1323
h''. Personnel 1324
<y^. Equipment and supplies 1325
d^\ Technical laboratorj' service 1326
k'. Pathologic service 1327
a.-". Clinical patholog}- 1327
b'^. Anatomic pathology 1327
V. Bacteriologic service 1327
m'. Serologic service 1328
n^. Chemical service 1328
o'. Research service 1328
p'. ^fuseum and air service 1328
q^. Rat investigation 1329
c. Section of infectious diseases 1329
d. Food and nutrition section 1331
e. Water supplv section 1334
f . Summarj-. . .' 1335
fi. Hospitalization 1336
a. Location 1338
b. Buildings:
a ''. Existing French hospitals 1338
b ^ Suitable building by lease 1339
c '. Construction 1339
c. Hospital centers: 1340
a ''. French buildings 1341
b \ Constructed barrack hospitals 1341
d. Bed capacity 1341
e. Infirmaries 1341
f . Administration 1342
g. Miscellaneous 1342
7. Sick and wounded record division 1343
X TABLE OF CONTENTS.
G. American Expeditionary Forces — Continued.
I. Chief surgeon's office and special activities— Continued. Page.
8. Medical and hospital supplies 1346
a. Supply depots 1347
b. Purchases in Europe 1347
c. Personnel 1348
9. Finance and accounting division 1348
a. Purpose 1348
b. Preparatory work 1348
c. Personnel 1349
d. Outline and scope of organization 1349
e. Results accomplished 1351
f. General resume 1353
g. Disposal of records 1354
10. Disbursing officer and technical representatives, Medical
Department, United States Army, American Expe-
ditionary Forces, London 1355
a. Early history of medical purchases in England 1355
b. Organization of office 1356
r. Methods of purchase of medical supplies 1356
d. General classes of supplies purchased 1357
e. Approximate money value of purchases 1357
11. Medical Department transportation 1358
a. Trains 1358
b. Barges 1360
0. Ambulances 1360
12. Veterinary Corps, American Expeditionary Forces 1362
13. Special developments, American Expeditionary Forces. . . . 1367
a. Professional services 1367
b. Mobile hospitals 1369
c. Hospital centers 1370
14. Professional ser\dces 1370
a. Activitiesof the senior consultant for tuberculosis.. . 1370
b. Acti\'ities of cardio- vascular section 1373
c. Acti\'ities of neuro-psychiatric ser^^.ce 1379
a'. Organization 1379
b'. Clinical summary 1380
a''. Psychoses (war psychoses) 1381
b''. Psychoneuroses 1382
c" . Epilepsy (the amnesias) 1383
^" . Constitutional psychopathic states. 1384
0." . Mental deficiency 1384
i" . Organic nervous diseases 1385
d. Medical research laboratories, Air serAdlce, Ameri-
can Expeditionary Forces 1387
1 5. Medical director of T'hemical Warfare Ser\dce 1394
a. Organization 1394
b. Duties of di^'ision gas officers 1397
c. Portable tunnels for neutralizing of mustard gas cases 1398
d. Motorized degassing stations 1399
e. ^ledical gas warfare board 1399
I (i. IJathing and delousing 1399
a. Organization 1399
b. Personnel 1400
c. Organization of bathing and delousing di\'isions 1401
d. Different styles of disinfestors 1403
a ' . Serbian barrels 1404
b ' . Canadian hot-air disinfestors 1404
c '. Portable hot-aii- disinfestors 1404
e. Bathing apparatus 1404
f . Portable bathing and delousing units in the billeting
areas 1405
g. The Camp Ancona delousing plant 1406
h. Bathing of troops at base ports 1406
i. Description of bathing and delousing plants 1407
j . Hot-air disinfecting chambers 1407
k. Gasoline heating for disinfecting chambers 1408
1 . Plan of operation 1408
TABLE OF CONTENTS. XI
G. American Expeditionary Forces — Continued.
I. Chief surgeon's office and special activities — Continued.
16. Bathing and delousing — Continued. Page.
m. Bathroom 1409
n. ^Medical examination room 1409
II. United States Army Ambulance Service with the French Army. . 1409
1. The Sanitary Service of the U. S. sections 1409
2. The efficiency of training 1410
.3. Field ser\-ice and Red Cross organizations 1411
4. Type of serAdce 1412
5. French evacuation and American , 1412
6. Di\dsion litter bearers 1413
7. The G. B. D.i in action 1413
8. British Army evacuation 1414
9. The United States Army Ambulance Ser\-ice in the battle of
the Argonne 1414
10. Recommendations for the Ambulance Ser^'ice of the Ameri-
can Expeditionary Forces 1419
11. Demobilization 1423
III. General medical inspection in the American Expeditionary Forces. 1425
IV. The sanitation of a field army 1426
1. Organization 1426
2. Outline of plan for area sanitation 1428
a. Sanitary sections 1428
b. Sanitary squads 1429
c. Relations of the Army sanitary office to the sanitary
inspectors of dixisions 1430
d. Laboratory and epidemiological ser\dce 1433
e. Problem of replacement di^isions 1435
V. Casualties, medical officers, American Expeditionary Forces 1435
VI. Circular, Chief Surgeon's Office 1439
1. Memorandum to commanding officer, Ser\'ice of Supply,
May 29 1919 1439
VII. Activities of the General Staff 1442
1. General Staff superAOsion, Medical Department 1443
2. Hospitalization 1448
a. Constructive program 1450
b. Evolution of plans, etc 1454
c. Development of hospital centers 1455
d. American Red Cross military hospitals 1457
6. Field hospitals 1464
f . Mobile hospitals 1465
g. Evacuation hospitals 1465
h. Concentration areas 1467
i. Convalescent depots 1468
j. General review of mobile hospitalization and evacua-
tion 1469
3. Medical re\dew, second battle of the Marne 1473
4. Medical review, Champagne defensive 1475
5. Medical review, St. Mihiel-Argonne-Meuse offensives and
others 1476
a. Medical review for American division with French
north of Chaisons-sur-Marne, October, 1918 1477
b. Medical review. Second Corps 1477
c. Medical review, Belgian front 1478
d. Medical review, Italian front 1478
e. Medical review, Russia 1479
6. Miscellaneous topics 1479
a. Medical representations at regulation stations 1479
b. Hospital trains 1480
c. Evacuation of battle casualties from front line 1481
2/ . Fixed or trench warfare 1481
b^. Open or mobile warfare 1482
d. United States Army ambulance service 1484
1 Grouping of the litter bearers of the division.
XII TABLE OF CONTENTS.
G. American Expeditionary Forces — Continued.
VII. Activities of the General Staff — Continued.
6. Miscellaneous topics — Continued. FAge.
e. Liai'^on of the American Expeditionarj^ Force med-
ical service with that of the Allies 1486
f . Profes-sional services 1487
g. Relations with the French 1488
7. Automatic supply 1490
a. Buildins; a supply reserve 1490
b. Purchase of supplies in Europe 1491
c. Tonnage allotments 1492
d. Distribution 1493
e. Establishment of medical supply depots 1493
f . Establishment of medical dumps 1494
g. System of medical supply replenishments 1495
ii. "Controlled stores " policy 1497
i. Equalization of stock 1497
j . Shortage of ambulances 1497
k. Fooling system 1498
1. Demobilization plans 1498
m. Light railways 1499
n. Summary 1500
0. Suggestions 1501
VIII. Medical activities of American Expeditionary Force in zone of
the armies 1508
1. Chief Surgeon's reports of armies 1508
a. First Army 1508
b . Second Army 1525
2. Division Surgeons' reports 1547
a. Third Division 1547
b. Fifth Divi^on 1564
c. Sixth Di\-i=>ion 1566
d. Seventh Division 1569
e. Twentv-sixth Division '. 1576
f . Twenty-ninth Divi^on 1589
g. Thirtv-second Divi^on 1592
ii. Thirty-third Division 1597
i. Thirtv-fifth Division 1602
j. Thirtv-sixth Di\n^ion 1613
k. Thirtv-ninth Division 1630
1. Forty-first Di\-i4on 1630
m. Seventy-seventh Di\-ision 1635
n. Seventv-ninth Division 1645
0. Eightieth Di\-ision .' 1650
p. Eighty-first Division 1655
q . Eighty-second Division 1657
r. Eighty-eighth Division 1660
s. Ninetieth Division 1665
t. Xinety-first Division . 1666
3. Chief surgeons of advance section, services of supply 1674
IX. Hospital reports ^ 1677
1. Evacuation hospitals _. 1677
a. Evacuation Hospital No. 1 1677
b. Evacuation Hospital No. 3 1678
c. Evacuation Hospital No. 4 1691
d. Evacuation Hospital No. 6 1694
e. Evacuation Hospital No. 8 1699
f. Evacuation Hospital No. 9 1703
g. Evacuation Hospital No. 10 1706
ii. Evacuation Hospital No. 11 1708
i. Evacuation Hospital No. 12 1713
j. Evacuation Hospital No. 13 1719
k. Evacuation Hospital No. 14 1719
1. Evacuation Hospital No. 15 1720
m. Evacuation Hospital No. 16 1721
n. Evacuation Hospital No. 18 1722
o. Evacuation Hospital No. 20 1724
TABLE OF CONTENTS. Xni
O. American Expeditionary Forces — Continued.
IX. Hospital reports — Continued.
1. Evacuational hospitals — Continued. Page.
p. Evacuation Hospital No. 21 1724
q. Evacuation Hospital No. 22 1726
r. Evacuation Hospital Xo. 23 1727
8. Evacuation Hospital Xo. 24 1728
t. Evacuation Hospital Xo. 25 1730
u. Evacuation Hospital Xo. 26 1730
v. Evacuation Hospital Xo. 27 1731
w. Evacuation Hospital Xo. 29 1732
X. Evacuation Hosi^ital Xo. 30 } 1733
y . Evacuation Hospital Xo. 33 1734
z. Evacuation Hospital Xo. 35 1735
al. Evacuation Hospital Xo. 36 1738
bl. Evacuation Hospital Xo. 37 1739
cl. Evacuation Hospital Xo. 49 1740
2. Hospital trains 1742
a. Train No. 53 1742
b. Train No. 54 1743
c. Train Xo. 58 1744
d. Train No. 59 1745
e. Train No. 60 1745
f. Train No. 61 1746
g. Train No. 62 1747
h. Train No. 63 1748
i. Train No. 66 1750
;. Train No. 70 1751
3. Medical Department, United States Army, district of Paris. 1751
4. Hospital centers 1755
a. Hospital center, Yittell 1755
b. Hospital center, Bzaoilles-sur-Meuse 1801
c. Hospital center, Langres 1805
d. Hospital center, Allerey , Saone et Loire 1808
e. Justice hospital group 1836
f. Mesves hospital center 1838
g. Hospital center, Limoges 1847
h. Mars hospital center 1849
i. Hospital center, Perigueux 1850
j. Hospital center, Pau Basses-Py ranees 1851
k. Hospital center, Nantes 1851
1. Hospital center, Riviera 1853
m. Hospital center, Beaxi Desert 1855
n. Hospital center Rimaucourt 1859
0. Hospital center, Vichy 1863
q . Concentration area. Join ville 1870
r. Gas hospital, justice hospital group 1872
5. Base hospitals 1876
a Provisional Rase Hospital No. 1 1876
b. Base Hospital No. 3 1876
c. Base Hospital No. 5 1878
d. Base Hospital No. 6 1880
p.. Base Hospital No. 7 1883
f. Base Hospital No. 8 1883
g. ProN-isional Base Hospital No. 8 1884
h. Base Hospital No. 9 1886
i. BaseHospitalNo.il 1887
j. Base Hospital No. 13 1890
k. Base Hospital No. 20 1890
1. Base Hospital No. 22 1892
m. Ba&e Hospital No. 24 1894
n. Base Hospital No. 28 1895
0. Base Hospital No. 29 1896
p. Base Hospital No. 30 1896
q. Base Hospital No. 31 1901
r. Base Hospital No. 33 1911
e. Base Hospital No. 34 1914
t. Base Hospital No. 35 1920
i
XIV TA^LE OF CONTENTS.
G. American Expeditionary Forces — Continued.
IX. Hospital reports — Continued.
5. Base hospitals — Continued. Page.
u. Base Hospital No. 37 1924
V. Base Hospital No. 38 1926
w. Base Ho.spital No. 40 1936
X. Base Hospital No. 41 1937
y. Base Hospital No. 42 1942
z. Base Hospital No. 43 1943
al. Base Hospital No. 44 1946
bl. Base Hospital No. 46 1948
cl. Base Hospital No. 47 1953
dl. Base Hospital No. 48 1955
el. Base Hospital No. 50 1956
fl. Base Hospital No. 51 1957
gl. Base Hospital No. 52 1960
hi. Base Hospital No. 53 1961
11. Base Hospital No. 54 1964
jl. Base Hospital No. 55 1966
kl. Base Hospital No. 58 1967
11. Base Hospital No. 59 1968
ml. Base Hospital No. 60 1970
nl. Base Hospital No. 61 1972
01. Base Hospital No. 62 1974
pi. Base Hospital No. 63 1975
ql. Base Hospital No. 64 1976
rl. Base Hospital No. 65 1979
si. Base Hospital No. 67 1981
tl. Base Hospital No. 68 1982
ul. Base Hospital No. 69 1983
vl. Base Hospital No. 71 1984
wl . Base Hospital No. 77 1985
xl. Base Hospital No. 78 1986
vl. Base Hospital No. 80 1987
zl. Base Hospital No. 81 1989
a2. Base Hospital No. 82 1990
b2. Base Hospital No. 83 1991
c2. Base Hospital No. 84 1992
d2. Base Hospital No. 86 1993
e2. Base Hospital No, 87 1994
f2. Base Hospital No. 88 1996
g2. Base Hospital No. 90 1997
h2. Base Hospital No. 91 1998
12. Base Hospital No. 92 1999
j2. Base Hospital No. 94 1999
k2. Base Hospital No. 95 2001
12. Base Hospital No. 96 2001
m2. Base Hospital No. 98 2002
n2. Biise Hospital No. 100 2003
02. Base Hospital No. 101 2004
p2. Base Hospital No. 104 2005
q2. Base Hospital No. 105 2006
r2. Base Hospital No. 106 2007
s2. Base Hospital No 107 2009
t2. Base Hospital No. 108 2010
u2. Base Hospital No. 110 2012
v2. Base Hospital No. Ill 2012
w2. Base Hospital No. 113 2012
x2. Base Hospital No. 114 2013
y2. Bate Hospital No. 116 2013
z2. Base Hospital No. 118 2014
a3. Base Hospital No. 119 2015
b3. Base Hospital No. 120 2015
c3. Base Hospital No. 1 21 2016
d3. Base Hospital No. 123 2016
e3. Base Hospital No. 131 2017
f3. Base Hospital No. 136 2019
TABLE OF CONTENTS. XV
G. American Expeditionary Forces— Continued.
IX. Hospital reports — Continued.
5. Base hospitals — Continued. P^g^-
<r^. Base Hospital No. 204 2020
h3. Base Hospital No. 208 2021
i3. Base Hospital No. 210 2022
i3. Base Hospital No. 218 2022
kS. Base Hospital No. 236 2023
13. Base Hospital No. 238 2023
6. American Red Cross Military Hospitals 2024
a. Hospital No. 1 ^ 2024
b. Hospital No. 2 2025
c. Hospital No. 4 2029
d. Hospital No. 5 2029
e. Hospital No. 6 2031
f . Hospital No. 9 2031
g. Hospital No. 21 2032
h. American Red Cross Hospital, Padova, Italy 2032
7. Base sections 2033
a. Base Section No. 1 2033
b. Base Section No. 2 2035
c. Base Section No. 3 2039
a\ Hospitalization in England 2039
y. Evacuation to the United States 2041
d. Base Section No. 4 2042
e. Base Section No. 5 2043
f . Base Section No. 7 2055
g. Base Section No. 8 : 2057
8. Mobile Hospitals 2058
a. Mobile Hospital No. 1 2058
b. Mobile Hospital No. 3 2058
c. Mobile Hospital No. 11 2059
d. Mobile Hospital No. 12 2061
9. Camp hospitals 2062
a. Camp Hospital No. 1 2062
b. Camp Hospital No. 2 2063
c. Camp Hospital No. 3 2064
d. Camp Hospital No. 5 2064
e. Camp Hospital No. 7 2065
f. Camp Hospital No. 8 2066
g. Camp Hospital No. 9 2067
h. Camp Hospital No. 10 2067
i. Camp Hospital No. 11 2070
j. Camp Hospital No. 12 2072
k. Camp Hospital No. 13 2078
1. Camp Hospital No. 14 2080
m. Camp Hospital No. 15 2081
n. Camp Hospital No. 19 2082
o. Camn Hospital No. 20 2083
p. Camp Hospital No. 21 2083
q. Camp Hospital No. 22 2086
r. Camp Hospital No. 23 2086
s. Camp Hospital No. 24 2087
t. Camp Hospital No. 26 2092
u. Camp Hospital No. 28 2095
V. Camp Hospital No. 29 2096
w. Camp Hospital No. 31 2097
X. Camp Hospital No. 34 2098
y. Camp Hospital No. 35 2100
z. Camp Hospital No. 36 2103
al. Camp Hospital No. 37 2103
bl. Camp Hospital No. 38 2104
cl. Camp Hospital No. 39 2105
dl. Camp Hospital No. 40 2105
el. Camp Hospital No. 41 2110
fl. Camp Hospital No. 42 2111
gl. Camp Hospital No. 43 2113
XVI TABLE OF CONTENTS.
G. American Expeditionary Forces — Continued.
IX. Hospital reports — Continued.
9. Camp hospitals— Continued. Page.
hi. Camp Hospital No. 45 2116
il. Camp Hospital No. 49 2117
jl. Camp Hospital No. 50 2118
kl. Camp HospiUl No. 52 2119
11. Camp Hospital No. 53 2120
ml. Camp Hospital No. 59 2121
nl. Camp Hospital No. 64 2122
ol. Camp Hospital No. 65 2123
pi. Camp Hospital No. 66 2124
ql. Camp Hospital No. 67 2126
rl. Camp Hospital No. 68 2127
si. Camp Hospital No. 69 2128
tl. Camp Hospital No. 70 1.128
ul. Camp Hospital No. 72 '4-^2?
vl. Camp Hospital No. 76 2i^i»
wl. Camp Hospital No. 78 213e
xl. Camp Hospital No. 82 21o«
yl. Camp Hospital No. 85 2132
zl. Camp Hospital No. 86 2133
a2. Camp Hospital No. 91 2133
b2. Camp Hospital No. 94 213C
c2. Camp Hospital No. 95 ^..,^ J 2135
d2. Camp Hospital No. 96 .,' . V. - 2136
e2. Camp Hospital No. 97 i.-^-.- 2136
f2. Camp Hospital No. 100 2136
g2. Camp Hospital No. 102 2138
h2. Camp Hospital No. 103 218-
12. Camp Hospital No. 104 2139
j2. Camp Hospital No. 105 2141
k2. Camp Hospital No. 106 2141
12. Camp Hospital No. 111... _. 2141
X- Report of organization and operation of the instruction and assembly
park for mobile units 2142
XI. Divisional training areas 2143
XII. Convalescent camps 2146
1 . Convalescent camp, Paris 2146
2. Convalescent camp, Mars 2147
3. Convalescent camp, Limoges 2148
4. Convalescent camp, Savenay 2149
TEXT TABLES.
1. Movement of the sick, by months, in United States, 1918 118
2. Movement of the sick, bv months, in Europe, 1918 118
3. Total strength of the Armv, 1918 118
4. Strength of the Army in United States, 1918 59
5. Strength of Army in Europe, 1918 - 60
6. Strength of troops, by months, stationed outside of large camps and in the
large camps in the L'nited States 61
7. Admissions, 30 leading diseases, total officers 79
8. Admissions, 30 leading diseases, officers in United States 80
9. Admissions, 30 leading diseases, officers in Europe
10. Admissions, 30 leading diseases, total enlisted men, American troops -^ 'oO
11. Admissions, 30 leading diseases, enlisted men in the United States 81
12. Admissions. 30 leading diseases, enlisted men, American troops, in Eiirope. 81
13. Admissions, 30 leading diseases, enhsted men, American troops, in
Philippine Islands - - 8
14. Admissions, 30 leading diseases, enlisted men, American troops, in Hawaii. S'.-
15. Admissions, 30 leading diseases, enUsted men, American troops, in
Panama 8L
16. Admissions, 30 leading diseases, enlisted men, native troops 84
17. Admissions, 30 leading diseases, native Philippine troops 84
18. Aclmissions, 30 leading diseases, native Hawaiian troops 85
19. Admissions, 30 leading diseases, Porto Rican troops 8..
20. Deal ha. 30 leading diseases, total officers 9<"
:]
TABLE OF CONTENTS. XVII
i'age.
21. Deaths 30 leading diseases, officers in United States 90
22. Deaths, 30 leading diseases, officers in Europe 91
23. Deaths, 30 leading diseases, total enlisted men, American troops 91
24. Deaths, 30 leading diseases, enlisted men, American troops, in United
States 92
25. Deaths, 30 leading diseases, enlisted men, American troops, in Europe 92
26. Deaths. 19 leading diseases, enlisted men, American troops, in Philippine
Islands 93
27. Deaths, 6 leading diseases, enlisted men, American troops, in Hawaii 93
28. Deaths, H leading diseases. enUsted men, American troops, in Panama. . . 93
29. Deaths, 30 leading diseases, enlisted men, native troops 94
30. Deaths, 15 leading diseases, native Pliilippine troops j 94
31. Deaths, 8 leading diseases, native Hawaiian troops 94
32. Deaths, 30 leading diseases, Porto Rican trocrps 95
33 Days lost, 30 leading diseases, total officers 100
-■^^r. Daj's lost, 30 leading diseases, officers in United States 100
- o5. Days lost, 30 leading diseases, officers in Europe 101
^ S6. Days lost, 30 leading diseases, total enlisted men, American troops 101
' 37. Days lost, 30 leading diseases, enlisted men in the United States 102
38. Days lost, 30 leading diseases, enlisted men in Europe 102
39. Days lost, 30 leading diseases, enlisted men, American troops, in Philippine
Islands 1 03
^ 40. Days lost, 30 leading diseases, enlisted men, American troops, in Hawaii. . 103
'^ 41. Days lost, 30 leading diseases, enlisted men, American troops, in Panama. 104
42. Df?''" lost, 30 leading diseases, enlisted men, native troops 104
43. Da jst, 30 leading diseases, native Phillippine troops 105
44. Dayo lOst, 30 leading diseases, native Hawaiian troops 105
45. Days lost, 30 leading diseases, native Porto Rican troops 106
46. Discharges, 30 leading diseases, total officers 108
8^ 47. Discharges, 17 leading diseases, officers in Europe Ill
^- 48. Discharges, 30 leading diseases, officers in United States Ill
49. Discharges, 30 leading diseases, total enlisted men, American troops 112
50. Discharges, 30 leading diseases, enlisted men in United States 112
51. Discharges, 30 leading diseases, enUsted men. American troops, in Europe. 113
52. Discharges, 17 leading diseases, enlisted men, American troops, in Philip-
pine Islands 113
53. Discharges, 23 leading diseases, enlisted men, American troops, in Hawaii. 114
54. Discharges, 23 leading diseases, enlisted men, American troops, in Panama. 114
55. Discharges, 30 leading diseases, total native troops 115
56. Discharges, 26 leading diseases, native Philippine troops 115
57. Discharges, 29 leading diseases, native Hawaiian troops 116
58. Discharges, 30 leading diseases, native Porto Rican troops 116
59. Admissions, diseases only, large camps. United States, order of standing. . 125
60. Deaths, diseases onl5^ large camps. United States, order of standing 125
61. Discharges, diseases only, large camps. United States, order of standing. . 126
62. Noneffective rates, diseases only, large camps. United States, order of
standing 126
63. Camp Beauregard, average strength, by month and source of command. . . 132
64. Camp Beauregard, movement of sick, bj' months, 1918 133
65. Camp Beauregard, admissions, special infectious diseases, 1917-18, abso-
lute numbers - - 134
J 66. Camp Beauregard, admissions, special infectious diseases, 1917-18, ratios
per 1,000 ; 136
67. Camp Beaiiregard, deaths, special infectious diseases, 1917-18, absolute
numbers 138
^^. Camp Beauregard, deaths, special infectious diseases, 1917-18, ratios per
1,000 140
1 69. Camp Bowie, average strength, by month and source of command 146
70. Camp Bowie, movement of sick, by months, 1918 147
2 71. Camp Bowie, admissions, special infectious diseases, 1917-18, absolute
P numbers 148
72. Camp Bowie, admissions, special infectious diseases, 1917-18, ratios per
f 1,000 150
73. Camp Bowie, deaths, special infectious diseases, 1917-18, absolute num-
bers 152
p 142367— 19— VOL 2 2
XVIIT TABLE OF CONTENTS.
Page.
74. Camp Bov\-ie, deaths, special infections diseases, 1917-18, ratios per 1,000. 154
75. Camp Cody, average strength, by month and source of command 160
76. Camp Cody, movement of sick, by moni hs, 1918 161
77. Camp Cody, admissions, special infectious diseases, 1917-18, absolute
numbers 162
78. Camp Cody, admissions, special infectious diseases, 1917-18, ratios per
1,000 164
79. Camp Cody, deaths, special infectious diseases, 1917-18. absolute numbers. 166
80. Camp Cody, deaths, special infectious diseases, 1917-18, ratios per 1,000. . 168
81. Camp Custer, average strength, by month and source of command 174
82. Camp Custer, movement of sick, bj' months, 191 8 175
83. Camp Custer, admissions, special infectious diseases, 1917-18, absolute
numbers 176
84. Camp Custer, admissions, special infectious diseases, 1917-18, ratios per
1,000 178
85. Camp Custer, deaths, special infectious diseases, 1917-18, absolute numbers 180
86. Camp Custer, deaths, special infectious diseases, 1917-18, ratios per 1,000. . 182
87. Camp Devens. average strength, by month and source of command 188
88. Camp Devens, movement of sick, bj^ months, 1918 189
89. Camp Devens, admissions, special infectious diseases, 1917-18, absolute
numbers 190
90. Camp Devens, g,dmissions, special infectious diseases, 1917-18, ratios per
1,000 192
91. Camp Devens, deaths, special infectious diseases, 1917-18, absolute
numbers 194
92. Camp Devens, deaths, special infectious diseases, 1917-18, ratios per
1,000 196
93. Camp Dix, average strength, by month and source of command 202
94. Camp Dix, movement of sick, by months. 1918 203
95. Camp Dix, admissions, special infectious diseases, 1917-18, absolute num-
bers , . . ; , 204
96. Camp Dix, admissions, special infectious diseases, 1917-18, ratios per
1,000 206
97. Camp Dix, deaths, special infectious diseases, 1917-18, absolute numbers. 208
98. Camp Dix, deaths, special infectious diseases, 1917-18, ratios per 1,000 210
99. Camp Dodge, average strength, by month and source of command 216
100. Camp Dodge, movement of sick, by months, 1918 217
101. Camp Dodge, admissions, special infectious diseases, 1917-18, absolute
numbers 218
102. Camp Dodge, admissions, special infectious diseases, 1917-18, ratios per
1,000 220
103. Camp Dodge, deaths, special infectious diseases, 1917-18, absolute num-
bers 222
104. Camp Dodge, deaths, special infectious diseases, 1917-18, ratios per 1,000. 224
105. Camp Doniphan, average strength, by month and source of command 228
106. Camp Doniphan, movement of sick, by months, 1918 229
107. Camp Doniphan, admissions, special infectious diseases, 1917-18, abso-
lute numbere 230
108. Camp Doniphan, admissions, special infectious diseases, 1917-18, ratios
per 1,000 232
109. Camp Doniphan, deaths, special infectious diseases, 1917-18, absolute
numbers - 234
110. Camp Doniphan, deaths, special infectious diseases, 1917-18, ratios per
1 , 000 -^ 236
111. Camp Eustis, average strength, by month and source of command 240
112. Camp Eustis, movement of sick, by months, 1918 240
113. Camp Eustis, admissions, special infectious diseases, 1917-18, absolute
numbers 241
114. Camp Eustis, admissions, special infectious diseases, 1917-18, ratios per 1,000 242
115. Camp Eustis, deaths, special infectious diseases, 1917-18, absolute num-
bers 243
116. Camp Eustis, deaths, special infectious diseases, 1917-18, ratios per 1,000. 243
117. Camp Forrest, movement of the sick, by months, 1918 244
118. Camp Forrest, admissions, special infectious diseases, 1917-18, absolute
niunbers 246
TABLE OF CONTENTS. XIX
Page.
119. Camp Forrest, admissions, special infectious diseases, 1917-18, ratios per
1.000 248
120. Camp Forrest, deaths, special infectious diseases, 1917-18, absolute num-
bers - . 250
121. Camp Forrest, deaths, special infectious diseases, 1917-18, ratios per 1,000. 251
122. Camp Fremont, average strength, by month and source of command 254
123. Camp Fremont, movement of sick, by months, 1918 255
124. Camp Fremont, admissions, special infectious diseases, 1917-18, absolute
numbers 256
125. Camp Fremont, admissions, special infectious diseases, 1917-18, ratios per
1,000 258
126. Camp Fremont, deaths, special infectious diseases, 1917-1918, absolute
numbers 260
127. Camp Fremont, deaths, special infectious diseases, 1917-18, ratios per
1 ,000 262
128. Camp Funston, average strength, by month, and source of command 268
129. Camp Funston, movement of sick, by months, 1918 269
130. Camp Funston, admissions, special infectious diseases, 1917-18, absolute
numbers 270
131. Camp Funston, admissions, special infectious diseases, 1917-18. ratios per
1 ,000 272
132. Camp Funston, deaths, special infectious diseases, 1917-18, absolute niun-
bers 274
133. Camp Funston, deaths, special infectious diseases, 1917-18, ratios per 1,000. 276
134. Camp Gordon, average strength, by month and source of command 282
135. Camp Gordon, movement of sick, by months, 1918 283
136. Camp Gordon, admissions, special infectious diseases, 1917-18, absolute
numbers 284
137. Camp Gordon, admissions, special infectious diseases, 1917-18, ratios per
1,000 286
138. Camp Gordon, deaths, special infectious diseases, 1917-18, absolute num-
bers 288
139. Camp Gordon, deaths, special infectious diseases, 1917-18, ratios per 1,000. 290
140. Camp Grant, average strength, by month and source of command 296
141. Camp Grant, movement of sick, by months, 1918 297
142. Camp Grant, admissions, special infectious diseases, 1917-18, absolute num-
bers 298
143. Camp Grant, admissions, special infectious diseases, 1917-18, ratios per
1,000 300
144. Camp Grant, deaths, special infectious diseases, 1917-18. absolute numbers. 302
145. Camp Grant, deaths, special infectious diseases, 1917-18, ratios per 1,000.. 304
146. Camp Greene, average strength, by month and source of command 309
147. Camp Greene, movement of sick, by months, 1918 309
148. Camp Greene, admissions, special infectious diseases, 1917-18, absolute
numbers 310
149. Camp Greene, admissions, special infectious diseases, 1917-18, ratios per
1,000 312
150. Camp Greene, deaths, special infectious diseases, 1917-18, ab-
solute numbers 314
151. Camp Greene, deaths, special infectious diseases, 1917-18, ratios per 1,000 . 316
152. Camp Greenleaf , movement of the sick, by months, 1918 318
153. Camp Greenleaf, admissions, special infectious diseases, 1917-18, absolute
numbers 320
154. Camp Greenleaf, admissions, special infectious diseases, 1917-18, ratios per
1,000 320
155. Camp Greenleaf, deaths, special infectious diseases, 1917-18, absolute nxun-
bers 322
156. Camp Greenleaf, deaths, special infectious diseases, 1917-18, ratios per 1000 324
157. Camp Hancock, average strength, by month, and source of command 330
158. Camp Hancock, movement of sick, by months, 1918 331
159. Camp Hancock, admissions, special infectious diseases, 1917-18, absolute
numbers 332
160. Camp Hancock, admissions, special infectious diseases, 1917-18, ratios per
1 ,000 334
161. Camp Hancock, deaths, special infectious diseases, 1917-18, absolute num-
bers 336
XX TABLE OF CONTENTS.
Page.
162. Camp Hancock, deaths, special infectious diseases, 1917-18, ratio per
1,000 338
103. Camp Humphrey's, average strength, by month and source of command. . . 341
1 64. Camp Humphreys, movement of sick, by months, 1918 343
165. Camp Humphreys, admissions, special infectious diseases, 1917-18, abso-
lute numbers 344
166. Camp Humphreys, admissions, special infectious diseases, 1917-18, ratios
per 1 ,000 .' 346
107. Camp Humphreys, deaths, special infectious diseases, 1917-18, absolute
numbers 348
16R. Camp Humphreys, deaths, special infectious diseases, 1917-18, ratios per
1,000 349
169. Camp Jackson, average strength, by month and source of command 354
170. Camp Jackson, movement of sick, by months, 1918 355
171. Camp Jackson, admissions, special infectious diseases, 1917-18, absolute
numbers 356
172. Camp Jackson, admissions, special infectious diseases, 1917-18, ratio per
1 , 000 358
173. Camp Jackson, deaths, special infectious diseases, 1917-18, absolute num-
bers 360
174. Camp Jackson, deaths, special infectious disciises, 1917-18, ratios per 1,000. 362
1 75. Camp Johnston, average strength, by month and source of command 366
176. Camp Johnston, movement of sick, by months, 1918 367
177. Camp Johnston, admissions, special infectious diseases, 1917-18, absolute
numbers 368
178. Camp Johnston, admissions, special infectious diseases, 1917-18, ratios per
1,000 370
179. Camp Johnston, deaths, special infectious diseases, 1917-18, absolute num-
bers 372
180. Camp Johnston, deaths, special infectious diseases, 1917-18, ratios per
1,000 373
1 81 . Camp Kearney, a^"erage strength, by month and source of command 378
182. Camp Kearney, movement of sick, by months, 1918 379
183. Camp Kearney, admissions, special infectious diseases, 1917-18, absolute
numbers 380
184. Camp Kearnev, admissions, special infectious diseases, 1917-18, ratios per
1,000 ! 382
185. Camp Kearnev, deaths, special infectious diserses, 1917-18, absolute niun-
bers " 384
1 86. Camp Kearney, deaths, special infectious diseases, 1917-1 8, ratios per 1,000. 385
187. Camp Lee, average strength, by month and source of command 390
] SS. Camp Lee, movement of sick, toy months, 1918 391
189. Camp Lee, admissions, si^ecial infectious diseases, 1917-18, absolute num-
bers 392
190. Camp Lee, admissions, special infectious diseases, 1917-18, ratios per
1,000 394
191 . Camp Lee, deaths, special infectious diseases, 1917-18, absolute nimibers. . 396
192. Camp Lee, deaths, special infectious diseases, 1917-18, ratios per 1,000 398
193. Camp Le\\'is, average strength, by month and source of command 404
194. Camp Lewis, movement of .sick, by months, 1918 405
195. Camp Lewis, admissions, special infectious diseases, 1917-18, absolute
numbers 406
196. Camp Lewis, admissions, special infectious diseases, 1917-18, ratios per
1,000 408
197. Camp Lewis, deaths, special infectious diseases, 1917-18, absolute num-
ber 410
198. Camp Lewis, deaths, special infectious diseases, 1917-18, ratios per 1,000.. 412
199. Camp Logan, average strength, by month and source of command 416
200. Camp Logan, movement of sick, by months, 1918 417
201. Camp Logan, admissions, special infectious diseases, 1917-18, absolute
mmibers 418
202. Camp Logan, admissions, special infectious diseases, 1917-18, ratios per
1 , 000 420
203. Camp Logan, deaths, special infectious diseases, 1917-18, absolute num-
bers 422
204. Camp Logan, deaths, special infectious diseases, 1917-18, ratios per 1,000. . 424
TABLE OF CONTENTS. XXI
Pagp.
205. Camp AlacArthur, average strength, by month and soui'ce of command 430
206. Camp MacArthur, movement of sick, by months, 1918 431
207. Camp MacArthur, admissions, special infectious diseases, 1917-18, abso-
lute numbers 432
208. Camp McArthur, admissions, special infectious diseases, 1917-18, ratios
per 1 ,000 434
209. Camp McArthur, deaths, special infectious diseases, 1917-18, absolute
numbers .■" 436
210. Camp MacArthur, deaths, special infectious diseases, 1917-18, ratios per
1 , 000 438
211. Camp McClellan, average strength, by month and source of command 444
212. Camp McClellan, movement of sick, by months, 1918 445
213. Camp McClellan, admissions, special infectious diseases, 1917-18, absolute
numbers 446
214. Camp McClellan, admissions, special infectious diseases, 1917-18, ratios
per 1 ,000 448
215. Camp McClellan, deaths, special infectious diseases, 1917-18, absolute
numbers 450
216. Camp McClellan, deaths, special infectious diseases, 1917-18, ratios per
1,000 451
217. Camp Meade, average strength , by month and source of command 455
218. Camp Meade, movement of sick, by months, 1918 456
219. Camp Meade, admissions, special infectious diseases, 1917-18, absolute
numbers 458
220. Camp Meade, admissions, special infectious diseases, 1917-18, ratios per
1,000 460
221. Camp Meade, deaths, special infectious diseases, 1917-18, absolute
numbers 462
222. Camp Meade, deaths, special infectious diseases, 1917-18, ratios per
1,000 464
223. Camp ]\Iills, average strength, by month and source of command 469
224. Camp Mills, movement of sick, by months, 1918 469
225. Camp Mills, admissions, special infectious diseases, 1917-18, absolute
numbers 470
226. Camp Mills, admissions, special infectious diseases, 1917-18, ratios per
1,000 472
227. Camp Mills, deaths, special infectious diseases, 1917-18, absolute numbers. . 474
228. Camp Mills, deaths, special infectious diseases, 1917-18, ratios per 1,000 476
229. Camp Pike, average strength, by month and source of command 482
230. Camp Pike, movement of sick, by months, 1918 483
231. Camp Pike, admissions, special infectious diseases, 1917-18, absolute
numbers 484
232. Camp Pike, admissions, special infectious diseases, 1917-18, ratios per
1,000 486
233. Camp Pike, deaths, special infectious diseases, 1917-18, absolute numbers. . 488
234. Camp Pike, deaths, special infectious diseases, 1917-18, ratios per 1,000. . 490
235. Camp SeNaer, average strength, by month and source of command 493
236. Camp SeWer, movement of sick, by months, 1918 494
237. Camp Se^'ier, admissions, special infectious diseases, 1917-18, absolute
numbers 496
238. Camp Se^'ier, admissions, special infectious diseases, 1917-18, ratios per
1,000 498
239. Camp Se^'ier, deaths, special infectious diseases, 1917-18, absolute
numbers 500
240. Camp Se^'ier, deaths, special infectious diseases, 1917-18, ratios per 1,000. . . 502
241. Camp Shelby, average strength, by month and source of command 505
242. Camp Shelby, movement of sick, by months, 1918 5C6
243. Camp Shelby, admissions, special infectious diseases, 1917-18, absolute
numbers 508
244. Camp Shelbv, admissions, special infectious diseases, 1917-18, ratios per
1,000 .' 510
245. Camp Shelby, deaths, special infectious diseases, 1917-18, absolute
numbers 512
246. Camp Shelby, deaths, special infectious diseases, 1917-18, ratios per 1,000. . 514
247. Camp Sheridan, average strength, by month and source of command 520
248. Camp Sheridan, movement of sick, by months, 1918 521
XXII TABLE OF CONTENTS.
1
Page.
249. Camp Sheridan, admissions, special infectious diseases, 1917-18, absolute
numbers 522
250. Camp Sheridan, admissions, special infectious diseases, 1917-18, ratios per
1,000 524
251. Camp Sheridan, deaths, special infectious diseases, 1917-18, absolute
numbers 526
252. Camp Sheridan, deaths, special infectious diseases, 1917-18, ratios per
1,000 528
253. Camp Sherman, average strength, by month and source of command 534
254. Camp Sherman, movement of sick, by months, 1918 535
255. Camp Sherman, admissions, special infectious diseases, 1917-18, absolute
numbers 536
256. Camp Sherman, admissions, special infectious diseases, 1917-18, ratios per
1,000 538
257. Camp Sherman, deaths, special infectious diseases, 1917-18, absolute
numbers 540
258. Camp Sherman, deaths, special infectious diseases, 1917-18, ratios per
1 ,000 542
259. Camp S\Tacuse, average strength, by month and source of command 546
260. Camp Syracuse, movement of sick, by months, 1918 546
261. Camp Syracuse, admissions, special infectious diseases, 1917-18, absolute
numbers 547
262. Camp Svracuse, admissions, special infectious diseases, 1917-18, ratios per
1,000." 548
263. Camp Syracuse, deaths, special infectious diseases, 1917-18, absolute
numbers 549
264. Camp Syracuse, deaths, special infectious diseases, 1917-18, ratios per
1,000 550
265. Camp Taylor, average strength, by month and source of command 554
266. Camp Taylor, movement of sick, by months, 1918 555
267. Camp Taylor, admissions, special infectious diseases, 1917-18, absolute
numbers 556
268. Camp Taylor, admissions, special infectious diseases, 1917-18, ratios per
1,000 558
269. Camp Taylor, deaths, special infectious diseases, 1917-18, absolute
numbers 560
270. Camp Taylor, deaths, special infectious diseases, 1917-18, ratios per 1,000. . 562
271. Camp Tra^ds, average strength, by month and source of command 568
272. Camp TraAds, movement of sick, by months, 1918 569
273. Camp Travis, admissions, special infectious diseases, 1917-18, absolute
numbers 570
274. Camp Tra\ds, admissions, special infectious diseases, 1917-18, ratios per
1 ,000 572
275. Camp TraAds, deaths, special infectious diseases, 1917-18, absolute num-
bers 574
276. Camp Travis, deaths, special infectious diseases, 1917-18, ratios per 1,000 . . 576
277. Camp Upton, average strength, by month and source of command 582
278. Camp Upton, movement of sick, by months, 1918 583
279. Camp Upton, admissions, special infectious diseases, 1917-18, absolute
numbers 584
280. Camp Upton, admissions, special infectious diseases, 1917-18, ratios per
1 ,000 - 586
281. Camp Upton, deaths, special infectious disease.'*, 1917-18, absolute
numbers 588
282. Camp Upton, deaths, special infectious diseases, 1917-18, ratios per 1,000. . . 590
283. Camp Wads-\vorth, average strength, by month and source of command. .. 594
284. Camp Wadsworth, movement of sick, by months, 1918 595
285. Camp Wadsworth, admissions, special infectious diseases, 1917-18, abso-
lute numbers - - 596
286. Camp Wadsworth, admissions, special infectious diseases, 1917-18, ratios
per 1,000 598
287. Camp Wadsworth, deaths, special infectious diseases, 1917-18, absolute
numbers 600
288. Camp Wadsworth, deaths, special infectious diseases, 1917-18, ratios per
1,000 602
289. Camp Wheeler, average strength, by month and source of command 608
290. Camp Wheeler, movement of sick, by months, 1918 609
TABLE OF CONTENTS. XXHI
Page.
291. Camp Wheeler, admissions, special infectious diseases, 1917-18, absolute
numbers 610
292. Camp ^Vheeler, admissions, special infectious diseases, 1917-18, ratios per
1,000 612
293. Camp ^Vlieeler, deaths, special infectious diseases, 1917-18, absolute
numbers 614
294. Camp Wheeler, deaths, special infectious diseases, 1917-^8, ratios per
1,000 616
295. Admissions and deaths, white and colored, total influenza, by camps 625
296. Admissions and deaths, "white and colored, influenza uncomplicated, by
camps 626
297. Admissions and deaths, white and colored, influenza with broncho-
pneumonia, by camps 627
298. Admissions and deaths, white and colored, influenza with lobar pneimionia,
by camps 628
299. Admissions and deaths, white and colored, influenza with other compli-
cations, by camps 629
300. Admissions and deaths. Avhite and colored, broncho-pneumonia, by camps.. 630
301. xVdmissions and deaths, white and colored, lobar pneumonia, by camps 631
302. Admissions and deaths, white and colored, total pneumonia, by camps... 632
303. Admissions and deaths, white and colored, common respiratory diseases,
by camps 633
304. Admissions and deaths, white and colored, total pneumonia, influenza,
and common respiratory diseases, by camps 634
305. Total influenza, admissions, United States, by months, all cases 637
306. Influenza, uncomplicated, admissions, United States, by months, all cases. 637
307. Influenza with broncho-pneumonia, admissions, United States, by months,
all cases 638
308. Influenza with lobar pneumonia, admissions. United States, by months,
all cases 638
309. Influenza with other complications, admissions, United States, by months,
all cases 638
310. Broncho-pneumonia and pneumonia, unclassified, admissions, United
States, by months, all cases 639
311. Lobar pneumonia, admissions. United States, by months, all cases 639
312. Total pneumonia, admissions. United States, by months, all cases 639
313. Common respiratory diseases, admissions, United States, by months, all
cases 640
314. Total influenza, pneumonia, and common respiratory diseases, admissions.
United States, by months, all cases 640
315. Total influenza, admissions, Europe, by months, all cases 643
316. Influenza, uncomplicated, admissions, Europe, by months, all cases, 1918.. 644
317. Influenza and broncho-pneumonia, admissions, Europe, by months, all
cases, 1918 644
318. Influenza with lobar pneumonia, admissions, Europe, by months, all
cases, 1918 644
319. Influenza with other complications, admissions, Europe, by months, all
cases, 1918 645
320. Broncho and unclassified pneumonia, admissions, Europe, by months, all
cases, 1918 645
321. Lobar pneumonia, admissions, Europe, by months, all cases, 1918 645
322. Pneumonia all, admissions, Europe, by months, all cases, 1918 646
323. Other respiratory diseases, admissions, Europe, by months, all cases, 1918. 646
324. Total influenza, pneumonia and other respiratory diseases, admissions,
Europe, by months, 1918 646
325. Total influenza, deaths. United States, by months, all cases, 1918 650
326. Influenza uncomplicated, deaths. United States, by months, all cases,
1918 650
327. Influenza ^vith broncho-pneumonia, deaths, United States, by months,
all cases, 1918 651
328. Influenza vrith lobar pneumonia, deaths, United States, by months, all
cases, 1918 651
329. Influenza ^\^th other complications, deaths, United States, by months, all
cases, 1918 651
330. Broncho-pneumonia, deaths, United States, by months, all cases, 1918... 652
331. Lobar pneumonia, deaths, United States, by months, all cases, 1918 652
XXIV TABLE OF CONTENTS.
Page.
332. Broncho-pneumonia and lobar pneumonia, deaths, United States, by
months, all cases, 1918 652
333. Other respiratorj^ diseases, deaths. United States, by months, all cases,
1918 653
334. Total influenza, pneumonia and other respiratory diseases, deaths. United
States, by months, all cases, 1918 653
335. Total influenza, deaths, Europe, by months, all cases, 1918 657
336. Influenza uncomplicated, deaths, Europe, by months, all cases, 1918 657
337. Influenza with broncho-pneumonia, deaths, Europe, bv months, all cases,
1918 " 658
338. Influenza with lobar pneumonia, deaths, Europe, by months, all cases,
1918 658
339. Influenza with others, deaths, Europe, by months, all cases, 1918 658
340. Broncho and unclassified pneumonia, deaths, Europe, by months, all
cases, 1918 659
341. Lobar pneumonia, deaths, Europe, by months, 1918 659
342. Total pneumonia, deaths, Europe, by months, 1918 660
343. Other respiratory diseases, deaths, Europe, by months, 1918 660
344. Total influenza, pneumonia and other respiratory diseases, deaths, Europe,
by months, all cases, 1918 661
345. Influenza uncomplicated, admissions and deaths, enlisted men in United
States stationed outside of large camps, 1918 665
346. Influenza with broncho-pneumonia, admissions and deaths, enlisted men
in United States stationed outside of large camps, 1918 666
347. Influenza with lobar pneumonia, admissions and deaths, enlisted men in
United States stationed outside of large camps, 1918 666
348. Influenza with other complications, admissions and deaths, enlisted men
in United States stationed outside of large camps, 1918 666
349. Broncho pneumonia, admissions and deaths, enlisted men in United States
stationed outside of large camps, 1918 667
350. Lobar pneumonia, admissions and deaths, enlisted men in United States
stationed outside of large camps, 1918 _ 667
351. Other respiratory diseases, admissions and deaths, enlisted men in United
States stationed outside of large camps, 1918 667
352. Total influenza, pneumonia and other respiratory diseases, admissions and
deaths, enlisted men in United States stationed outside of large camps,
1918 - - 668
353. Total influenza with complications, showing admissions and deaths, white
and colored, absolute numbers and ratios. United States 668
354. Total influenza with complications, showing admissions and deaths, white
and colored, absolute numbers and ratios, Europe _. . 668
355. Total pneumonias, primary and secondary, admissions and deaths, white
and colored, absolute numbers and ratios. United States 669
356. Total pneumonias, primary and secondary, admissions and deaths, white
and colored, absolute numbers and ratios, Europe 670
357. Nativity, cases in United States and Europe, 1918, influenza Call) 671
358. Nati\dty, cases in United States and Europe, 1918, influenza uncompli-
cated 672
359. Nativity, cases in United States and Europe, 1918, influenza with broncho-
pneumonia 673
360. Nativity, cases in United States and Europe, 1918, influenza with lobar
pneumonia 674
361. Nati\dty, cases in United States and Europe, 1918, influenza with other
complications 675
362. Nativity, cases in United States and Exirope, 1918, broncho-pneumonia
and pneumonia unclassified 676
363. Nativity, cases in United States and Europe, 1918, lobar pneumonia 677
364. Pneumonia, by months, 1906-1915, United States, white and colored, ad-
missions and deaths, absolute numbers 678
365. Pneumonia, by months, 1906-1915, United States, white and colored, ad-
missions and deaths, ratios per 1,000 679
366. Influenza, by months, 1906-1915, United States, white and colored, ad-
missions and deaths, absolute numbers 680
367. Influenza, by months, 1906-1915, United States, white and colored, ad-
missions and deaths, ratios per 1,000 681
TABLE OF CONTENTS. XXV
368. Total influenza, pneumonia and other respiratory diseases, by months.
United States, white and colored, admissions and deaths, absolute num-
bers, 1906-1915 682
369. Total influenza, pneumonia and other respiratory diseases, by months,
United States, white and colored, admissions and deaths, ratios per 1,000,
1906-1915 683
370. Influenza, pneumonia and common respiratory diseases, adnjissions, 1862-
1918, inclusive, by years, absolute numbers and ratios, per 1,000 684
371. Influenza, pneumonia and common respiratory diseases, deaths, 1862-1918,
inclusive, by years, absolute numbers and ratios per 1,000 686
372. Total respiratory diseases, including influenza, pneumonia and common
respiratory diseases, shown separately and by totals, enlisted men in
United States in large camps, by the last three months of 1917-18 and
all of 1918, admissions, absolute numbers 688
373. Total respiratory diseases, including influenza, pneumonia and common
respiratory diseases, shown separately and by totals, enlisted men in
United States in large camps, by the last three months of 1917-18 and
all of 1918, admissions, ratios per 1,000 698
374. Total respiratory diseases, including influenza, pneumonia and common
respiratory diseases shown separately and by totals, enlisted men in
United States in large camps, by the last three months of 1917-18 and
all of 1918, deaths, absolute numbers 708
375. Total respiratory diseases, including influenza, pneumonia and common
respiratory diseases, shown separately and by totals, enlisted men in
United States in large camps, by the last three months of 1917-18 and all
of 1918, deaths, ratios per 1,000 718
376. Total respiratory diseases, including influenza, pneumonia and common
respiratory diseases shown separately and with total for enlisted men in
United States, by State of occurrence, excluding all camps, admissions
and deaths, absolute numbers and ratios per 1,000 728
377. Total measles, admissions and deaths, enlisted men in large camps, United
States, absolute numbers and ratios per 1,000 793
378. Measles uncomplicated, admissions and deaths, enlisted men in large
camps. United States, absolute numbers and ratios per 1,000 794
379. Measles with broncho-pneumonia, admissions and deaths, enlisted men in
large camps. United States, absolute numbers and ratios per 1,000 795
380. Measles with lobar pneumonia, admissions and deaths, enlisted men in
large camps, United States, absolute numbers and ratios per 1,000 796
381. Measles with other complications, admissions and deatlis, enlisted men in
large camps. United States, absolute numbers and ratios per 1,000 797
382. Total measles, admissions, enlisted men, wliite and colored, all cases, in
United States, by months 798
383. Measles, uncomplicated, admissions, enlisted men, white and colored, all
cases, in United States, by months 798
384. Measles with broncho-pneumonia, admissions, enlisted men, white and
colored, all cases, in United States, by months 799
385. Measles with lobar pneumonia, admissions, enlisted men, white and
colored, all cases, in United States, by montlis 79 9
386. Measles with other complications, admissions, enlisted men, white and
colored, all cases, in United States, by months 800
387. Total measles, admissions, enlisted men, white and colored, all cases, in
Europe, by montlis 800
388. Measles, uncomplicated, admissions, enlisted men, white and colored,
all cases in Europe, by months 801
389. Measles with broncho-pneumonia, admissions, enlisted men, white and
colored, all cases, in Europe, by months 801
390. Measles with lobar pneumonia, admissions, enlisted men, white and
colored, all cases, in Europe, by months 801
391. Measles with other complications, admissions, enlisted men, white and
colored, all cases, in Europe, by months 802
392. Total measles, deaths, enlisted men, wliite and colored, all cases, in United
States, by montlis 802
393. Measles, uncomplicated, deaths, enlisted men, white and colored, all cases,
in United States, by montlis 803
394. Measles with broncho-pneumonia, deaths, enlisted men, white and colored,
all cases, in L'nited States, by months 803
395. ^Measles with lobar pneumonia" deaths, enlisted men, white and colored,
all cases, in United States, by months 804
XXVI TABLE OF CONTENTS.
396. Measles with other complicationa, deatlis, enlisted men, wliite and colored,
all cases, in United States, by months 804
397. Total measles, deatlis, enlisted men, wliite and colored, all cases, in
Europe, by months 805
398. Measles, uncomplicated, deaths, enlisted men, wliite and colored, all cases,
in Europe, bj- months 805
399. Measles with broncho-pneumonia, deaths, enlisted men, white and colored,
all cases, in Europe, by months 806
400. Measles with lobar pneumonia, deatlis, enlisted men, white and colored,
all cases, in Europe, by months 806
401. Measles with other complications, deaths, enlisted men, white and colored,
all cases, in Europe, by months 807
402. Measles, all, admissions and deaths, enlisted men stationed in States out-
side of large camps, in United States, by montlis, absolute numbers and
ratios 807
403. Measles, uncomplicated, admissions and deaths, enlisted men stationed in
States outside of large camps, in United States, by months, absolute
numbers and ratios 808
404. Measles with broncho-pneumonia, admissions and deaths, enlisted men
stationed in States outside of large camps, in United States, by months,
absolute numbers and ratios 808
405. ^Measles with lobar pneumonia, admissions and deaths, enlisted men
stationed in States outside of large camps, in United States, by months,
absolute numbers and ratios 809
406. Measles with other complications, admissions and deaths, enlisted men
stationed in States outside of large camps, in United States, by montlis,
absolute numbers and ratios 809
407. Nativity, measles, all, United States and Europe, cases, 1917-18, white
and colored, absolute numbers and ratios 810
408. Nativity, measles, uncomplicated, United States and Europe, cases,
1917-18, wliite and colored, absolute numbers and ratios 811
409. Nativity, measles with broncho-pneumonia, United States and Europe,
cases,' 1917-18, white and colored, absolute numbers and ratios 812
410. Nativity, measles with lobar pneumonia. United States and Europe, cases,
1917-18, white and colored, absolute numbers and ratios 813
411. Nati^dty, measles with other complications. United States and Europe,
cases," 1917-18, wliite and colored, absolute numbers and ratios 814
412. Summary, measles with various complications, enlisted men, United
States, white and colored, admissions and deatlis, absolute numbers and
ratios per 1,000 815
413. Summary, measles with various complications, enlisted men, in Europe,
white and colored, admissions and deatlis, absolute numbers and ratios
per 1, 000 815
414. Measles with various complications and with total for the last three months
of 1917 and for the year 1918, showing by camps the admissions by
months, absolute numbers 816
415. Measles with various complications and with total for the last tliree montlis
of 1917 and for the vear 1918, showing by camps the admissions by
months, ratios per 1,000 823
416. Measles with various complications and with total for the last three months
of 1917 and for the year 1918, showing by camps the deaths by montlis,
absolute numbers 830
417. ^Measles with various complications and with total for the last tliree months
of 1917 and for the year 1918, showing by camps the deaths by months,
ratios per 1,000 837
418. Measles with various complications and with total for enlisted men, in
United States, by State of occurrence, exclusive of large camps, admis-
sions and deatlis, al^solute numbers and ratios per 1,000 _ 844
419. Mumps, admissions and deaths, large camps, enlisted men, white and col-
ored, absolute numbers and ratios per 1,000 _. . 854
420. Mumps, admissions, United States, by months, for enlisted men, white
and colored, absolute numbers and ratios per 1,000 855
421. Mumps, admissions, Europe, by months, for enlisted men, white and
colored, absolute numbers and ratios per 1,000 855
422. Mumps, deaths, United States, by months, for enlisted men, white and
colored, absolute numbers and ratios per 1,000 855
TABLE OF CONTENTS. XXVII
Page.
423. Mumps, deaths, Europe, by months, enlisted men, white and colored, abso-
lute numbers and ratios per 1,000 856
424. Mumps, admissions and deaths, enlisted men. United States, by State of
occurrence, outside of large camps, by months, absolute numbers and
ratios per 1,000 856
425. Nativity, mumps. United States and Europe, 1917-18, white and colored,
absolute numbers and ratios per 1 ,000 i 857
426. Mumps, admissions, enlisted men in United States, by large camps, last
three months 1917 and the year 1918, absolute numbers 858
427. Mumps, admissions, enlisted men in United States, by large camps, last
three months 1917 and the year 1918, ratios per 1 ,000 860
428. Mumps, deaths, enlisted men in United States, by large camps, last three
months 1917 and the year 1918, absolute numbers 861
429. Mumps, deaths, enlisted men in United States, by large camps, last three
months 1917 and the year 1918, ratios per 1,000 862
430. Mumps, enlisted men, United States, by State of occurrence, exclusive of
large camps, absolute numbers and ratios per 1,000 863
431. Cerebrospinal meningitis, admissions and deaths, enlisted men in United
States, white and colored, by large camps, absolute numbers and ratios
per 1,000 869
432. Cerebrospinal meningitis, admissions. United States, by months, enlisted
men, white and colored, absolute numbers and ratios per 1,000 870
433. Cerebrospinal meningitis, admissions, Europe, by months, enlisted men,
white and colored, absolute numbers and ratios per 1,000 870
434. Cerebrospinal meningitis, deaths. United States, by months, for enlisted
men, white and colored, a])solute numbers and ratios per 1,000 870
435. Cerebrospinal meningitis, deaths, Europe, by months, enlisted men,
white and colored, absolute numbers and ratios per 1,000 871
436. Cerebrospinal meningitis, admissions and deaths, enlisted men, United
States, by State of occurrence, excluding the large camps, by months,
absolute numbers and ratios per 1,000 871
437. Cerebrospinal meningitis, nativity, cases in United States and Europe,
1917-18, white and colored, absolute numbers and ratios per 1,000 872
438. Cerebrospinal meningitis, admissions, enlisted men in United States, by
camps, the last three months of 1917 and the year 1918, absolute num-
bers. 873
439. Cerebrospinal meningitis, admissions, enlisted men in United States, by
camps, last three months of 1917 and the year 1918, ratios per 1,000 874
440. Cerebrospinal meningitis, deaths, enlisted men in United States, by camps,
last three months of 1917 and the year 1918, absolute numbers 875
441. Cerebrospinal meningitis, deaths, enlisted men in United States, by camps,
last three months of 1917 and the year 1918, ratios per 1,000 876
442. Cerebrospinal meningitis, enlisted men, United States, by State of occur-
rence, exclusive of large camps, absolute numbers and ratios per 1,000. . 877
443. German measles, admissions and deaths, enlisted men in United States,
white and colored, by large camps, absolute nurabers and ratios per 1,000. 882
444. German measles, admissions. United States, by months, enlisted men,
white and colored, absolute numbers and ratios per 1,000 883
445. German measles, admissions, Europe, by months, enlisted men, white
and colored, absolute numbers and ratios per 1,000 883
446. German measles, deaths. United States, by months, for enlisted men, white
and colored, absolute numbers and ratios per 1,000 883
447. German measles, deaths, Europe, by months, enlisted men, white and
colored, absolute numbers and ratios per 1,000 884
448. German measles, admissions and deaths, enlisted men. United States, by
States of occurrence, excluding the large camps, by months, absolute
numbers and ratios per 1,000 884
449. German measles, nativity, cases in United States and Europe, 1917-18,
white and colored, absolute numbers and ratios per 1,000 885
450. German measles, admissions, enlisted men in United States, by camps,
last three months of 1917 and the year 1918. absolute numbers 886
451. German measles, admissions, enlisted men in United States, by camps,
last three months of 1917 and the year 1918, ratios per 1,000 887
452. German measles, deaths, enlisted men in United States, by camps, last
three months of 1917 and the year 1918. absolute numbers 888
XXVIII TABLE OF COlSrTElSrTS.
Page.
453. German measles, deaths, enlisted men in United States, by camps, last
three months of 1917 and the year 1918, ratios per 1,000 889
454. German measles, enlisted men. United States, by State of occurrence,
exclusive of large camps, absolute numbers and ratios per 1,000 890
455. Diphtheria, admissions and death?, enlisted men in United States, white
and colored, by large camps, absolute numbers and ratios per 1,000 894
456. Diphtheria, admissions, United States, by months, enlisted men, white
and colored, absolute numbers and ratios per 1,000 895
457. Diphtheria, admissions, Europe, by months, enlisted men, white and col-
ored, absolute numbers and ratios per 1,000 895
458. Diphtheria, deaths. United States, by months, for enlisted men, white and
colored, absolute numbers and ratios per 1 ,000 895
459. Diphtheria, deaths, Europe, by months, enlisted men, white and colored,
absolute numbers and ratios per 1,000 896
460. Diphtheria, admissions and deaths, enlisted men. United States, by State
of occurrence, excluding the large camps, by months, absolute numbers
and ratios per 1,000 896
461. Diphtheria, nati\'ity, cases in United States and Europe, 1917-18, white
and colored, absolute numbers and ratios per 1,000 897
462. Diphtheria, admissions, enlisted menin United States, by camps, last three
months of 1917 and the year 1918, absolute numbers 898
463. Diphtheria, admissions, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, ratios per 1 ,000 899
464. Diphtheria, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, absolute numbers 900
465. Diphtheria, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, ratios per 1,000. . /. 901
466. Diphtheria, enlisted men, United States, by State of occurrence, exclusive
of large camps, absolute numbers and ratios per 1,000 902
467. Scarlet fever, admissions and deaths, enlisted men in United States, white
and colored, by large camps, absolute numbers and ratios per 1,000 906
468. Scarlet fever, admissions, United States, by months, enlisted men, white
and colored, absolute numbers and ratios per 1,000 907
469. Scarlet fever, admissions, Europe, by months, enlisted men, white and col-
ored, absolute numbers and ratios per 1,000 907
470. Scarlet fever, deaths. United States, by months, for enlisted men, white and
colored, absolute numbers and ratios per 1,000 907
471. Scarlet fever, deaths, Europe, by months, enlisted men, white and colored,
absolute numbers and ratios per 1,000 908
472. Scarlet fever, admissions and deaths, enlisted men, United States, by
State of occurrence, excluding the large camps, by months, absolute
numbers and ratios per 1,000 908
473. Scarlet fever, nativity, cases in United States and Europe, 1917-18, white
and colored, absolute numbers and ratios per 1,000 909
474. Scarlet fever, admissions, enlisted men, in United States, by camps, last
three months of 1917 and the year 1918, absolute numbers 910
475. Scarlet fever, admissions, enlisted men in United States, by camps, last
three months of 1917 and the year 1918, ratios per 1,000 911
476. Scarlet fever, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, absolute numbers 912
477. Scarlet fever, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, ratios per 1 ,000 913
478. Scarlet fever, enlisted men. United States, by State of occurrence, exclu-
sive of large camps, absolute numbers and ratios per 1,000 914
479. Tj^hoid fever, admissions and deaths, enlisted men in United States,
white and colored, by large camps, absolute numbers and ratios per 1,000. 918
480. Tj'phoid fever, admissions, United States, by months, enlisted men, white
and colored, absolute numbers and ratios per 1,000 919
481. T\T)hoid fever, admissions, Europe, by months, enlisted men, white and
colored, absolute numbers and ratios per 1,000 919
482. TvTJhoid fever, deaths, United States, by months, for enlisted men, white
and colored, absolute numbers and ratios per 1,000 919
483. T\T)hoid fever, deaths, Europe, by mouths, enlisted men, white and col-
ored, absolute numbers and ratios per 1,000 920
484. Typhoid fever, admissions and deaths, enlisted men. United States, by
State of occurrence, excluding the large camps, by months, absolute
numbers and ratios per 1,000 920
TABLE OF CONTENTS. XXIX
Page.
485. T\T)hoid fever, nati\'ity, cases in United States and Europe, 1917-18, white
and colored, absolute numbers and ratios per 1,000 921
486. Tj'phoid fever, admissions, enlisted men, in United States, by camps, last
three months of 1917 and the year 1918, absolute numbers 922
487. Tj-phoid fever, admissions, enlisted men in United States, bv camps, last
three months of 1917 and the year 1918, ratios per 1,000 '. 923
488. Typhoid fever, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, absolute numbers and ratios per 1,000. 924
489. T^-phoid fever, enlisted men. United States, by State of occurrence, exclu-
sive of large camps, absolute numbers and ratios per 1,000 926
490. Malarial fevers, admissions and deaths, enlisted men in United States,
white and colored, by large camps, absolute numbers and ratios per 1,000. 929
491. Malarial fevers, admissions. United States, by months, enlisted men, white
and colored, absolute numbers and ratios per 1,000 930
492. Malarial fevers, admissions, Europe, by months, enlisted men, white and
colored, absolute numbers and ratios per 1,000 930
493. Malarial fevers, deaths. United States, by months, for enlisted men, white
and colored, absolute numbers and ratios per 1,000 930
494. Malarial fevers, admissions and deaths, enlisted men. United States, by
State of occurrence, excluding the large camps, by months, absolute
numbers and ratios per 1,000 931
495. Malarial fevers, natix-ity, cases in United States and Europe, 1917-18,
white and colored, absolute numbers and ratios per 1,000 931
496. Malarial fevers, admissions, enlisted men, in United States by camps, last
three months of 1917 and the year 1918, absolute numbers 932
497. Malarial fevers, admissions, enlisted men, in United States, by camps-, last
three months of 1917 and the year 1918, ratios per 1,000 933
498. Malarial fevers, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, absolute numbers 934
499. Malarial fevers, enlisted men, United States, by ^ tate of occurrence, exclu-
sive of large camps, absolute numbers and ratios per 1,000 935
500. Tuberculosis, admissions and deatlis, enlisted men, in United States, white
and colored, by large camps, absolute numbers and ratios per 1,000 941
501. Tuberculosis, admissions. United States, by months, enlisted men, white
and colored, absolute numbers and ratios per 1,000 942
502. Tuberculosis, admissions, Europe, by months, enlisted men, white and
colored, absolute numbers and ratios per 1,000 942
503. Tuberculosis, deaths. United States, by months, for enlisted men, white
and colored, absolute numbers and ratios per 1,000 943
504. Tuberculosis, deaths, Europe by months, enlisted men, white and colored,
absolute numbers and ratios per 1,000 943
505. Tuberculosis, admissions and deaths, enlisted men, United States, by
State of occurrence, excluding the large camps, by months, absolute
numbers and ratios per 1,000 944
506. Tuberculosis, nati^dty, cases in United States and Europe, 1917-18, white
and colored, absolute numbers and ratios per 1,000 944
507. Tuberculosis, admissions, enlisted men, in United States, by camps, last
three months of 1917 and the year 1918, absolute numbers 945
508. Tuberculosis, admissions, enlisted men, in United States, by camps, last
three months of 1917 and the year 1918, ratios per 1,000 946
509. Tuberculosis, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, absolute numbers 947
510. Tuberculosis, deaths, enlisted men in United States, by camps, last three
months of 1917 and the year 1918, ratios per 1,000 948
511. Tuberculosis, enlisted men. United States, by State of occurrence, exclu-
sive of large camps, absolute numbers and ratios per 1,000 949
512. Total venereal diseases, admissions. United States, large camps, enlisted
men, white and colored, absolute numbers and ratios per 1.000 960
513. Syphilis, admissions. United States, large camps, enlisted men, white and
colored, absolute numbers and ratios per 1.000 960
514. Chancroid, admissions. Unite<l States, large camps, enlisted men, white
and colored, absolute numbers and ratios per 1.000 961
515. Gonorrhea, admissions. United States, large camps, enlisted men, white
and col( red. absolute niinbers and ratios per 1,000 962
516. Total venereal, admissions. United States, by months, enlisted men.
white and colored, absolute numbers and ratios per 1,000 962
XXX TABLE OF CONTENTS.
Page.
517. Syphilis, admissions. United States, by montlis, enlisted men, white and
colored, absolute numbers and ratios per 1 .000 963
518. Chancroid, admissions. United States, by months, enlisted men, white and
colored, absolute numbers and ratios per 1 ,000 963
519. Gonorrhea, admissions, United States, by months, enlisted men, white
and colored, absolute numbers and ratios per 1,000 963
520. Total venereal diseases, admissi.ms, Europe, enlisted men, white and col-
ored, absolute numbers and ratios per 1,000 964
521. Syphilis, admissions, Europe, enlisted men, white and colored, absolute
numbers and ratios per 1 ,000 964
522. Chancroid, admissions. Europe, enlisted men, white and colored, absolute
numbers and ratios per 1,000 964
523. Gonorrhea, admissions. Europe, enlisted men, white and colored, absolute
niimbers and ratios per 1.000 965
524. Total venereal, admissions, State of occurrence, by months, enlisted men,
white and colored, absolute numbers and ratios per 1,000 965
525. Syphilis, nativity. United States and Europe, 1917-18, enlisted men, white
and colored, absolute numbers and ratios per 1 .000 966-
526. Chancroid, nativity. United States and Europe. 1917-18, enlisted men.
white and colored, absolute numbers and ratios per 1,000 967
527. Gonorrhea, nativity, United States and Europe, 1917-18, enlisted men,
white and d >lored, absolute numbers ana ratii )S per 1 ,000 968
528. Total venereal, nativity. United States and Europe, 1917-18, enlisted men,
white and colored, absolute numbers and ratios per 1,000 969
529. Total venereal diseases, detected in second million drafted men, shown by
State from which inducted, the number of cases and ratio per 1,000 men. 970
5.30. Total nativity for syphilis detected in second million drafted men shown
by State from which inducted, the numl)er of cases and ratio per 1,000
m'en 970
531. Total nativity for chancroid, detected in second million drafted men,
shown bv State from which inducted, the number of cases and ratio per
1.000 men ._ 971
532. Total nativity for gonorrhea, detected in second million drafted men, shown
by State from which inducted, the number of cases and ratio per 1,000
men 971
533. Total venereal diseases. United States, enlisted men, bv length of service,
1918 -■' 971
534. Syphilis, chancroid, gonorrhea, and total venereal diseases. United States,
in large camps, last three months of 1917 and the year 1918, enlisted
men in United States, absolute numbers 972
535. Syphilis, chancroid, gonorrhea, and total venereal diseases. United States,
in large camps, last tlu'ee months of 1917 and the year 1918, enlisted men
in United States, ratios per 1,000 978
536. Syphilis, chancroid, gonorrhea, and total venereal diseases, enlisted men
in United States by State of occurrence, excluding large camps, abso-
lute numbers and ratios per 1,000 984
537. Venereal diseases, enlisted men in United States, admission rates, decade
1907-191G and for the years 1917-18. ._. . 987
538. Venereal diseases, enlisted men, Philippine Islands, as compared Avith
Philippine Scouts and Porto Ricans, native troops, 1908-1917, with
average for the decade and the year 1918 988
539. Nativity, total cases, United States and Europe, 1917-18, admissions,
days lost, discharges, and deatlis, absolute numbers and ratios per 1 ,000 . . 991
540. Nunierical statement of relative nativity rate, by States, for white troops
only for special diseases, white and colored, admissions and deaths 992
541. Nativity, infectious diseases, Southern States, white and colored, enlisted
men with ratios per 1,000 for the total cases of the section 1002
542. Comparative ratios per 1.000 for diseases, enlisted men. white and colored,
I'nited States, admissions and deaths, discharges and days lost 1005
543. Special diseases, admissions, Viith hypothetical numbers for 1861-62,
1898-99, showing the number of cases that would have occurred for each
disease with the strength of 1917-18 if the same rate had prevailed during
the former vears with actual numbers for each disease which occurred
during 1917-18 1013
TABLE OF CONTENTS. XXXI
Page.
544. Special diseases, deaths, with hypothetical numbers for 1861-62, 1898-99,
showing the number of cases that would have occurred for each disease
with the strength of 1917-18 if the same rate had prevailed during the
former years with actual numbers for each disease which occurred dur-
ing 1917-18 1013
545. Special diseases, admissions, two years of Civil War (1861-62), Spanish-
American War, and Philippine Insurrection (1888-89) and 1917-18, for
total American troops, absolute numbers and ratios per 1.000 1014
546. Special diseases, deaths, two years of CiA-il War (1861-62), Spanish-
American War and Philippine Insurrection (1888-89) and 1917-18, for
total American troops, absolute numbers and ratios per 1,000 1014
APPENDIX.
Table I. NatiAnty strength, showing number of white and colored soldiers
drafted or voluntarily enlisted from various States II
II. Strength, native troops, by months, Porto Ricans, Filipinos, and
Hawaiians II
III. Strength of large camps, by months and by States, enlisted men. . . Ill
IV. Strength, by States, excluding the soldiers in the large camps, by
months, total enlisted men IV
V. Rates, enlisted men, United States, 1862-1917, admissions, deaths,
discharges, and days lost VI
VI. Arm of serAdce, United States and Europe, admissions, days lost,
discharges, and deaths, absolute numbers only VII
VII. Admissions from disease, enlisted men. United States, by State of
occurrence, exclusive of men in large camps, by months, absolute
numbers VIII
VIII. Admissions from disease, enlisted men. United States, by State of
occurrence, exclusive of men in large camps, by months, ratios
per 1,000 X
IX. Deaths from disease, enlisted men. United States, by State of occur-
rence, exclusive of men in large camps, by months, absolute
numbers XII
X. Deaths from disease, enlisted men. United States, by State of occur-
rence, exclusive of men in large camps, by months, ratios per
1,000 XIII
XI. Days lost from disease, enlisted men. United States, by State of
occurrence, exclusive of men in large camps, by months, absolute
numbers XV
XII. Days lost from disease, enlisted men, United States, by State of
occvurence, exclusive of men in large camps, by months, ratios
per 1,000 * .XVII
XIII. Discharges from disease, enlisted men. United States, by State of
occurrence, exclusive of men in large camps, by months, absolute
numbers XIX
XIV. Discharges from disease, enlisted men. United States, by State of
occurrence, exclusive of men in large camps, by months, ratios
per 1,000 XX
XV. Physical status demobilization examinations, November 11, 1918-
July 1, 1919, by months XXII
XVI. Diagnosis and causative agent for some of the more important traimia-
tisms and causes XXIV
XVII. Battle injuries, .\merican Expeditionary Forces, admissions, officers
and enlisted men, white and colored, absolute numbers and ratios
per 1,000.. XXVIII
XVIII. Battle injuries, American Expeditionary Forces, deaths, officers and
enlisted men, white and colored, absolute numbers and ratios per
1,000 XXXI
XIX. Battle injuries, American Expeditionary Forces, days lost, officers
and enlisted men, white and colored, absolute numbers and ratios
per 1,000. XXXIV
XX. Battle injuries, .\merican Expeditionary Forces, discharges, officers
and enlisted men, white and colored, absolute numbers and ratios
per 1,000 XXXVII
XXXII TABLE OF CONTENTS.
General Tables.
Page.
XXI. Admissions, officers and enlisted men, American and native troops,
at home and abroad, all diseases and injuries, Avith causative agent,
absolute numbers XXXVIII
XXII. Admissions, officers and enlisted men, American and native troops,
at home and abroad, all diseases and injuries, with causative agent,
ratios per 1,000 LXXVIII
XXIII. Deaths, officers and enlisted men, American and native troops, at
home and abroad, all diseases and injuries, with causative agent,
absolute numbers CXVIII
XXIV. Deaths, officers and enlisted men, American and native troops, at
home and abroad, all diseases and injiiries, with causative agent,
ratios per 1,000 CL
XXV. Days lost, officers and enlisted men, American and native troops, at
home and abroad, all diseases and injuries, with causative agent,
absolute numbers CLXXVIII
XXVI. Noneffective rates, officers and enlisted men, American and native
troops, at home and abroad, all diseases and injuries, with causative
agent, ratios per 1,000 CCXVIII
XXVII. Discharges for disability, officers and enlisted men, American and
native troops, at home and abroad, all diseases and injuries, with
causative agent, absolute numbers CCLVII
XXVIII. Discharges for disability, officers and enlisted men, American and
native troops, at home and abroad, all diseases and injuries, with
causative agent, ratios per 1,000 CCXC
International Tables.
Table I. Movement of the sick at home and abroad, 1918, absolute num-
bers CCCXXII
II. Movement of the sick at home and abroad, 1918, ratios per 1,000. CCCXXII
IV. Movement of the sick, by months, 1918, American troops, enlisted
men, at home, absolute numbers CCCXXII
IVa. Movement of the sick, bv months, 1918, American troops, enlisted
men, at home, ratios per 1,000 CCCXXIII
I Vb. Movement of the sick, by months, American troops, American Expe-
ditionary Forces, absolute numbers CCCXXIII
IVc. Movement of the sick, by months, American troops, American Expe-
ditionary Forces, ratios per 1,000 CCCXXIV
FIGURES.
1. Admissions, diseases onlv, enlisted men United States Army in United
States, 1862-1918, inclusive 61
2. Deaths, diseases onlv, enlisted men United States Army in United States,
1862-1918, inclusive o2
3. Noneffective rate, diseases onlv, enlisted men United States Army in
United States, 1862-1918, inclusive 65
4. Discharges, diseases only, enlisted men United States Army in United
States, 1862-1918, inclusive - . . . 66
5. Comparative admission rates, 1918, officers and enlisted men American
and native troops, by countries 69
6. Compai-ative death rates, 1918, officers and enlisted men American and
native troops, by countries 70
7. Comparative noneffective rates, 1918, officers and enlisted men Ameri-
can and native troops, by countries '. 72
8. Comparative discharges, 1918, officers and enlisted men American and
native troops, by countries 73
9. Leading diseases, 1918, admission rates, enlisted men American troops in
various countries where serving 77
10. Leading diseases, 1918, admissions, officers in United States, Europe and
total army, and for native troops, in their respective countries 78
11. Leading diseases, 1918, deaths, enlisted men American troops in various
countries, where ser\dng 88
12. Leading diseases, 1918, deaths, officers in United States, Europe and total
army, and for native troops, in their respective countries 89
TABLE OF CONTENTS. XXXIII
Page.
13. Leading diseases, 1918, noueffective rates, enlisted men American troops
in various countries, where ser\'ing 98
14. Leading diseases, 1918, noneffectiAe rates, officers in United States, Europe
and total army, and for native troops, in their respective countries 99
15. Leading disea-ses, 1918, discharges, enlisted men American troops in
various countries, where serving ? 109
16. Leading diseases, 1918, discharges, officers in United States, Europe, and
total Army, and for native troops in their respective countries 110
17. Strength of United States Army in the United States, 1918, officers and
white and colored enlisted men 120
18. Strength of United States Army in Europe, 1918, officers and white and
colored enlisted men 121
19. Strength of total L^nited States Army, 1918, officers and white and colored
enlisted men 122
20. Movement of the sick, by months. United States 123
21. Movement of the sick, by months, Europe 124
22. Map showing camp sites of the large camps in United States, 1918 127
23. ('amp Beauregard, strength, officers and white and colored enlisted men,
by months 130
24. Camp Beauregard, movement of the sick by months, enlisted men only. . 131
25. Camp Bowie, strength, officers and white and colored enlisted men, by
months 144
26. Camp Bowie, movement of the sick by months, enlisted men only 145
27. Camp Cody, strength, officers and white and colored enlisted men, by
months 158
28. Camp Cody, movement of the sick by months, enlisted men only 159
29. Camp (I'uster, strength, officers and white and colored enlisted men, by
months ". 172
30. Camp Custer, movement of the sick by months, enlisted men only 173
31. Camp Devens, strength, officers and white and colored enlisted men, bv
months ". 186
32. Camp Devens, movement of the sick by months, enlisted men only 187
33. Camp Dix, strength, officers and white and colored enlisted men, bv
months ". 200
34. Camp Dix, movement of the sick by months, enlisted men only 201
35. Camp Doclge, strength, officers and white and colored enlisted men, b>
months 214
36. Camp Dodge, movement of the sick by months, enlisted men only 215
37. Camp Doniphan, strength, officers and white and colored enlisted men,
by months 226
38. Camp Doniphan, movement of the sick by months, enlisted men only. . . 227
39. Camp Eustis, strength, officers and white and colored enlisted men, bv
months ". 238
40. Camp Eustis, movement of the sick by months, enlisted men only 239
41. Camp Forrest, movement of the sick, by months, enlisted men only 245
42. Camp Fremont, strength, officers and white and colored enlisted men, bv
months *. 252
43. Camp Fremont, movement of the sick, by months, enlisted men only. . . . 253
44. ('amp Funstou, strength, officers and white and colored enlisted men, b\
months 266
45. ("amp Funston, movement of the sick, by months, enlisted men only.. . . 267
46. Camp Gordon, strength, officers and white and colored enlisted men, bv
months '. 280
47. Camp Gordon, movement of the sick, by months, enlisted men only 281
48. Camp Grant, strength, officers and white and colored enlisted men, bv
months .'. 294
49. Camp Grant, movement of the sick, by months, enlisted men only 295
50. Camp Greene, strength, officers and white and colored enlisted men, by
months.^ 307
51. Camp Greene, movement of the sick, by months, enlisted men only 308
52. Camp Greenleaf, movement of the sick, by months, enlisted men only 326
53. Camp Hancock, strength, officers and white and colored enlisted men, b\-
months 328
')4. Camp Hancock, movement of the sick, by months, enlisted men only.. .. 329
142367— 19— VOL 2 3
XXXIV TABLE OF CONTENTS.
Page.
55. Camp Ilumphreys, strength, officers and white and colored enlisted men,
by months 340
56. Camp Humphreys, movement of the sick, by months, enlisted men only. . 342
57. Camp Jackson, strength, officers and white and colored enlisted men, by
months 352
58. Camp Jackson, movement of the sick, by months, enlisted men only 353
59. Camp Johnston, strength, officers and white and colored enlisted men, by
months T 364
60. Camp Johnston, movement of the sick, by months, enlisted men only 365
61. Camp Kearney, strength, officers and white and colored enlisted men, by
months 375
62. Camp Kearney, movement of the sick, by months, enlisted men only 376
63. Camp Lee, strength, officers and white and colored enlisted men, by
months 387
64. Camp Lee, movement of the sick, by months, enlisted men only 388
65. Camp Lewis, strength, officers and white and colored enlisted men, bv
months '. 402
66. Camp Lewis, movement of the sick, by months, enlisted men only 403
67. Camp Logan, strength, officers and white and colored enlisted men, by
months 414
68. Camp Logan, movement of the sick, by months, enlisted men only 415
69. Camp Mac Arthur, strength, officers and white and colored enlisted men, by
months 428
70. Camp MacArthur, movement of the sick, by months, enlisted men only. . . 429
71. Camp McClellan, strength, officers and white and colored enlisted men, by
months 442
72. Camp McClellan, movement of the sick, by months, enlisted men only. .. 443
73. Camp Meade, strength, officers and white and colored enlisted men, by
montlas 456
74. Camp Meade, movement of the sick, by montlis, enlisted men only 457
75. Camp Mills, strength, officers and white and colored enlisted men, by
months 467
76. Camp Mills, movement of the sick, by montlis, enlisted men only 468
77. Camp Pike, strength, officers and white and colored enlisted men, by
months 480
78. Camp Pike, movement of the sick, by months, enlisted men only 481
79. Camp Sevier, strength, officers and white and colored enlisted men, by
montlis 494
80. Camp Se\aer, movement of the sick , by months, enlisted men only 495
81. Camp Shelby, strength, officers and white and colored enlisted men, by
months 506
82. Camp Shelby, movement of the sick, by months, enlisted men only 507
83. Camp Sheridan, strength, officers and white and colored enlisted men, bj'
months 518
84. Camp Sheridan, movement of the sick, by months, enlisted men only . . . 519
85. Camp Sherman, strength, officers and white and colored enlisted men, by
months 532
86. Camp Sherman, movement of the sick, by months, enlisted men only 533
87. Camp SjTacuse, strength, officers and white and colored enlisted men, by
months 544
88. Camp Syracuse, movement of the sick, by months, enlisted men only 545
89. Camp Taylor, strength, officers and white and colored enlisted men, by
months 552
90. Camp Taylor, movement of th? sick, by months, enlisted men only 553
91. Camp TraAis, strength, officers and white and colored enlisted men, by
months 566
92. Camp Tra\ds, movement of the sick, by months, enlisted men only 567
93. Camp Upton, strength, officers and white and colored enlisted men, by
months •. 580
94. Camp Upton, movement of the sick, by months, enlisted men only 581
95. Camp Wadsworth, strength, officers and white and colored enlisted men, by
montlis 592
96. Camp Wadsworth, movement of the sick, by months, enlisted men only. . 593
97. Camp Wheeler, strength, officers and white and colored enlisted men, bv
months '. 606
98. Camp Wheeler, movement of the sick, by months, enlisted men only 607
TABLE OF CONTENTS. XXXV
Page.
99. Fneumonia, influenza, and common respiratory diseases, admission and *
death rates, by years, total enlisted men American troops, 1862-1918,
inclusive 620
100. Pneumonia, influenza, and other respiratory diseases, admissions and
deaths, by months, total enlisted men in United States, 1906-1915,
inclusive .^ 621
101. Influenza, by camps, admissions and deaths, 1918, ratios per 1.000 623
102. Pneumonia, influenza, and other respiratorj' diseases, by camps, admis-
sions and deatlis, 1918. ratios per 1,000 624
103. Total respirator^' diseases, by months, admissions and deaths, total enlisted
men in United States 654
104. Total respiratory diseases, by months, admissions and deaths, total enlisted
men in Europe 655
105. Nativity influenza for United States and Europe 662
106. Nativity influenza with broncho-pneumonia for United States and Europe 662
107. Nativity influenza with lobar pneumonia for United States and Europe. . 663
108. Nativity broncho-pneumonia and pneumonia , exclusive of United States
and Europe 663
109. Nati^■ity lobar pneumonia in United States and Eui'ope 664
110. Measles, by camps, in United States, 1918, enlisted men, ratios per 1,000.. 789
111. Measles, by months, enlisted men in United States and Europe 790
112. NatiWty measles. United States and Eiu"ope 791
113. Mumps, by camps, 1918, enlisted men, admissions and deaths 851
114. Mumps, by months, enlisted men in United States, admissions and deaths. 852
115. Cerebrospinal meningitis, by camps. United States, enlisted men, 1918,
admissions and deaths 865
116. Cerebrospinal meningitis, by months, United States and Eiu"ope, enlisted
men, admissions and deaths 866
117. Cerebrospinal meningitis, nativity. United States and Europe 867
118. German measles, by camps, enlisted men. United States, 1918, admissions
and deaths 879
119. German measles, by months, enlisted men, United States and Eiuope,
admissions and deatlis 880
120. Gennan measles, nativity. United States and Europe 881
121. Diphtheria, bv camps, enlisted men. United States, 1918, admissions and
deaths " 892
122. Diphtheria, by months, enlisted men. United States and Europe, admis-
sions and deaths 893
123. Diphtheria, nativity, United States and Europe 893
124. Scarlet fever, by camps, enlisted men, United States, 1918, admissions and
deaths 904
125. Scarlet fever, by months, enlisted men. United States and Europe, admis-
I sions and deaths 905
■ 126. Scarlet fever, nativity. United States and Etirope 905
127. Typhoid fever, by camps, enlisted men. United States, 1918, admissions
and deaths 915
128. Malarial fever, by camps, enlisted men, United States, 1918, admissions
and deaths 928
129. Tuberculosis, bv camps, enlisted men, United States, 1918, admissions and
deaths .' 937
130. Tuberculosis, nativity. United States and Eiu-ope 938
i 131. Venereal disease, by camps, enlisted men, United States, 1918, admis-
sions and deaths 952
132. Venereal disease, by months, enlisted men, United States and Europe,
admissions and deaths 953
133. Venereal disease, natixdty. United States and Europe 954
134. Strength, Medical Department, United States Armv, bv months, April,
1917-June, 1919 '....". 1112
135. Commissioned corps. Medical Department, United States Army, Novem-
ber-December, 1918 1113
]3(j. Medical Department, United States Army, commissioned and enlisted.
United States and Eiu"ope, November-December, 1918 1116
137. Total Medical Department, United States Army, commissioned, enlisted,
and civilian, November-December, 1918 1117
- Patients received at ports of embarkation from overseas, period July 1, 1918,
to June 30, 1919 1163
XXXVI TABLE OF CONTENTS.
Page.
139. Classification of patients from overseas 1162
140. Distribution of overseas patients to general and base hospitals in the United
States, July 1, 1918, to June 30, 1919 1161
141. Movement of sick, by weeks, base hospital. Camp Dodge, Iowa 1168
142. Animals, United States and France, strength, bv weeks, Julv, 1918-
December, 1918 "i '. ". 1216
143. Army animals, annual admissions, noneffective rates and death rates or
causes, large camps in United States 1218
144. Armv animals, deatlis or cavises, by weeks. United States, December, 1917-
December, 1918; Europe, September, 1918, to December, 1918 1219
14."). Army animals, noneffective rates, important diseases, Julv-December,
1918 ". 1220
146. Army animals, noneffective rates, influenza, by weeks, United States and
France .' 1226
147. Armv animals, pneumonia, noneffective rates, by weeks, United States
and France 1227
148. Army animals, dermatitis gangrenosa, noneffective rates, by weeks, United
States and France 1227
149. Army animals, strangles, noneffective rates, bv weeks, United States and
France ' 1228
l.'jO. Army animals, tlu^ush, noneffective rates, by weeks, United States and
France - 1230
I.tI. Army animals, scratches, noneffective rates , by weeks, United States and
France - 1231
1.52. Army animals, picked-up nails, noneffective rates, by weeks, United States
and France 1231
REPORT OF THE SURGEON GEiNERAL, V. S. ARMY.
F. SPECIAL DIVISIONS, SURGEON GENERALS OFFICE.
I. DIVISION OF SANITATION.
1. Tntroductiox.
The division of sanitation, which for many years has been one of
tlie three permanent divisions of the SurejEron General's Office, has
imdergone great expansion during tlie war. The activities of the
diN'ision at the outset of hostilities had to do chiefly with the primary
sanitation of camps, the development of a sanitary inspection service,
and the adoption of physical standards for the draft. It rapidly
extended to the handling of all (juestion.s relating to the health and
well-being of troops and the sanitation of camps, cantoninents, per-
manent posts, hospitals, ports of embarkation, transports, military
trains, and other military stations. Its function includes the physi-
cal examination and selection of recruits and registrants; the physi-
cal examination of soldiers prior to demobilization; the selection of
camp and division surgeons, camp and division sanitary inspectors,
epidemiologists, sanitary engineers, and surgeons for recruit depots:
the direction of medico-military activities in camps, cantonments,
and other stations in so far as they relate to the Surgeon General's
Office: supervision of the hygiene and sanitation of camps; advising
the War Department with reference to camp sites, housing, air space,
clothing, food, water supplies, sewerage systems, and garbage dis-
posal; the control of fly and mosquito breeding and the elimination
of these pests: the destruction of lice and other disease-bearing in-
sects; the search for and quarantine of '" carriers " of disease and
""contacts" with disease: the desi^i and construction of quarantine
and detention camps; the administration of quarantine and other
measures necessary to prevent the spread of comuumicable diseases.
and the inspection of camp. post. base, and general hospitals. In
sum. the activities of the division of sanitation include all the func-
tions of a health departuient in a civil comuiunity and many other
duties in addition.
To accomplish the work above indicated, the division of sauitation
has been organized into the following sections:
Scftio)! (if sdnifaii/ iih^ixrlioits. — Makes routine sanitary inspections ot camps,
cantonments, posts, liospitals. and student army traininjr corps units: makes
technical inspections as to food, diets, food conservation, vermin contnd, sani-
tary enjrineerin;:. moscpiito conrrol. etc. Also makes special inspections in case
of specific complaints.
Medical record.-^ xertion. — Receives, records, and tiles reports of sick and
wounded: codes the cards and prepares permanent statistical tables of sickness
and injury; collects and tabulates data reirardinfr physical examination and
discharge for disability.
Current xtatisitics scctioti. — Keceives and consolidates daily and weekly tele-
grams and cablejrrams regarding sickness and injury : prepares weekly and
spei-ial health reports regarding troops at home and abroad.
1015
1016 REPORT OF THE SURGEON GENER.VL OF THE ARMY.
Communicable disvaxc ncction. — Prepares graphic charts of disease, analyze.<
current statistics, prepares reports on same and investigates and advises regard-
ing disease prevention. On November 1. 1918, this section was transferred to
the divsion of infectious diseases and laboratories.
Sanitary engineering section. — Investigates and recommends regarding sani-
tary engineering problems, such as water supply, sewage treatment and dis-
posal, garbage collection and disposal, mosquito and Hy control, and miscel-
laneous problems.
Food and nutrition section. — Gives technical advice on food products, rations,
diets, and food conservation ; makes food surveys and compiles statistical re-
ports; directs special laboratory investigations into matters relating to food
preservation, and food conservation and food values. Until December 1, 1918,
this section was a separate division of the Surgeon General's Office.
Student Army Training Corps section. — Through liaison with the various di-
visions of tlie Surgeon General's Office it handled assignments of officers, nurses,
and enlisted men to Student Army Training Corps units, and supplied them
with equipment and hospitalization. This section was abolished after demobili-
zation of the Student Army Training Corps units.
Miscellaneous section. — Handles a variety of problems, including administra-
tive sanitary personnel for camps, ciintonments, and recruit depots, physical
standards and examinations, investigation of vermin problems, supervision of
development battalions, etc.
At each camp or caiitoniaeiit is a sanitary organization which, in
ofeneral function, corresponds to the organization in this office. The
division of sanitation is kept informed as to every detail in sanitation
and disease prevention in camps and cantonments in tlie United
States, through experienced and specially qualified medical officers of
(he Regular Army, acting as sanitary inspectors, v,'ho visit the camps
and report directly to the Surgeon General regarding matters investi-
gated by them. Weekly telegraphic reports are received in the divi-
sion of sanitation from all camps and stations in the United States,
and also cablegrams from the American Expeditionary Forces, which
give cui-rent information as to the total amount of sickness, the num-
ber of new cases of the more common diseases and the number of
deaths during the week, Avith causes thereof, together with the
strength of the command for the same period. From this data it is
possible to compute weekly the rates per 1,000 of sickness and deaths,
and compare one station with another and one week with another.
Since September 1, 1917, there haA^e been published regularly a weekly
bulletin of health conditions which is given to the press for publica-
tion. Daily telegraphic reports are received regarding the occurrence
of a few of the more dangerous infectious diseases. Furthermore,
the monthly sanitary reports from all military stations, as well as
any special sanitary reports, pass through and are acted upon in the
division of sanitation.
When sanitary defects or deficiencies are brought to the attention
of the Surgeon General's Office immediate steps are taken to correct
them, either by instructions sent to the camp surgeon, if the correction
lies within his power, or by correspondence with the higher authori-
ties of the War Department, if this action is necessary. Ultimate
report as to action taken and results obtained is received in this divi-
sion and filed.
At the outset of the war, on recommendation of the division of
sanitation, the AVar Department issued Special Regulations, No. 28, a
compilation of sanitary instructions for the guidance of medical offi-
cers and line officers. Supplements to Special Regulations. No. 28
have been issued from time to time, and in addition numerous memo-
randa and circulars from the division have been promulgated for the
SANITARY DIVISION. 101 7
current guidance of all concerned in sanitary methods. The most im-
portant changes are No, 2, relating to lice, and No. 4, relating to
" carriers," which appear below :
Special Regvlations No. 28.
Changes No. 2. Wak DEPAKXiXENX,
Washington, June 11, 1918.
Parai,a-aph IS* is added to Special Regulations, No. 28, Sanitary Regulations,
and Control (if Connnunicihle r>iseases, 1917, as follows :
ISi. Lice. — Numerous reports indicate that lousiness is occurring to a greater
or less extent among troops in this country and on transports, and to a much
larger extent among our troops overseas. Body lice transmit typhus fever, a
disease which has been a serious scourge In some of the European armies. They
are believed to transmit " tx*ench fever," which in many commands in France
causes a higher admission rate than any disease except the common itch. The
same methods of inspection and disinfection which are effective in preventing
lousiness will also have a very important effect in detecting and preventing the
common itch.
There are three distinct kinds of lice: The head louse, the pubic louse or
" crab," and the body louse or " grayback." The latter is the most difficult to
prevent and the most important in spreading disease. All kinds of lice are
readily visible to the naked eye. as are also their eggs or " nits." All lice, by
their bites, produce Itching. Body lice leave small reddish marks on the body
when they bite.
The head louse lives on the scalp and the hairs of the head ; very rarely else-
where. The nits are firmly attached to the hairs, particularly at the back of
the head. The adult louse is easily killed by applying kerosene to the head, but
the eggs are not killed by tliis treatment. When a man has head lice his hair
should be saturated with kerosene and then cut short and the clippings burned.
The head should be sliampooed several hours later. Search should then be
made for nits, and if any remain they should be removed. Softening the nits
with hot vinegar favors their removal and destruction. Hair shoidd be kept
short at all times and occasional search made for lice. The issue of the neces-
sary amounts of kerosene and vinegar by the Quartermaster Corps is hereby
authorized.
Pubic lice, or " crabs," live in the hair about the private parts ; very rarely
elsewhere. The nits are attached to the hairs. The method of getting rid of
them is the same as for head lice.
Body lice, or " graybacks," should properly be called " clothes lice " as they
live and lay their eggs in the clothing and are rarely present on the body except
when feeding. The adult lice as well as the nits, are to be found not only
on the underclothing but also in many instances on the outer clothing, particu-
larly in the seams of the garments. The fork of the trousers is a region
especially liable to harbor adults and nits. The body louse readily passes from
man to man when soldiers are sleeping near each other. The development and
spread of body lice is favored wlien troops are crowded together and have
insufficient bathing and laundiy facilities. Both body and crab lice are fre-
quently contracted during sexual intercourse with infested prostitutes. Thoy
are rarely contracted from latrine seats.
To get rid of the body louse it is necessary to bathe the body most thor-
oughly and to boil or steam launder the underclothes. The outer clothing also
must be disinfected, either by steam, hot air, or by the careful pressing of the
garments, paying special attention to the seams. Immersion in gasoline will
destroy the adult louse, but not the nits. Smearing the seams of garments with
vaseline is of use when complete disinfection is impracticable. Aiitilice
powders, such as naphthalene, are of some use in limiting the development of
lice, but can not take the place of the above measures. The delousing of
clothing will be carried out imder the supervisions of the Medical Department.
At the semimonthly physical inspections special attention will be given to the
detection of lice on the body or in the clothing. Upon receipt of orders for
oversea service, daily inspections by medical officers will be made of commands
under such orders, particular care being taken to detect and eliminate lice.
Similar inspections will be made on shipboard.
The ultimate responsibility for the personal cleanliness of the soldier rests
with the company or detachment commander. In providing for such cleanliness
the prevention of lousiness will be considered one of the most important factors.
Enlisted men will be thoroughly and repeatedly instructed in the substance of
1018 REPORT OF THE SURGEON GENERAL OF THE ARMY,
this regulatiou. It will especially be impressed upon them that any persistent
itching, burning, or irritation of the head or covered parts of the body is almost
certain to be an indication of the presence of lice, common itch, or other dis-
ease or parasite. Such sensations should be an immediate cause for consulting
the surgeon. (S. R. No. 28, 0. No. 2. June 17, 1918.)
By order of the Secretary of War:
Peyton C. March,
General Chief of Staff.
Official :
H. P. McCain,
The Adjutant General.
Spkcial Regulations No. 28.
Chaxuks No. 4. War Department,
Wfi-^hington, March 11, 1919.
l'aragra]»li i\i is a<lileil to Si»ecial Ke.uulations No. 'IS. Sanitary Regulations
and Control of Conimunicahle Diseases. 1917, as follows:
6A. Examination of iKrnianmt food haniUcr-s. — At military stations where
the necessary facilities are available, either through local or department labora-
tories, no person will be employed as a "i)ermanent food handler " until it has
been determined by at least one satisfactory examination of the stools and
urine that he is not a carrier of the l)acilli of t.vphoid, parat.vphoid. or dysentery.
Where cholera is endemic or e]»idemic, the examination should also include
search for the cholera viltrio. The term '•permanent food handler" will be
con.strued to mean all persons who regularly handle uncovered food, such as
cooks, assistant cooks. l)akers. dietitians, mess sergeants, butchers, milkers, and
other milk handlers, attendants in exchanges who dispense ice cream, milk, and
bottled goods, and any other person who comes in constant and intimate contact
with food. This examination will be repeated every six months in the case of
individuals constantly employed.
(Vmipan.v. troop, battery, and detachment commanders, officers in charge of
bakeries and of special messes, officers in conunand of hosi>itals. and exchange"
officers will report in writing to the surgeon the names of all permanent food
handlers under theii- jurisdiction. The camp, division, post, or other senior
surgeon of a c(»mman(l will take the necessar.v ste]i to have these men examined
and the result of the examination reported to the organization connnander
without delay.
The triple typhoid inoculation confers a high degree of jirotection against
typhoid and paratyphoid fever, but it does not give absolute i)rotection against
massive infection with the causative organisms. The use of the trijile inocula-
tion has enormotisly reduced the incidence of enteric fevers in armies, but its
use does not warrant neglect of the other well-known sanitar.v i)recautions
against these diseases. One of the most ready means of causing massive in-
fection with typhoid and parat.vphoid organisms is through the agen<y of a
carrier employed in the handling of food. (S. R. No. 28. C. No. 4. Mar. 11,
3919. t
By order of the Secretary of War:
Frank McIntyre.
Major Gi'iicral. Act inn Chief of Staff.
Official:
I'. C. Harris.
The Adjutant General.
Below are brief summaries of the work accomplished l)y some of
the sections and subsections referred to above.
2. Sectiox or Sanitary Inspections.
In its inception the inspection service of the division of sanitation
had to do mainly with matters of pure sanitation in its narrower sense.
As a result of requests from other divisions of the Surofeon General's
Office for first-hand information regarding their special lines of work,
the scope of the inspection service has been greatly extended and nqw
SANITARY DIVISION. 1019
covers practically every activity pertaining to the Medical Depart-
ment. It orradiially became apparent that there was need of coordi-
nating the inspection work of the sanitary division with the profes-
sional and technical inspections which have to be made from time to
time by specialists in other divisions of the Surgeon General's Office.
For accomplishing this purpose there was established on January 1,
1918. the section of sanitary inspections, which is a subdivision of
the division of sanitation.
This system enables the Surgeon (reneral to keep in close personal
touch with the sanitary situation at all stations. The officers making
inspections, on their return to Washington, confer personally with
the depai-tments and divisions concerned in the correction of sani-
tary deficiencies, and take a personal interest in following up such
matters and obtaining such remedial action as is practicable. It has
been found that in most instances this procedure secures far more
rapid and satisfactory results than can be obtained by the usual
Avritten report emanating from the command where the defect exists.
At the conclusion of an inspection the sanitary inspector umkes a
report to the comnumding officer regarding the defects he has found
and submits recommendations for such remedial action as lies within
tbe power of local authorities.
At the outset sanitary inspection^ were chiefly confined to National
Army and National Tiuard camps. Subsequently more and more
of the other commands directly imder the control of the War De-
partment were included, such as aviation fields, recruit depots, ar-
senals, disciplinary barracks. pri.son camps, and general hospitals.
The work increased greatly as a result of the establishment of many
special camps and general hospitals. It was contemplated that the
inspection section would cover all commands that were not under the
jurisdiction of department connnanders and would inspect each
station once every H or 12 weeks. Special or more frequent inspec-
tions have been made when epidemics or other conditions warranted.
The scope of the sanitary inspection differs materially from that
uuide by the Insjjector (leneral's Department. Less stress is laid on
details of a purely military nature and much more stress is laid on
matters largely technical, such as general camp sanitation, nursing
and professional care of the sick, competency of medical officers,
handling of infectious diseases, prevention of venereal disease, man-
agement of quarantine and detention camps, extra cantonment health
activities, medical supplies, hospital construction, laboratories, spe-
cial diets, training of sanitary trains, mosquito eradication, water
purification, sewage disposal, physical examination for entry into
the service and for demobilization, development battalions, conva-
lescent centers, etc.
More than 700 separate inspections have been made by inspectors
from this section and practically every station not under control of
a department commander has been visited. .Vll large camps and
hospitals have been visited many times.
3. Medical Records Section'.
From e\ery cam}), military ])ost. hospital, oi' other station in this
country or abroad, wherever American troops may be serving, in-
dividual report cards of every case of sickness or injury of any im-
1020 REPORT OF THE SURGEON GENERAL OF THE ARMY.
portance are sent to the medical record section. There were re-
ceived here chiring the war approxiniately 10,000.000 of these cards.
After careful examination and verification these individual records
are filed in an alphabetical file. From this file it is possible to fur-
nish much information upon recfuest to relatiACS and friends con-
cerning- the details of sickness, injuries, and deaths among loved ones.
It is here also that evidence must be obtained to adjust many claims
for compensation or war risk insurance which are filed with the
"War Risk Bureau. From these records the information is trans-
ferred, by numbers which have been previously assigned to each
subject, to statistical cards. These numbers are then perforated
upon the cards with specially designed machines. The cards are then
sorted and counted and the time lost as a result of sickness or injury
by each individual soldier is automatically added by electrical ma-
chines. It is thus possible to assemble promptly, with a minimum
amount of labor, detailed information relative to the occurrence
of diseases in various sections of the country, in various seasons of
the year and among troops from the various States. The same
character of card is also prepared showing the results of the physical
examinations of men who were drafted into the National Army. It
has thus been possible for the first time since the Civil War to
secure an accurate and careful analysis of diseases and defects among
men of military age in the various sections of the United States.
This statistical material is of immense value to the medical profes.iion
as well as to everyone in the United States who is interested in
social uplift and in the welfare of the country at large.
As distinguished from the " current statistics," the statistics fur-
nished bj' this section are the final and accurate figures for s'ckness,
injury, deaths, and discharges for disability in the Army. They are
analyzed in many ways and compiled to form the (N^mplex tables
which appear in the annual reports of the Surgeon General and
which furnish an extremely valuable assemblage of data on vital '
statistics for comparison with similar material gathered in civil
life and in the armies of foreign nations.
4. Current Statistics Section.
With the outbreak of the war and the collection of vast armies,
it became necessary that the Surgeon General be kept currently in-
formed as to the amount of sickness and the success of his efforts to
combat epidemics. The index of success or failure of sanitaiT meas-
ures is the number of healthy soldiers in the Army as compared
with the number on sick report. The success or failure of the
Medical Department in its efforts to promote healthful living con-
ditions among troops is therefore indicated by the relative incidence
of disease among those troops. This fact made it necessary that the
sanitary division should be kept posted, by fairly reliable and current
information, on the health conditions among troops. Monthly san-
itary reports and reports of inspectors were too infrequent to serve
this purpose. To solve the problem thus presented, a section of
current vital statistics was established in the diA'ision of sanitation,
and this section was organized and besan to function on Septembov
1. 1917.
SANITARY DIVISION. 1021
This section compiles its statistics from diiily and weekly tele-
graphic reports, which are sent to it by every department surgeon,
camp surgeon, and connnandiiig officer of a general hospital, and by
surgeons in charge of ports of embarkation, independent posts, and
camps throughout the United States. Weekly cabled reports are
likewise received from the chief surgeon of the American Expedi-
tionary Forces, and the surgeon of the American forces at Vladivos-
tok. Upon the consideration and study of these reports are based
estimates of morbidity and mortality in the various camps and in
the Army as a whole. The Surgeon General is thus kept informed at
all times as to health conditions in every zone of operation. On
these figures are based the weekly reports to the Secretary of War,
to the Chief of Staff, and to the public press.
During the period of mobilization of the National Army these
statistics were the current available source of information on the
health of the Army. Later, during the measles-meningitis epidemic
of Xovember, 1917, and influenza-pneumonia pandemic of September
and October. 1918. the section of current statistics furnished the only
up-to-tlie-minute source of information on the relative progress or
abatement of these epidemics in our camps. This information was
vitally necessary in determining at what points help was most urgently
needed for checking the ravages of the epidemic : to what places, and
at what times, it would be safe to move healthy troops : and in what
localities a more rigid system of quarantine should be established in
order to halt the further spread of the contagion.
Tlie statistics obtained and compiled by this section are not abso-
lutely accurate. It would be impossible in the short time in which
they are prepared and sent out by the various surgeons to have them
accurate. Final diagnosis on a given case sometimes can not be
reached in a very short time. A patient reporting sick may be con-
.sidered to have, on first appearance, a certain ailment, and it will be
so reported, but more thorough diagnosis will later show that some-
thing entirely different is the trouble. The statistics of this section
are. liowever. sufficiently accurate to serve their purpose, althougii
they would never do as a source of information on which to base i
permanent statistical history of the war. But they have proved of
the greatest value in giving the division of sanitation a fairly re-
liable estimate of health conditions among our troops, thereby aiding
it to a very considerable extent to meet the various and peculiar
health problems which arise from time to time among the American
forces.
5. Section of Co^r^riNiCABLE Diseases.
With a view to making a more intensive study of infectious dis-
eases, a section of comminiicable diseases was established January 1.
1918. in the division of sanitation. At that time epidemics of
measles, pneumonia, and meningitis were raging extensively in the
various camps and cantonments, and special interest attached to the
relationship existing between pneumonia and measles, which then
appeai-ed of primary importance, although at a later date this rela-
tionship became less marked. In the fall of 1918 the severe epidemic
of influenza, with the succeeding high incidence of pneumonia,
claimed first attention of the section. Both in the earlier period
and during the influenza epidemic, the section became particularly
1022 REPORT OF THE SURGEON GENERAL OF THE ARMY.
iiiipresscMl witli the importance of contact and drojilet infection in
tlie spreadino- of communicable diseases, and with the necessity ol"
treatiiiir pneumonia as an infectious disease. The division of sani-
tation took steps to prevent overcrowding in l)arracks and tents, and
to minimize in liospitals the danger of droplet infections by re(iuir-
mg the use of cubicles for the patients and masks and <J^owns for
the attendants. Memoranda emphasizino^ the conununicability of
pneumonia were circulated to all concerned. More recently the im-
portance of careful dishwashinjj in the prevention of respiratoiv
disease has received particulai- attention. On reconunendation of th(5
Surgeon General two circulars were issued in October. 1918. by the
War Department with reference to the necessity for the sterilization
of dishes. Based on experience with the operation of these circulars,
reconunendation was made to the Adjutant General on May 24, 1911t.
that tliis subject nuitter be embodied in S])ecial Keindations -28 in the
followinor words:
I
('I.KAX!X(; .MK8S KQT ll'M K.\ T AM) DFSHES.
Iiulivicluals wlm ;iiv ill, or aie becoming ill, with diphtliefia, scarlet fevev,
pneiuiionia, measles, iiiiinips, nieninjiitis, tuberculosis, t.vphoid fever, dysentery,
.ir cholera are very likel.v to have their liaiuls aud mess kits more or less soiled
with the dischiU'ji'es from their noses, mouths, and intestines. These discliarges
contain il>e jrt rms of the above-mentioned diseases. When soldiers individually
Wash their mess c;[Uii)!nents in receptacles used in common, ano dry theiii with
dish towels used in common, thet-e is danjjer of transmitting the ijerms of these
diseases frcun the IkukIs and mess efjuipment of one soldi'^r to the hands and
Tiuss e(|uipmept (.p another. This transnussion may take plrice thromih soil-
ing the lijinds with the dishwater contaminated by previous users, or by
smearing the bands with the moisture from the dish towels sinularly contami-
nated. From the inferted hands and mess equipment of an individmil the
germs of these diseases may readily l»e transferred to his mouth arid nose,
thereby causing the soldier to develop the malady in question. These matters
are of particular and extreme importance at times when respiratory or intesti-
nal diseases of a serious nature are prevalent. To guard against these dangers,
the following instructions will be strictly adhered to. The importance of taking
these precautions is particularl.v great in hospitals.
(a) Wlien practicable to assemble the mess equipment of a company or de-
tachment, or when dislies other than the mess e(iuipment are used, all such
mess equii)ment oi' dishes, innnediately after each meal, will be thoroughly
washed with soap and warm water, then carefully rinsed in hot water, and
tinally actually boiled or steamed in a boiler, galvanized-iron can, or other
suitable receptacle. After boiling or steaming, the dishes should be rapidly
removed, drained, and allowed to dry in the air while still hot. If not prac-
ticable to completely air-dry the dishes, they may be dried with dish towels,
an ample stippl.v of which should Jie provided. After each meal, dish towels
should he thoroughly boiled with soap, washing powder, ammonia, lye, or other
suitable cleansing material, then thoroughly rinsed and hung out to dry in the
sun.
ib) When the cleansing of mess e(|uipnient by each individual soldier is nec-
essary, one of the following two methods will be tised. The first method is
much the better.
First method : When facilities therefor are available, mess kits will Ite
washed with soap imder running wtiter, preferably warm water, in .such man-
ner that the mess kit and hands of one soldier do not come in contact with the
mess kits and hands of other soldiers, nor with the water wdiich has come in
contact with the mess kits and hands of another soldier. The mess kits will
then be shaken and air-dried. T'nder nf> circumstances will a common dish
towel be used in this method, but there is no objection to each soldier having
jin individual dish towel, provided he uses it exclusively for his own mess
kit. Boiling of the mess kits is not necessary if this method of washing is in
force.
SANITARY DIVISION. 1023
Second method : In this method thi-ee suitable containers such as galvanized
iron cans or boilers are necessary, and provision must be made for maintain-
ing the water in one of thesel containers constantly at a' boiling temperature
during the entire period the cleansing process is going on. Generally in camps
and cantonments this can not be accomplished unless a trench, or suitable
rock or brick device, is provided, in which a small Are is kept burning under
The receptacle for boiling water. The tirst two ivceptacles will contain hot,
soapy water. I<:acli .soldier will thoroughly wash his mess kit in the tirst re-
ceptacle of soapy watei-, rinse it in the .second receptacle of soapy water, and
tiually rin.se it again in tlie receptacles containing water which is actually
boiling. During the washing and rinsing, in the first and second receptacles,
each soldier must take care that he does not soil his hajids with ,the wash
water which may have been contaminated by preceding u.sers. The use of
the swabs previously advised has been found to be undesii-able. because their
handles quickly become wet with dish water and .so soil the hands of the
soldier using them. After the final rinsing in boiling water, the mess kits
will be immediately well shaken and air-dried. Undei- no circumstances will
a C()nnnon dish towel be used in this method, but individual dish towels may
be u.sed under tlie conditions laid down in the' preceding paragraph. After
completing the washing of their mess kits by this method each soldier should
at once thoroughly wash his hands.
(c) After they have been clean.sed, mess equipment and dislies will be pro-
tected from the access of flies, roaches, dust, and dirt.
(d) In this regulation all reference to dishes and mess equipment will in-
clude cups, saucers, drinking glasses, platters, vegetable dishes, knives, forks,
spoons, and other utensils.
(r) The u.se of common drinking cups is prohibited.
With a view to increasing the efficiency in handling coiiimunicable
diseases at the hirge camps, steps were taken to station at each an
officer with special training in epidemiology, who was assigned as
'"epidemiologist" to assist the camp or division surgeon and the
sanitary inspector in making an intensive study of epidemiological
problems and in carrying out measures within the camp for the pre-
vention of communicable diseases. Such officers Avere assigned early
in January. 1918. and their work has been generally most satisfac-
tory. They have been given ample authority, through the sanitary
inspectors, to make effective their recommendations.
It was early re<-ognized by the ^Medical Department that in the
control of communicable diseases in camp it Avas essential that in-
coming drafted men should he received in detention camps and kept
in small groups during the first two weeks of their service, instead
of being domiciled in barracks accommodating several score of indi-
viduals. Xo such detention camps were provided in the original
])lan of the cantonments, l)ut these, and also (juarantine camps, were
improvi.sed at many stations. Ultimately authority was obtained
fiom the War Department to con.struct i:>ernuinent detention and
tjiiarantine camps, consisting of frame huts, each of which would
hold eight men on the basis of oO square feet of floor space per man.
These detention and quarantine camps were nearing completion
when the signing of the armistice put a stop to this work.
The e])idemics of measles, influenza, meningitis, and pneumonia,
together with the occurrence of other diseases of less importance,
has furnished a wealth of material for study. Many monographs on
tliese subjects have been prepared by the section of communicable
diseases and some of these have already been published in current
medical iournals.
1024 report of the surgeox gexer.vl of the army.
6. Sa>'itary Engineering Section.
The American Army station of to-day is a highly organized, sys-
tematically functioning communit}'. Its problems of practical sani-
tation and of sanitary engineering are as complex, as carefully con-
sidered, and as thoroughly and effectively solved as are those of the
most progressive modern American city of considerable size. This
statement applies equally to the general and base hospital, to the per-
manent Army post of the regular Military Establishment, and to that
new institution, the great semipermanent, fixed camp and canton-
ment. It applies to the Army bases of the American Expeditionary
Forces as well as to the establishments created almost overnight in
our own country.
Every one of our military establishments, wherever it may be, is
a model of cleanliness and order. Its supplies of water and food
conform to the highest standards, both as respects adequacy and
quality. Its wastes are removed with scrupulous care and regularity
and are disposed of innocuously and Avith dispatch.
The sanitary engineering section of the Sanitarj^ Corps was or-
ganized to assist the Medical Department of the Army in the many
problems of practical sanitation with which it has to deal and which
require to be successfully solved in order that the health and morale
of our troops may be promoted and held at tlie point of highest effec-
tiveness. The immediate duties of this group of sanitary engineers
are very important. Both at home and abroad they comprehend the
determination of the quality of the water supplied to all troops and
the supervision of methods and procedure of treatment necessary to
the production of absolute hygienic safety in the use of such waters.
They are concerned with the operation of sewage-treatment plants
and tlie disposal of sewage and sewage effluents in such manner that
the public health shall not suffer. The disposal of sullage water, the
collection and disposal of garbage, manure, and miscellaneous wastes
of sanitary significance demand their attention. Sanitary squads
and water trains, commanded by sanitary engineer officers, have been
developed to assist in the sanitation of our Army camps at home, the
rehabilitation of the devastated areas in Europe and the provision
of adequate and safe water supplies for mobile troops.
In this section of the Sanitary Corps have been gathered from all
parts of the United States many of the most highly trained and com-
petent sanitary engineers to be found anywhere.
SUBSECTION OF FLY AND MOSQUITO CONTROL.
The campaign for the control of flies and mosquitoes was carried
on in the larger camps and cantonments by camp sanitary engineers
under the direction of the respective camp surgeons. Tlie work was
coordinated by this division through the section of sanitary engineer-
ing. In the extracantonment areas a similar work was carried on
by the United States Public Health Service.
The methods used were simple and effective. In the control of
mosquitoes drainage represents the most essential part of the prob-
lem. Mosquitoes breed in standing water ; hence if the water is kept
moving or drained away no breeding can occur. Where drainage is
SANITARY DH^ISION. 1025
impracticable the water surfaces are oiled once a Tveek' to prevent
mosquito breeding. Some types of mosquitoes will breed in spite of
oiling, in which event a larvacide is used on the water to kill the
wriggler.
The results have been very marked. In some camps wdiere mos-
quitoes were usually swarming before work was undertaken it became
very difficult to collect any mosquitoes for museum specimens. The
records show that very few cases of malaria were contracted while
tlie soldier was in camp.
For effective results in fly control it was necessary to remove daily
all manure, garbage, and other decomposing matter, sweep stable
and picket lines, apply larvacide in some instances to the soiled
ground, set flytraps, hang sticky fly paper, use fly swatters, and
screen all buildings. Most of the fly breeding takes place in horse
jiianure, prompt removal of which is the first and most important
factor in the prevention of fly breeding.
The results in the control of flies were not as spectacular as in
the case of mosquitoes, because drainage and oiling could be done
without interfei-ence on the part of careless troops, while the effec-
tive control of flies required the close cooperation of every organiza-
tion in camp. It was particular!}^ difficult to attain satisfactory re-
sults in the immense remount stations which contained thousands of
horses and mules and were often located very close to the camp, and
Avhere frequently there were insufficient men to properly remove the
manure. In some of the remount stations the topograph}' and the
character of the soil were such as to render satisfactory policing well-
nigh impossible.
The net results of the control of flies as regards the actual carrying
of disease is hard to estimate, but there has been a conspicuous ab-
sence of any suggestion of fly-borne disease epidemics during the
present war. In the Spanish-American War a large part of the
typhoid fever which occurred is believed to have been conveyed by
flies.
7. Food and Nutrition Section.
The division of food and nutrition of the Surgeon General's Office
was authorized by the Secretary of War, under date of October 16,
1917, to safeguard the nutritional interests of the Army (1) by
means of competent inspection of food with reference especially to
' its nutritional value, (2) by seeking to improve the mess conditions,
and) (3) by studying constantly the suitability of the ration as a
workingman's diet. Its personnel consisted of officers and enlisted
men of the Sanitarj- Corps. Soon after the signing of the armistice
the division was discontinued and the food and nutrition service was
made a section in the division of sanitation. As an approach to
the problems above mentioned, nutritional survej^s were conducted
in all the training camps, quantitative estimates of the, food con-
sumed and wasted being made in typical messes, instructions in food
economy and food sanitation being given to the mess personnel, and
general constructive criticism as regards the provisioning and ra-
tioning of troops being offered.
Under date of July 15, 1918 (G. O. No. 67, W. D.) , the division was
} authorized to station nutrition officers in all camps having a strength
1026 EEPORT OF THE SURGEOX GENERAL OF THE ARMY.
of more than 10.000. The duties of these officer.'- were defined as
follows :
(a) To advise the coiuiimudin;: oHker, the eaiiiiJ quart ennaster, ami the
camp surjreon on all inatters relatint;' to tlu' ((rinitositloii ami nutritive value of
foods.
(h) To inspect, as directed by the <()nniiandinji ofticer, foods and ration.s in
the hands of organizations with reference to nutritive value, freedom from
adulteration, spoilajie, or deterioration from an.v cause.
(c) To cooperate with the school for cooks and bakers, where such schools
exist, in the instruction of mess serjreants and me.ss officers in the fundamentals
of nutrition.
(d) To' assist in The cMdrdination of mess i-eq\urements with subsistence
supplies.
(e) To cooperate with and advise the conservation and reclamation officer
with reference to the best classiffcation. separation, and disposition of wastes
from food.
(f) To report through the camp surgeon on all matters relating to food con-
ditions of the camp, as these may affect the nutritional welfare of the troops.
Special nutrition officers for inspection of food and mess condi-
tions in hospital.s. liospital ships, and in hospital trains and for
laboratory study of certain problems were also provided. At the
signing: of the armistice more than TO officers were on duty in this
coimtry and 40 trained officers had been sent overseas where they
rendered important service with the American Expeditionary Forces,
both in Enofland and France.
The school of nutrition at Camp Greenleaf was adapted to train
the officers already well prepared in the fundamentals of nutrition.
They received in addition training in military forms and pi-ocedure
and particularly Army nutritional conditions. Although the school
was established early in April. 191S. owing to lack of full authoriza-
tion not much was accomplished previous to August. For purposes
of instruction, messes of the camp were placed under the general
supervisory control of the school, and the senior instructor served as
nutrition officer for the entire camp.
The supply of men properly qualified in the science of nutrition
having been practically exhausted, plans were made to institute? an
intensive course for framing men with general biological or chemical
experience. Through the courtesy of Col. William H. Welch, director
of the school of hygiene and public health of Johns Hopkins Uni-
versity. Baltimore". Md.. and Prof. E. V. McCollum of that school,
arrangements were made to receive, as a part of the Student Army
Training Corps of that university, a limited number of men of
draft age for an intensive course of six weeks in food chemistry,
physiology of digestion, assimilation, etc.. preliminary to their selec-
tion for commission in the Sanitary Corps and further training at
Camp Greenleaf. The first four or five men had reported to this
school Avhen the armistice was signed.
General Order No. 67 specified certain duties for the nutrition
officers, but it was intended only as a guide to camp surgeons in fit-
ting the qualifications of the incumbent to the particular needs of
his camp. A considerable number of other duties came to be per-
formed by the nutrition officer. Some of these were the accumula-
tion and dissemination of data regarding local costs and comparative
costs of food; the maintenance and control of a camp marketing sys-
tem: the conduct of a nutritional survev of the entire camp. etc.
Thev cooperated with numerous other officers in the camps, as for
SANITARY DIVISIOX,
1027
instance the sanitary inspector, the officer in charge of schools for
bakers and cooks, the rechimation officer, the subsistence officer, the
morale officer, etc.
During the existence of the food and nutrition service as a separate
division, and as a section of the division of sanitation, a large amount
of research "work was carried out in the following laboratories, at
each of which was stationed some of the personnel of the division
or section :
Harrlman Research Laboratory, New York. Research work previously ini-
tiated was continued. The problems under immediate and intensive study
were:
1. A chemical method for the detection of early spoilage in meat.
2. Tlie toxicity of spoiled meat and methods of counteracting the same.
3. Best methods of preserving meat against spoilage.
4. Comparative methods of dehydration of vegetables with special reference
to the effects of dehydration upon the antiscorbutic properties of vegetables.
Wolcott Gibbs Laboratory, Cambridge. Mass. Since the 1st of .July the in-
vestigation of the physiochemical properties of gluten or the physical chemis-
try of bread making at the Wolcott Gibbs Laboratory has been concluded.
Massachusetts In.stitute of Technology. In connection with tlie work on
dehydration there were conducted many bacteriological and mycological ex-
aminations of dehydrated products and investigations into their keeping quali-
ties under different conditions of storage.
Bureau of Chemistry Laboratory, Washington, D. C. Between July 1, 1918,
and the current date, approximately 2,000 analyses were made in the labora-
tories of tlie Bureau of Chemistry, largely by officers and enlisted men sta-
tioned in these laboratories. They were :
Fruit, dried 14
Ice cream 4
Impurities, alkaloids, poisons 102
Milk, evaporated 870
Mincemeat, sausage 10
Pudding powder, chocolate,
cocoa 19
Vinegar 3
Miscellaneous 81
Total foods 1,438
Beverages 43
Baking powder 7
Beans, soy 6
Butter, cheese, oleomargarine,
lard, oils 33
Candy, jam, preserves, honey,
syrup, sugar 84
Canned goods 60
Coffee 4
Coloring, artificial 7
Flavoring extracts 19
Fat in grease 15
Flour, bread, crackers, corn-
meal 72
Garbage analyses, about 550 (about half, however, done by personnel of
Bureau of Chemistry).
The above .nummary does not include all the analyses, since in many cases
the exact number was not reported.
Investigations regarding supplies in quartermaster storehouses were made at
a nuiulter of camps and aviation fields. During the latter part of .luly and
the early parr of August, visits were made to Camps Sevier, Wadsworth. .lack-
son, and Greene. Under orders dated August 12 similar inspections were naade
at Camps Sherman, Grant, and Custer, at Wilbur Wright Field, Chanute Field,
Aviation Mechanics" Training School ar Minneapolis, and Selfridge Field.
Special attention v,-as paid to refrigeration of meat and other perishables, the
storage of fresh vegetables, the condition of dried fruits, the bakery, and the
danger of infection of food supplies in warehouses by means of flies or other
insects. Conferonces were held with subsistence officers or subdepot quarter-
hiasters at each of the camps visited.
Investigations on dehydrated foods begun during tlie latter part of 1917 were
continued, and inspections of the methods of manufacture and handling were
made in a number of plants using this method of food conservation and preserva-
tion. The purchase by the Army of very large quantities of dehydrated foods
made this kind of inspection particularly desiral>le. and the newness of the
luethods of manufacture require d that the inspection be done by a general food
sanitarian.
142367— 19— VOL 2 — —4
1028 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
Ho»>innin<2: Aiioiist 1 an officer was assianed to nutritional [)r()l)lenis
in liaso and oencM-al hospitals. Inspection tiips were made to the
Middle West, New York, New Phigland section. Sontheastern section,
NeM'port News section, and a hrief trip to Fort McHenry, Md., visit-
ing approximately 50 hospitals in all. Opportunity was encountered
to be of assistance along several lines:
in) Adaptation of the menus to tlic <lietiir\ i-c(niireincii|s of llic \;ii-ioiis types
of i>atients.
ill) RediK'tioii of waste. A Imlletiii of waste control was piv])are(l and cir-
culated as a circular letter.
(<■) The dithcult prohleni of cettinjr food to the patient in an nltr.Mctive con-
dition.
ill) Vario\is other pi-ohlenis in mess manas'enient.
The ])est practices as exemplified iit other hospitals have been re-
ported and discussed in hospitals where defects Avere noted. Tlie aim
was to serve as a medium of transmission of ideas from one hospital,
to another. As a residt of this expei-ience fom- papers were pre-
pared and published.
Aside from the a(hninistrative woik. thi' ix'rsounel in tlie office of
the Surgeon General engaged in three main lines of activity:
1. The .study of reiH)rts of nutritional survey parties ;ind of special reports
submitted l)y nutrition officers. This involved the evaluation and coordination
of a lariie mass of data.
A mess ollicers" manual \\as prep.-ired by several otbcers in the section co-
operatinii'. It was itul)lished by Lea iV: Febiger, of Philadelphia. A consider-
able numlHM- of copies was r»ni-chased by the Medical r>e]>ai"tment for distri-
bution.
Ba.sed on nutritional surveys an improved ration for training canii)s was sub-
mitted b.\ the Surgeon General to The Adjutant Generad imder date of June
3. 1918. Several conferences in reference to this ration with representatives
from Tlie Adjutant (ieneral's Office, the Inspector General's Office, the Quar-
termaster Corps, and officers of the General Staff were participated in by the
director of the section. The findings of th'- nutritional survey parties were in-
dorse<l, but the pi'oposed ration was not adopted.
2. Advice to other departments of the Ai-my and the American Red Cross.
A considerable number of new food products have been submitted to the sec-
tion by the subsistence division. Office of Purchase, Storage and Trafiic, Gen-
eral Staff, and by various individuals for analyses, tests, and recommendations
regarding their use in Army messes. In this connection also a considerable
number of reports on si)oilage of foods as noted by nutritional survey parties
and nutrition (»fticers were compiled and transmitted to the subsistence divi-
sion. The American lied Cro.ss ration for American prisoners of war was re-
vised at the request of the Quartermaster General. A ration for German
prisoners in American detention camps was ]n'epared, and at the request of
the American Red Cross consideration was given to the problem of spending
the funds guaranteed by the Serbian Government in the most nutritionally
economical manner for food materials available to be supplied by the Red Cross
to Serbian prisoners in Austria-Hungary.
3. Special studies. Some of the special studies nuide l)y the jjersoiniel of the
office were the following:
Standardization of specifications for dehydrated vegetables.
Recalculation of light diet for base hospitals.
Monthly average increase in cost of 1,000 calories compared with increase
of quartermaster's allowance.
The dehydration of citrus fruits with special reference to preservation of
antiscorbutic properties.
Food consumptif)n in relation to season and in relation to local weather
conditions.
Food consumittion in organizations of different character.
Total consumption of the most important articles of food in ba.se lt«8-
pitals.
Material derived from reports of nutritional surve.v parties and special
reports of base hospitals classified for use of scliools for dietitians.
SAKITAEY DIVISION. >. 1029
Menus of liiiih caldric value ami low cost.
Compilation of garbaj;e analyses.
Average food consumption in Army camps.
Variability of tlie diet in tlie Army after a length of time in camp.
Food consumption in tlie Army compared with that in other occupations.
Distribution of nutrients in the Army diet.
Comparison of training rations in allied armies.
Percentage of calories supplied by chief components of the ration.
Comparison of Army diet with that of civilian households.
Mineral constituents of the soldier's diet.
Food economy in the training camps.
Food efficiency and sanitation.
In connection with these studies and with the work in camps a large number
of graphs and charts were jn-epared. and a great number of interesting and
valuable monographs were published.
Beginning shortly after the signing of tlie annistice the discharge
of the personnel of the section of food and nutrition was begun.
The training of additional personnel was interrupted at once and
the students taking special courses at Johns Hopkins and at Camp
Greenleaf were reconnnended for discharge. Additional officers were
assigned to the port of embarkation. Hoboken, for the purpose of
supervising mess conditions among debarking troops, particularly
the wounded. The nutrition work at hospitals went on without
interruption.
8. Stuoext AR:NrY Training Corps Skcttox.
This corps was organized under authority of the act of Congress
approved May 18. 1917, connnonly known as the selective-service
act, as amended by the act of August 31, 1918. and under General
Orders, No. 79, War Department. August 24. 1918. The date fixed
for the in(hiction of the students was October 1, 1918. There were
about 5(50 units of this corps organized in various colleges and tech-
nical schools throughout the country, with a total enlistment of ap-
proximately 180.000 men. These units were administered by the
War Department couunittee on education and special training. The
]Medical Department functions of these units were handled in the
division of sanitation, the Student Army Training Corps section
being organized for the purpose. The Medical Department activi-
ties include selection and assignment of the Medical Department
personnel (medical and dental officers, contract surgeons, enlisted
men of the Medical Department, and fenude nurses) : plans for hos-
pitalization : provision of equipment and supplies ; examination of
accounts for professional services; and the meeting of the many
medical administrative emergencies arising from time to time.
r^pon the signing of the armistice, demobilization was immediately
I'ldered and was completed by December '21. 1918. These units,
therefore, continued in existence less than three months. Commis-
sioned medical officers were not available for duty with these units
a- a general rule, and it was necessary to secure physicians in various
connnunities who were willing to accept special contracts covering
the necessary })i'()fessional services. There were 75.") local physicians
recommended by the proper college authorities, who were thus made
>pecial contract surgeons for the time being. These physicians, who
were not familiar with military medical work, made all physical ex-
aminations at time of induction, attended the sick, supervised sani-
1030 REPORT OF THE SURGEON GENERAL OF THE ARMY.
tation, and in most cases carried out the administrative duties of
post surgeons. The few available commissioned medical officers were
assigned as surgeons to the larger units, assisted by contract sur-
geons. Although the units were organized during the epidemic of
influenza and although the situation at a number of istitutions was
a difficult one, nevertheless the medical service in general was effi-
ciently administered in a manner which demonstrated the earnestness,
adaptability, and professional ability of the civilian physicians con-
cerned.
9. Miscella>:eous Section,
subsection on vermin infestation and disinfestation.
The eradication of vermin-infestation and louse-borne diseases has
been one of the most important sanitary problems in the war. The
unprecedented scale of the war, combined with the conditions under
which it has been fought, led to a prevalence of lice among soldiers
that has never been equaled before. Xo army abroad was spared from
this pest and from the diseases conveyed by them. Practically every
man that reached the front area became louse-infested.
The body louse or '' cootie *' transmits relapsing fever, trench fever,
and typhus fever, the latter disease alone having claimed over 1,000,-
000 lives since the beginning of the war among the armies and civil
population of Europe,
The campaign against the louse in the American Expeditionary
Forces was conducted by careful vermin inspections, by frequent
change of underclothing and by bathing, while " delousing "' methods
for destroying lice and eggs on the body and in the clothing were
provided.
The bathing and delousing activities in the American Expedition-
aiy Forces were handled by the Quartermaster Department until
sometime after the signing of the armistice, when an officer of the
ISIedical Corps was detailed for duty with the Quartermaster De-
partment in charge of this work. The percentage of infestation at
the date this officer (Col. H. L. Gilchrist, Medical Corps) assumed
charge was approximately 90 per cent. The percentage of infestation
six weeks later among all troops was determined to be about 3 per cent.
The full account of bathing and delousing activities in the American
Expeditionarj' Forces appears in another part of this report.
The problem of excluding vermin infestation and louse-borne
diseases from the United States was of great importance. The fol-
lowing program was put into effect:
Soldiers are detained for two weeks at foreign ports during which
time any cases of infectious disease are removed and universal de-
lousing is practiced. Vermin inspections are conducted on transports
sailing from Europe and each soldier examines his clothing daily for
vermin en route. On arrival in the United States precautions are
taken to prevent civilians from coming in contact with troops, and
they are immediately transported to the nearest debarkation camp
where universal delousing is again practiced. Each debarkation
camp has a large deverminizing plant (called a " sanitary process
plant " at port of embarkation. Hoboken) , capable of delousing 5,000
men a day. The process consists of a minute examination of the per-
'
SANITARY DIVISI02S^. 1031
son and the clothing, followed by a hot suds shower bath and sterili-
zation of all clothing by steam. Civilians as well as soldiers on
troop shif)S are inspected and treated at the ports. All troop trains
from ports of debarkation are cleaned with vacuum cleaners after
each trip.
Up to the present time over 2,000,000 troops have been returned
to the United States, and not a case of a louse-borne disease has
been introduced into this country, nor has vermin infestation been
carried into civil comnmnities by discharged soldiers.
-•V«t
SUBSECTION OF DE^'EL0PMEXT BATTALIONS.
On May 9, 1918. the War Department issued General Orders,
No. 45, providing for the formation of one or more development
battalions in all large camps and cantonments. The division of
physical reconstruction of the Surgeon General's Office made a
series of studies for the purpose of determining positions where
soldiers with slight physical handicaps might be assigned to limited
service, with a view to freeing able-bodied men tlien doing such
work for full combatant duty. On September 9 the activities of
development battalions, in so far as they related to the Surgeon
General's Office, were placed under the direction of the division of
sanitation, which established a group of medical inspector-instructors
who traveled from camp to camp in order to put into effect uniform
methods of organizing and administering the developmental work in
these battalions. Twenty-seven camps were thus visited. Through
the aid of these instructors, and of the circulars of instructions issued
by the committee on development battalions, about 15 camps evolved
very efficient systems of training in their development battalions
before the signing of the armistice put a stop to the work. In these
camps the men were rapidly classified and either promptly dis-
charged as unfit for any military service or given courses in physical
development, under the supervision of medical officers, with a view
to putting them in a better condition to perform certain military
functions. Soldiers with venereal disease were kept in special com-
panies in the development battalion and given intensive treatment
until cured or found to be incurable.
The following figures from the camps which submitted reports
indicate approximate numbers of men treated in development bat-
talions and results obtained :
Total number of men trained, transferred, or discharged from develop-
ment battalions, approximately 224, 717
Classified as follows :
(a) Venereals (34.4 per cent of total) 77,4.56
(&) Orthopedic cases (12.7 per cent of total) 28,823
(n) Mental conditions (2.1 per cent of total) 4,798
(fl) Functional heart conditions (4.8 per cent of total) 10,917
(e) Miscellaneous physical (23.7 per cent of total) 53.540
(f) Xon-Engli.sh speaking, illiterates, morally unfit, conscientious
objectors, draft evaders, and enemv aliens (22.3 per cent
of total) 33,621
From the above the following number were classified and trans-
ferred to service or were discharged or were otherwise disposed of:
1. Class A.— Full duty (18 per cent of total 224,717) 41,450
2. Class C-1.— Limited overseas duty (20 per cent of total 224.717)— 46,054
1032 JiEPORT OK THK SUHOEON CENEHAL OF THE ARMY.
3. Class C--2. — Limited clomestic service only (19 per cent of total
224,717) 42, 530
4. Total number discharged 36,274
5. Total deserted 919
fi. Total deaths 1,356
Total 168,583
The figures indicate that at least 57 per cent of the men trans-
ferred to develo})ment battalions were reclassified and assigned to
some essential duty in the Army. If the war had continued, tlie
saving of man i)ower by this organization would have been very
great.
SlliSKCTlOX OK PHYSICAI. KXA M 1 N AIIOXS.
The proper ai^piication of suitable physical standards is of funda-
mental importance in an army. The health and well being of the
troops and their military efficiency depends on a judicious primary
selection. During the early months of the war there were pre-
scribed two distinct physical examinations in camps for registrants,
a preliminai'V examination made immediately following the arrival
at camp, usually by regimental or battalion medical officers, and a
final examination made by various boards of specialists (tubercidosis,
cardio- vascular, orthopedic, psychiati'ic. etc.). While the i)relimi-
nary examination was promptly made, under this sy.stem several
months often elapsed before the various boards were able to complete
the physical surveys in individual connnands. In many cases when
orders were received to j)repare for overseas service, there was a
hurried efl'ort to complete the special examinations, which frequently
resulted in the elimination of men as physically unfit after they had
been in training for a considerable i)eriod and were equipped and
otherwise ready for overseas service. This elimination necessitated
filling the gaps with untrained men at the last moment. To correct
the defects noted, a change in system was adopted in April. 1918,
under which physical examinations were made immediately after
arrival in camp in a single examination by a board of medical offi-
cers, including all necessary specialists. '1 lie system as outlined above
has been continued and has operated satisfaetonly. All special ex-
amining boards were dissolved and their personnel made available
for the single camp examining lx)ard presci'ibed under the above
system.
Each camp examining board is made up of si)ecialists from all
l>ianches of medicine and surgery, and every soldier in the course
of his examination is required to pass unclothed before the different
specialists in order to receive a critical examination of every part
of the body. Each professional section is responsible for its own
division of work, and the manager, or chief medical examiner, for
the coordination and general efficiency of the whole examining board.
Special Eegulations, Xo. Go (physical standards), was revised in
this section in September. 1918, and provides for a single physical
standard applying to all military personnel — enlisted and commis- ,
sioned. During the early months of the war there were different
standards for drafted men and for voluntary enlistments, the stand-
ards for enlisted men of the Regular Army being much higher than
those for drafted men. The dual standard resulted in much confusion
i-nd many apparent inconsistencies on the ]iart of the AVar Depart-
SAIS'ITARY DIVISION. 1033
ment. for it was not readily understood outside the service why a
man who was rejected for service in the Recrnhir Arniv was hiter
accepted in the draft.
In anticipation of demobilization, new funn^ for recording the
])hysical examination jirecedino; separation from the service were pre-
]5ared in this section several days before the signing; of the armistice,
Avere ai)proved by the War Department., were printed, and were
ready for distribution at the time demobilization was ordered. A
compi-ehensive scheme for conducting the physical examination was
also worked (nit, the necessary instructions being incorporated in
Circular Xo. 78. War Department. 1918. governing physical examina-
tions in camiis. The machinery foi- the physical examination of
registrants Avas made use of in conducting the examination for de-
mobilization, the same type of examining board being employed and
the same careful examination given as for entrance into the service.
Monthly reports are received in this section from all camps and
stations in the Ignited States covering the com})osition of examining
boards and the details of physical examinations during the i)receding
month. Sei)arate reports are required for examinations jireceding
separation from the service, for voluntary enlistments, and for men
discharged on surgeon's certificate of disability, and until the sign-
ing of the armistice such reports were also recjuired covering exami-
i nations of registrants entering the service. These monthly reports
I are consolidated and tabulated in this section, and detailed informa-
I tion is always available covering the status of physical examinations
at all stations.
f Much difficulty had been experienced from the lack of proper
buildings in which to conduct physical examinations. Plans were
drawn and repeated recommendations were made foi- the construc-
• tion of a special building for this purpose in every large camp and
f cantonment. Finally, just before the armistice was signed, plans had
i been approved for the construction of a very satisfactory building
, Avhich was designed for the work of physical examinations, vaccina-
[ tion. fui'uishing of clothing and equipment, insurance and all cleri-
; cal work conne<-ted with the activities of the personnel officer. The
plans for this building were initiated in this section, and if the con-
struction had been completed the work of examination would have
l)('»Mi greatly facilitated.
INFUIEXZA-rXKlMOMA EPIDEMIC IX THE FALL OK I'JlS.
(All statistics In the following discussion are taken from current weekly health reports.)
The health of troo])s was excellent up to the latter part of Septem-
ber, when the epidemic of influenza-pneumonia appeared in our east-
ei n camps. At the beginning of the period covered by this report
I duly 1. 191S). the annual death rate for disease as above by current
weekly health reports was 8.1 per 1,000. The death rate remained
remarkably low during the sunmier and early fall, the highest rate
between July 1 and September 21 being 8.1 for the week ending July
;■). 1918. The lowest rate was 2.1 for the week ending July 26. The
latter part of September, with the appearance of the influenza-pneu-
monia epidemic, mortality rates immediately soa^red. All previous
records for mortality from disease among the troops in camps were
>liattere(l. The rise and subsecjuent fall in annual death rates, from
\V(>(>k to week, is well shown on the following page.
1034
EEPOET OF THE SURGEON GENER.\L OF THE ARMY.
Seprenibor 18 2.3
Sei)teiuber 21 4. 4
.September 27 32. 4
October 4 81.8
October 11 206.4
October 18 i 190.1
October 25 02. 7
November 1 43 2
November 8 33
November 15 19.7
November 22 13.7
November 29 13.2
And SO forth.
It \vill be seen that the peak, as reoards deaths. Avas reached on
October 11. The epidemic had spread rapidly from camp to camp
due to the continued interchange of personnel from infected to non-
infected camps, and vice versa. This transfer of personnel from
camp to camp during the continuance of the epidemic was inadvisable
and dangerous, which fact was strongly pointed out to the War De-
partment at the time with proper recommendations from this office,
but, on the ground of military necessity, troop movements were con-
tinued under slight restrictions.
One result of the free intercommunication of military personnel
was that practically all military camps in the United States were at
the height of the epidemic almost simultaneously. While the peak,
as far as concerns the death rate, was reached for the week ending
October 11. the height of the epidemic, with reference to new cases
reported, was attained sometime earlier.
The influenza-pneumonia epidemic was a world-wide calamity.
The number of deaths caused by the disease throughout the world in
1918 is variously estimated. It is certain that deaths were numbered
in the millions, one estimate stating that 6.000.000 fatalities occurred
within the period of the last six months of 1918. No plague of his-
tory approaches this experience of 1918 in the number of lives lost
Avithin a short period of time. In comparing the incidence of the
disease and its mortality in Army camps in the United States with
the incidence and mortality in civil communities, it is probable that
the case incidence, in proportion to population, and also the death
rate, will be shown to be considerably higher than in adjoining ciA^il
communities. It is easily explained why this should be.
1. Soldiers in camps were in the most susceptible age groups — 20
to 40. It has been the common observation throughout the present
epidemic in civil communities that it is a disease affecting chiefly
young and middle-aged men and women, and that infants, children,
and the aged have been relatively immune from attack. If accurate
statistics were available as to the relative incidence of the disease and
death rate for men of military age in civil life, it is believed that the
mortality statistics of the Army would compare more favorably with
those of adjacent civil communities.
2. The greater density of population in camps, as compared with
civil communities, is another adverse factor so far as the Army shoAv
ing is concerned.
3. Housing conditions : In camps troops are housed in large num-
bers in a single room, which increases the liability to contact and
droplet infection from the sick to the well. In civil life, on the
contrary, the majority of men have individual sleeping rooms, and
the liability to contact and droplet infection is relatively small.
The military practice of eating in large groups, and the methods
emploA'Cd for washing mess kits, may also have been factors favoring
the spread of the disease in the camps.
SANITARY DIVISION.
1035
From the standpoint of prevention, it may be said that very little
has been accomplished in Army camps or in civil life. In camps
where all kno^vn measures for the prevention of the spread of respira-
tory diseases were enforced, the incidence of disease apparently was
as great as in other camps where less rigid preventive measures were
enforced. Where certain preventive measures were applied early,
it was possible to retard the progTess of the epidemic and cause it
to be spread over a longer period of time, but it has not been shown
that such measures have accomplished reduction in the absolute
number of cases occurring in one command as compared with an-
other. In general it may be said that all susceptible human material
in an individual camp suffered from an attack of the disease during
the continuance of the epidemic. The percentage of susceptibles, as
shown b}^ records from various camps in the United States, appar-
ently varied from 25 to 40 per cent of the command.
The Medic-al Department met this emergency most efficiently. The
heavy responsibilities and burdens placed upon camp surgeons dur-
ing the height of the epidemic in our large camps can not be ap-
preciated unless one has liAed through the ej)idemic in the camp
itself. Medical officers, nurses, and enlisted men of the Medical
Dei^artment deserve the greatest credit for their self-sacrificing de-
votion to dutj', day after day, without proper opportunity for rest
or relaxation. The proportion of medical officers, nurses,- and at-
tendants who contracted the disease and lost their lives is extremely
high as compared with all other classes of camp personnel.
Full credit, too, nmst be given commanding officers, subordinate
line officers, and enlisted men of the line, many of whom were detailed
for dut}' with the Medical Department during the height of the emer-
gency. Without exception, commanding generals gave the fullest
support and assistance to camp surgeons, without which it would
have been impossible to have successfully handled the difficult prob-
lems j)resent in every camp at this time.
The first case of influenza of the present epidemic reported among
troops in the United States appeared September 7 at Camp Devens.
The disease was not at once recognized, the fulminating character of
the infection suggesting cerebrospinal meningitis. Cases appeared
on September 8 and the following days, the number raj^idly increas-
ing day by day. The height of the epidemic was reached on Septem-
ber 20, 13 days after the appearance of the first recognized case. By
the 30th of September this one camp had reported about 10,000 cases
of influenza, nearly 2,000 cases of pneumonia, and 500 deaths from a
command of approximately 45,000 men. This brief description of
the course of the epidemic at Camp Devens may fairly be applied
to all other Army camps which were subsequenth- infected. The dis-
ease extended rapidly, other camps being attacked in the following
order and on the dates indicated :
Camps : Date of onset.
Upton Sept. 13.
Lee Sept. 17.
Dix Sept. IS.
.Jackson Sept. 18.
Hoboken Sept. 19.
Syracii.se Sept. 19.
Goi-clon Sept. 19.
Humphreys 1 Sept. 20.
Logan Sept. 20.
Funston Sept. 20.
Camps : Date of onset.
Meade Sept. 20.
Grant Sept. 22.
Taylor Sept. 22.
Sevier Sept. 23.
Lewis Sept. 23.
Sherman Sept. 23.
Newport News Sept 23.
Pike Sept. 24.
Beauregard Sept. 25.
1036 REPORT OF THE SURGEON GENERAT. OF THE ARMY.
RECOM>If:NDATIONS TO THE WAR UEPART^IENT FOR THE CONTROL OF THE
INFLUENZA EPIDEMIC.
About the middle of September when it was recognized that a
most serious situation existed at Camp Devens, and that the disease
Avas certain to spread to other camps in the United States, it was
reconmiended by this office that during the continuance of the epi-
demic new men shoukl not be sent to Camp Devens, nor shoukl men
be sent away from that camp. Camp Devens Avas then overcrowded,
having nearly 10,000 men in camp at the time over and above the
normal housing capacity. It was pointed out that new men brought
into the camp at this time would almost surely contract the disease
and add to the already heavy bui'den of the camp in caring for
them. Further, that in transferring men from the camp, a virulent
form of disease would almost surely be conveyed to other stations.
The AVar Department in returning this communication stated that
it was impossible to cancel the movement of registrants who were
due at Camp Devens on September 25, but that orders had been
issued to cancel the movement of 3,000 registrants who were due to
report at Camp Devens on October T. The disease had at this time
made its appearance at Camp Dix, and similar action was recom-
mended with respect to sending new men to Camp Dix, or sending
men away from that camp as had been recommended for Camp
Devens. The War Department ordered all future movements of
registrants to Camp Dix canceled during the continuance of the
epidemic.
The following telegram Avas sent to the commanding officers of all
camps (Sept. 27) :
Keference all nioveuients of nieu to and from yoiii* camp at this time. AU
possible preoavitions will be taken asainst transfer of any influenza contacts,
but movements of officers and men not contjicfs will be effected promptly as
ordered.
The effect of this order was to restrict movements of troops very
slightly, if at all. Under orders previously issued, camp command-
ers were not authorized to transfer " contacts " of any communicabl*
disease. Further, practically all men in the infected camp had been
exposed to the disease and their transfer to other stations resulted
in the introduction of disease to stations previously uninfected.
On September 26 the situation was reviewed in a letter addressed
to the Chief of Staff, and as at this time there were 18 camps
heavily infected, emphasis was laid on the fact that the disease was
now no longer local, and the restrictive measures reconnnended for
Camp Devens and Camp Dix in the earlier communication should
be applied to all military camps. It was then predicted that if the
experience at Camp Devens should be repeated in all our military
camps that our losses by death would amount to 8.000 to 10,000 men
in the 16 cantonments alone. This prediction was justified as shown
by the experience of subsequent weeks. In the summary of recom-
mendations it Avas urged that —
1. All draft calls of registrants destined for severely infected camps in the
inniiediate future be canceled. The list of .severely infected camps is here-
with appended. The duraticm of the need for such cancellation can not now
Ite estimated.
SAXITAEY DIVISION". ^ 1037
2. Transfer of military persuiiiiel from one camp or station to another be
reduced to the minimum required by urgent military necessities, especially
restricting military movement of troops from an infected to an uninfected
camp or station, or vice versa.
Influenza-pneumonia developed also on troopships bounc^ for
Europe during this period. Many cables were received from the
other side indicating explosive outbreaks of the disease, with high
fatalities among troops. It was reported that troops were arriving
" improperly clothed, having only one blanket, no overcoats, and
light cotton underwear." Overcrowding of troopships was consid-
ered by this office as the most menacing insanitary condition then
existing with reference to the spread of disease. Under date of
October 1. the attention of the War Department was invited to this
condition, and request made that^ —
The overcrowding of troopships be immediately relievetl covering such shii)-
ments as may be imperative during the present epidemic. It Is believed that
the present authorized capacity of troopships should be reduce<l at least one-
half for the present, and it was so recommended.
The action taken on this reconnuendation was as follows:
In view of the instructions which had already been issued from the War
I »ei)artment on the sub.1ect of physical examinations and inspections prior to
<leparture to camps, and prior to embarkation, your recommendation for a re-
duction in the transport capacity to 50 i^er cent, and that troops be held in
quarantine foi- one week prior to embarkation, is disapproved.
It may be said in passing that the severe outbreak of influenza
and pneumonia and tlie heavy mortality therefrom on troopships
was not due except in part to unsatisfactory sanitar}' conditions.
In general, the sanitation of ships was very good. Overcrowding
and lack of sufficient hospital space, medical personnel, and sup-
plies undoubtedly increased the percentage of pneumonia compli-
cations, and also the case mortality from that disease. But it should
be emphasized that the epidemic outbreak would have occurred in
the same troops had they remained in camps in the Ignited States.
and the fatality theiefrom would have been practically the same
as occurred aboard troopships. In later shipments of troops, after
the peak of the epidemic had been passed in the majority of Army
camps, recommendation was made that only commands who had
passed through the. epidemic be selected for shipment overseas:
that those who had actually had the disease could now be trans-
jDorted overseas with safety, and those who had not had the disease
might be assumed to be immune from an attack if they had lived
in the camp which had passed through a severe epidemic without
contracting the influenza. Therefore, shipments of troops made
later than Octol)er 15 Mere accomplished with very little influenza
and pneumonia among troops en route.
Early in the epidemic (Sept. -28. 1918), before the disease had
actually appeared in the majority of Army camps, the following-
review was submitted to the Chief of Staff by the Surgeon GonoiTii.
together with appropriate reconunendations :
1. The iireseiit influeii/a epidemic among troojts in the I'nited States has
assumed serious proportions, and as the disease extends to other camps, the
noneffectiveness and mortality may he expected to materially increase. Every
possible measure must be taken in all camps and stations, infected as well as
noninfected, to prepare for handling epidemics of this disease, to restrict
its ravages, and refluce the mortality therefrom. With this end in view, it
1038 REPORT OF THE SURGEOX OEXERAT. OF THE ARMY.
is rocommentled that instructions be sent all comuuinding officers substantially
as follows: ,. .,, ,
2 Influenza is a " crowd " disease. Epidemics of the disease will be more
extensive and the complications more frequent and serious in direct proportion
to the degree of overcrowding in camps. Where housing facilities or tentage
are inadequate to allow for each man in camp a minimum of 50 square feet
of floor space in barracks or tents, immediate steps will be taken to remove
a part of the command and place them in camp under canvas if no other means
are available for relieving overcrowding. If the camp is not infected, the
number of men in camp in excess of the number for which accommodations
are available, based on the minimum of 50 square feet per man, may be
reported to The Adjutant General with a view to their transfer to another
camp or station which is noninfected, and where accommodations may be
available.
3. The prevention of overcrowding of influenza patients in hospitals or
barracks extemporized as hospitals, is of the greatest importance. For each
influenza patient under treatment the minimum of 100 square feet of floor
space is required ; furthermore, each patient must be kept and treated in
a cubicle during the continuance of the disease. Hospital facilities will be
entirely inadequate as soon as the disease assumes epidemic proportions. Early
provision must be made to completely vacate barrack buildings, preferably
near the base hospital, which in the presence of an epidemic will be required as
extemporized hospitals. Ample provision in bed capacity must be made in ad-
vance as admissions will frequently number well over 1,000 daily during a well-
developed epidemic. The treatment in regimental infirmaries or in parts
of barracks occupied by well men. of a disease as contagious as influenza,
should not be permitted. Barrack buildings used as temporary hospitals or-
dinarily will be administered by the hospital staff as an adjunct to the main
hospital.
4. Temporary details of commissioned and enlisted personnel, including
cooks and kitchen helpers, from the line may be necessary to assist the medical
officers in handling the situation. Additional medical officers and nurses will
be supplied from the Surgeon General's Otlice so far as they are available
upon proper request. Unskilled workers must come from an extemporized
personnel detailed from the line or other camp source to supplement the
trained personnel on duty at the hospital. Sufficient trained Medical Depart-
ment enlisted men are not available for transfer,
5. It is recommended that a synopsis of these instructions, if approved,
be transmitted by wire to all camps and cantonment commanders, depart-
ment and independent station commanders. The element of time is of vital
importance. Delay in sending out these instructions by mail, in the view of
this office, would not be justified in the present emergency.
The War Department action on the foregoing recommendations
was prompt and efficacious. A night letter was sent to commanding
generals of all camps, embodying in full the substance of the above
letter. The effect of these instructions in camp was to secure the
fullest possible cooperation and support on the part of commanding
officers for camp surgeons, commanding officers of base hospitals,
and others responsible for the management of the epidemic in camps.
Special inspectors froui this office visited the majority of these camps
during the height of the epidemic, and no single report was re-
ceived indicating that the line of the Armj' had not given the
Medical Department all assistance and support that it was possible
for them to give. The telegraphic instructions sent to commanding
officers at this time, it is believed, were responsible more than any
other measure for the efficient management and handling of the
emergency. The Medical Department alone would luive been unable
to meet the onergency without criticism if the support and coopera-
tion of commanding officers had not been directed by the War De-
partment.
SANITARY DIVISIOX. 1089
For troops in the United States, as a whole, the epidemic may be
said to have rim its course within a period of about eight weeks. For
each individual camp the duration of the epidemic was about four
weeks. Thus the period from September 15 to November 15 repre-
sents the period of abnormal high mortality due to influenza-pneu-
monia. Subsequent to November 15 influenza continued in nearly
nil camps, but with relatively few cases in comparison with those re-
ported during the height of the epidemic. The influenza appearing
subsequent to November 15 was, as a rule, less virulent and less fre-
quently complicated by pneumonia. The mortality rates subsequent
to November 15 approximated those obtaining during the corre-
sponding period of 1917.
In France the epidemic followed much the same course and ex-
tended over much the same period of time as in the United States.
The high-watei- mark for deaths from influenza and pneumonia among
troops in the United States was 6,160 for the week ending October 11
and in the American Expeditionary Forces, France, 1.151 for the
Aveek ending October 17. 1918. There were approximately 1,600,000
officers and men in the United States and the same number in the
American Expeditionary Forces, France, during the months of Sep-
tember, October. November, and December. 1918. It is of interest to
note that the disease was much less prevalent and fatal among our
troops of the Expeditionary Forces than among troops in the United
States. During the last four months of 1918 deaths from influenza
and pneumonia number 22.186 in the United States and 8,812 in the
American Expeditionarj' Forces, France, the respective commands
being of approximately, equal strength. The question arises. Why
should the disease have been much more fatal in camps in the United
States than among our troops abroad? These explanations suggest
themselves :
(a) Camps in the United States were filled to overflowing with
new draftees who were unaccustomed to Army conditions, who were
unseasoned, and who were huddled together in large groups under
conditions most favorable for contact and droplet infection from
man to man. Troops in the United States were therefore more sus-
ceptible to all camp diseases, including influenza, than were the more
seasoned troops composing the American Expeditionary Forces in
France. Furthermore, unseasoned troops when attacked by diseases
are less resistant to the effects of the disease than seasoned troops.
(h) The practice of housing men in large numbers in a single
room in cantonments in the United States was conducive to high
incidence of any prevailing acute respiratory disease, and especially
influenza and its most serious complication, pneumonia. In France,
conditions were entirely different. Practically all combat divisions
were in the advance zone at the time and well spread out over wide
areas. Where troops were billeted, the men were separated in small
groups in their billets and, shelters and were able to remain more or
less isolated from other groups. Further, they were living more or
less in the open during active operations, and while it might be
assumed that individual resistance would be greatly reduced by the
fatigue and stress of battle and that such troops would be more
susceptible to influenza, it appears that the wide separation of these
men and their life in the open, during this period, more than offset
the disadvantageous conditions of fatiaiie and stress under which
1040 REPORT OF THE SURGEON UEXER.VL OF THE ARMY.
they Aveiv living:. It is coniiuented upon by medical officers who
served in France that in connnands of the Service of Supply, wiiere
troops were housed in barracks with a hxvge number of men to a
single room, the epidemic ran much the same course with high mor-
tality as it ditl in cantonments in the United States. It was observed
that the percentage of infection and the fatalities from influenza and
pneuuK^nia in France were much greater among troops of the Service
of Supply than among troops at the front. There is but one ex-
planation that satisfactorily covers this divergence, and that is the
different method of housing and the degree of dispersion of men over
wide arefis at the front as against the crowded barracks on restricted
areas in the Service of Supply.
(c) Soldiers in France were of longer service and a large pro-
portion of them had passed the preceding winter in camps in the
Ignited States. Many of them had had influenza in a mild form
earlier in their service and thus ac(juired a relative immunity.
In France the epidemic followed much the same course and ex-
tended over much the same period of time as in the United States.
The high-water mark for deaths from influenza and pneumonia
among troops in the United States was G.IGO for the week ending-
(Jctol)er 11, and in the American Expeditionary Forces, France,
1.451 f(n' the week ending October 17. 1918. There wei'e approxi-
mately 1.000,000 officers and men in the United States and the same
numl)er in the American Expeditionary Forces, France, during the
months of September. October. November, and December, 1918. It
is of interest to note that the disease was much less prevalent and
fatal among our troops of the Expeditionary Forces than among
troops in the United States. During the last four months of 1918
deaths from influenza and pneumonia numbered 22,186 in the United
States and 8,812 in the American Expeditionary Forces, Prance, the
respective commands being of approximate!}- equal strength. The
question arises. Why should the disease have been much more fatal
in camps in the United States than among our troops abroad?
These explanations suggest themselves:
[a) Camps in the United States were filled to overflowing with
new draftees Avho were unaccustomed to Army conditions, who were
unseasoned, and Avho were huddled together in large groups under
conditions most favoiable for contact and droplet infection from
man to num. Troops in the I'nited States were therefoi'e more sus-
ceptible to all camp diseases, including influenza, than were the more
seasoned troops composing the American Expeditionary Forces in
France. Furthermore, unseasoned troops when attacked by disease
are less resistant to the effects of the disease than seasoned troops.
{b) The practice of housing men in large numbers in a single
room in cantonments in the United States was conducive to high
incidence of any prevailing acute respiratory disease, and especially
influenza and its most serious complication, pneumonia. In France
conditions were entirely different. Practically all combat divisions
were in the advance zone at the time, and well spread out over wide
areas. AVhere troops were billeted, the men were separated in small
groups in their billets and shelters and were able to remani more or
less isolated from other groups. Further, they were living more
or less in the open during active operations, and while it might be
SANITARY DIVISION. 1041
;i>sume(l that individual resistance would be greatly reduced by the
fatigue and stress of battle and that such troops would be more sus-
ceptible to influenza, it appears that the wide separation of these men
and their life in the open, during this period, more than offset the
disadvantageous conditions of fatigue and stress under which they
were living. It is commented upon by medical officers who served
in France that in commands of the Services of Supply, where troops
Avere housed in barracks, with a large number of men to a single
room, the epidemic ran much the same course, with high mortality,
as it did in cantonments in the United States. It was observed that
the percentage of infection and the fatalities from influenza and
pneumonia in France were much greater among troops of the Services
of Supply than among troops at the front. There is i)ut one expla-
nation that satisfactorily covers this divergence and that is the ditfer-
ent method of housing and the degi'ee of dispersion of men over wide
areas at the front as against the crowded barracks on restricted areas
in the Services of Supply.
(c) Soldiers in France were of longer service and a large propor-
tion of them had passed the preceding winter in camps in the United
States. Many of them had had influenza in a mild form earlier in
their servi( e and thus acquired a relative immunity.
In comparing sick rates for the month of December. 1917 and 1918,
it will be noted that in December, 1918, fewer cases of measles, scar-
let fever, and meningitis are appearing, while influenza has taken
the place of the three diseases mentioned in maintaining sick rates
at about the same level as last year. The pneumonia of December.
1917. was, as a rule, a complication of measles and scarlet fever.
The pneumonia of 1918 is almost entirely a complication of influ-
enza. The comparative freedom from measles, scarlet fever, and
meningitis in the last quarter of the calendar year 1918, and the
first half of the year 1919, was probably due to the fact that new.
unseasoned men were no longer coming into Army camps, and that
the men already in camps had passed through epidemics of camp
diseases and were relatively immune. For the greater part of the
period up to the outbreak of the influenza epidemic new men were
pouring* into the camps at the rate of about 200.000 per month.
Froiri the date of the signing of the armistice, November 11, all
draft calls were canceled. The statistics of sickness and death
among troops in camps in the United States for the winters of 1917-
18 and 1918-19 will not be properly comparable as no new men
have been inducted during the latter period. Further, the condi-
tions in Aiiny camjjs were more favorable in other respects for the
winter of 1918-19 than for the previous winter: construction work
had all been completed, ample hospital facilities were ready, camp
machinery Mas moving smoothly, supplies and personnel were ade-
quate and satisfactory, and the criticisms of unpreparedness which
were directed against the Medical Department in 1917 (for which
the Medical Department wa.s not responsible), could no longer in
fairness or truth be made in the winter of 1918-19.
II. DIVISION OF LABORATORIES AND INFECTIOUS DISEASES.
The principal changes in the organization of this division from
the year 1918 were in the separation of the section of urology and
1042
REPORT OF THE SURGEON GENERAL OF THE ARMY.
dermatology from the division, urology becoming a section of the
division of surgery and dermatology going to internal medicine, and
tlie addition to the division of the Army Medical Museum and in-
struction laboratory at that place.
At the beginning of the fiscal year, July 1, 1918, there were 527
medical officers of the laboratory service on duty in the United States,
184 Sanitary Corps officers, and 125 female technicians; the division
had also sent overseas 315 trained laboratory workers; a total of
1,151. As the number of female technicians increased, it became
necessary to secure first one and then a second female physician.
Both were employed as contract surgeons to supervise the many de-
tails and large correspondence relating to the training schools, at
the New York City Board of Health, the Massachusetts Institute of
Technology, the Eockefeller Institute, and the stations to which the
technicians were assigned. By the middle of August the personnel
had increased to 1,333, distributed as follows: Overseas, 470; at
schools of instruction, 250; at general hospitals, 86; at base hospitals,
post hospitals, the Army Medical School and Museum, 484 ; at ports
of embarkation, 37 ; at the Surgeon General's office, 6.
The principal changes in laboratory personnel are shown in the
following table :
Aug. 1.
Sept. 1.
Oct. 1.
Nov. 1.
Dee. 1.
470
250
4S4
37
6
536
321
345
50
7
636
314
423
52
10
665
315
466
54
11
766
24S
General hospitals, post hospitals, base hospitals,
Army Medical School, and Army Medical Museum.
Ports of embarkation
492
66
Surgeon General's OfRee
11
Total
1,333
1,358
1,564
1,698
1,755
The end of November found the largest personnel on duty of any
time during the war. The total of 1,755 persons was made up as
follows : Medical officers, 945 ; Sanitary Corps officers, 405 ; female
technicians, 398; contract surgeons, 6.
After the 1st of December the effect of demobilization became ap-
parent, and on January 2, 1919, the total strength was 1,493 ; Febru-
ary 1, 1,333: November 1, 1,279; April 1, 1,194; May 1, 1,130; June
1, 908 ; July 1, 836.
All the schools for the special instruction of laboratory personnel,
Medical and Sanitary Corps officers, enlisted men of the Medical
Department, and female technicians were continued in 1918. The
principal schools for officers were the Army Medical School, the
Yale Army Laboratory School, the Army Auxiliary Lal)oratory No.
1 at the Eockefeller Institute, New York, the medical officers' train-
ing camp at Fort Oglethorpe, Ga., and, in addition, the laboratories
of some of the base hospitals, particularly that at Camp Devens, Mass.
Enlisted men were trained principally at the Army Medical School
and the Yale Army Laboratory School, though a few were sent to
the Rockefeller Institute, and many were necessarily trained at the
various camps.
Providing proper faculties for these schools was a matter of great
difficulty, and all of them were undermanned the greatest part of
the time, entailing long hours of teaching upon the existing facul-
LABORATORY DIVISION. 1043
ties. The department is thoroughly appreciative of the work done
by this small group of enthusiastic and devoted workers and takes
pleasure in acknowledging how much it owes to their patriotic de-
votion to duty.
During the influenza epidemic the schools were all practically
closed, as it was necessary to send the students to duty in camps and
civil communities because of the scarcity of physicians.
At no time during the war was there a sufficient nmnber of trained
pathologists in the service. The same condition seems to exist in
civil life, for it proved impossible to find a sufficient number of
trained men. The medical profession apparently realizes the signifi-
cance of this lack of trained men, and doubtless some effort will be
made in future to attract more men to this specialty by providing
additional positions in uni verities, colleges, and hospital-', where
^he experience necessary can be gained under suitable conditions for
routine work, research, and cooperation with other departments oi'
the institutions. It is evident that something is needed to make the
calling of pathologist more attractive than it hiis been in the past.
In the Army hospitals a distinct step was made when the position of
chief of the laboratory service was made coordinate in standing and
authority with that of the chiefs of the medical and surgical services.
Formerly the laboratory department had been a brevet of the medi-
cal service, with the result that many young men, finding promotion
impossible in the laboratory, left it for clinical work in medicine and
surgery. This has now been changed, so that a laborator}- man may
l)e promoted and still work in his proper special line. During the
year arrangements were made for the instruction of medical officers
in pathology at St. Elizabeths Hospital, Washington, where an aver-
age of 600 autopsies are performed yearly, and also at the Brady
laboratories of the New Haven hospital. At the latter place patho-
logical technicians were trained, in addition, and a considerable num-
ber were distributed to hospitals in this country' and abroad. Some
received further instruction in neuropathology at the Army Medical
Museum, and were also distributed to hospitals for the treatment ol
nerve injuries.
Pathology, however, is a subject in which a large experience is
acquired slowly, and, in spite of efforts to train additional men by
the arrangement of special coures of instruction, the number of
(jualified pathologists could not be greatly increased during the war.
The study of respirator}' diseases, particularly pneumonia, was
continued throughout the year. A commission of five officers was
sent to Camp Funston in July, 1918, and they were enabled to make
a thorough and complete study of acute respiratory infections at
that camp, including epidemiological, bacteriological, and patho-
logical investigation, before the great wave of epidemic influenza
appeared. Their conclusions included a statement that a mild form
of acute epidemic influenza had been present in the camps for months
before the fatal form of the disease became evident. Upon the con-
clusion of the survey at Funston. the gi'oup was transferred to Camp
Pike, arriving about three weeks before the outbreak of the great
epidemic. Both these studies are rich in results and give a picture
of the respiratory disease condition both before and after, as well
as during, the epidemic, made in a comparable way by the same
142367— 1&— VOL 2 5
1044 REPORT OF THE SURGEON GENERAL OF THE ARMY.
jSfroup of men. Partial reports ha^-e already appeared in the current
medical literature.
A series of studies on acute lobar pneumonia produced by type 1
pneumococci in monkevs has been carried out at the Army Medical
School and will soon be published. The studies show the changes
in the respiratory oi-gans from hour to hour after intratracheal
inoculation and have given a perfectly clear explanation of the
pathological picture seen in human beings. A considerable number
of new points have been brought out. which add much to our knowl-
edge of the histogenesis and bacteriology' of pneumonia.
In August, 1918. the Army 'Medical School prepared a vaccine
against pneumonia, containing pneumococci of types 1, 2. and 3.
and this vaccine was used on more than a hundred thousand men
without any bad results. The degi'ee of protection given by the
vaccine is still beinir studied and statistics are not yet readv as to
the number of vaccinated men who developed pneumonia. The de-
termination of the value of the vaccine was made unexpectedly diffi-
cult by the outbreak of influenza, which began during the following
month. The vaccine, like that used by Lister in South Africa and
by Austin and Cecil in this country, was designed to give protection
against primary lobar pneumonia and secondary pneumonias, like
those following influenza, had not been taken into consideration.
The difficulty of eliminating influenza pneumonias from the tables
had made the compilation quite laborious. It may be said, however,
that there is apparently good clinical and laboratory evidence for
believing that a considerable degree of protection can be given,
howevpr. bv such a vaccine.
Studies on the etiology, pathology, and bacteriology of influenza
Avere carried out energetically throughout the Army. Many reports
have already appeared, and additional studies are still being- carried
on. both at camps and the Army Medical School, upon which reports
may soon be expected. There is no room for doubt but that it was
the same disease with which we had to deal throughout the United
States, as showed by the clinical course of the disease and the patho-
logical specimerLs which have been sent into the Army Medical
^Museum. Yet the bacteriological reports are not uniform, although
in the greater number of the laboratories the influenza bacillus of
Pfeiffer was regularly found at some portion of the respiratory tract,
sometimes in pure culture, though more often in association with
other organisms capable of growing in the lung. At a few camps
quite contrary findings were reported. In addition, the influenza
bacillus was foimd in many persons who were either not ill at all or
who Avere suffering from some other disease. At the Walter Reed
a series of lunar punctures were made on influenza pneumonias with
the result of finding a pure culture of bacillus influenza in most of
the cases. The significance of this finding is still being investigated.
There is considerable diversity of opinion as to the importance of
the influenza bacillus and, as the question is by no means settled,
extensive studies have been planned and are being carried out at the
Army Medical School, which at the time of reporting promise to
contribute to our knowledge of the etiology and pathogenesis of the
disease.
An influenza vaccine, consisting of many pure cultures of the in-
fluenza bacillus without any other organisms was prepared at the
LABORATORY DIVISION. 1045
Army Medical School, and was used at many camps. It can not be
said, however, that in the dosage used, that it was efficacious in pre-
venting infection or in diminishing the mortalitj' of the disease, and
after a short trial during October, November, and December, its use
was abandoned although in animals there seemed to be some indica-
tion of its value.
Empyema investigations continued through the year, and exten-
sive reports have already been published in the current medical
periodicals. The number of cases and the mortality was much
less than during the preceding year, as will be seen by consulting
the statistical tables. It is believed that a distinct advance has
been made in our Imowledge of the subject, and it has been shown that
distinct lines of treatment are indicated by the bacteriological ex-
amination as to whether the cause is the pneumococcus or the strep-
tococcus. The pathological physiology of the disease was reported
upon quite fully by Graliam and Bell, and the principles of surgi-
cal treatment have been firmly established for the first time.
The question of haeiiiolygic streptococcus carriers and cases and,
in fact, the bacteriology' of streptococcus infections at the beginning
of the year was in considerable confusion, and to bring order out
of it a conference of experts in the field was called together at the
Kocke feller Institute at Princeton, X. J., with the permission and
active interest of Prof. Theobald Smith. The conferees num-
bered about 20 and represented the principal workers in this field.
As a result of the meeting, a circular on standard methods of strep-
tococcus investigation was prepared, printed, and distributed to all
Army laboratories. Its effects were excellent and the standard
methods and nomenclature permitted the collection of comparable
data from the entire country.
Studies on the importance of chronic and acute carriers of these
organisms are still lieing carried out; though reports have been pul)
lished from time to time in the current medical journals, it is felt
that many points still remain to be investigated.
Epidemic cerebrospinal meningitis, while prevalent, particularly
after influenza, did not become alarming, and very little new was
developed. Some studies already published show that there is reason-
able grounds for believing that chronic carriers are immune to the
disease, and also that vaccination is theoretically possible and that,
if necessary, large numbers of troops could be immunized against the
disease. Very little work was necessary to control the few chronic
carriers; two incipient epidemics were apparently easily controlled
by the recognition of the carriers, who yielded as a rule to medical
oi- surgical treatment after a time.
In the early part of the year, the number of chronic carriers was
so great that a special camp in Florida was planned for their recep-
tion and treatment, but. with the advent of better Aveather in the
spring, the number rapidly diminished and it never became necessary
to establish the carrier camp.
Triple typhoid vaccine was manufactured throughout the year
at the Army ^fedical School in ample quantities. From August 1.
1918, to ]March 12. 1919. triple typhoid lip vaccines were in use. but.
as they were adopted as a war measure and as some details regard-
ing their manufacture needed further investigation, and the question
of their value as protective agents was in question, their use was dis-
1046 REPORT OF THE SURGEON GENERAL OF THE .ARMY.
continued and the use oi: the saline triple typhoid vaccine was re-
sumed.
The sharp outbreak of anthrax, due to the use of infected shaving
brushes, referred to in the last annual report, continued for a time
in the current year, but the good effects of the principal preventive
measures quickly became apparent, and early in the year cases ceased
to be reported. A full statement of the number of cases and deaths
will be found in the statistical tables. The principal protective meas-
ures adopted in the Army were the adoption of a regulation prevent-
ing the purchase of shaving brushes by the Army except from fac-
tories which had been inspected and passed by the United States
Public Health Service and the disinfection by hot cresol and forma-
lin solutions of brushes already purchased. Early in July the United
States Public Health Service certified eight firms of whom it was safe
to purchase, and additional inspections rapidly increased the number
of plants equipped with apparatus for the disinfection of the hair of
which the brushes were made. It was interesting to learn that all hair
used in making shaving brushes has to be boiled to straighten the
hair, except that from horses, and, as the boiling kills the anthrax
spores, it is horsehair alone which remains infected, and anthrax
bacilli were obtained in the laboratory from horsehair -alone, of all
the varieties examined.
The policy of ordering all chronic typhoid bacillus carriers to the
Walter Reed General Hospital for treatment was adopted, as the
number found in the routine examination of all food handlers proved
to be small; much smaller, in fact, than was expected (see statistical
tables for nnmbers), and such a policy proved practical. The prin-
cipal results of the surgical treatment at the Walter Reed has been
published, and it is here merely necessary to state that five out of
seven chronic carriers were cured by a complete cholecystectomy, giv-
ing a much higher percentage of cures than has been obtained here-
tofore by any method of treatment.
Enlargement of the laboratories in all the camp base hospitals wa»s
undertaken early in the year, and the floor space provided was ap-
proximately doubled to provide working room for the many activities
of the laboratory personnel. For the newer hospitals an entirely new
laboratory plan was prepared, which is much more satisfactory in its
arrangement than the original plan used in 1917. Due to the conclu-
sion of the war. not many of these were built, but they, particularly
the one at Camp Mills, X. Y., have proved very satisfactory. For the
semipermanent tuberculosis hospitals, particularly the one at Denver,
Colo., a still better plan was worked out.
Plans and specifications for two new permanent department labora-
tory buildings, to be located at Fort McPherson, Ga., for the South-
eastern Department, and at Fort Sheridan, 111., for the Central De-
partment, were prepared, but up to the present time no action has
been taken on the recommendations.
Receiving wards for infectious diseases were never planned to meet
the needs which developed, more particularly in the South, where
measles prevailed extensively, and in July, 1918, a new set of plans
was prepared, after consultation with the principal pediatricians and
contagious-disease specialists. A few such buildings were erected and
most of the older buildings were modified to give suitable receiving
wards, in which cross infection could not readily take place.
1-ABORATORY DIVISION. 1047
The arsphenamine manufactured in this country was fully as good
as tlie product formerly obtained from Germany, yet, nevertheless,
deaths continued to be reported from time to time following its use.
In cooj^eration with the Army Medical School and the Hygienic
Laboratory of the Public Health Service, it was arranged to raise the
pennissible juinimum lethal dose for small animals to about double
that shown by the German salvarsan in this country at the outbreak
of the war. The manufacturers willingly complied with this request,
and early in the year the arsphenamine situation was more satisfac-
tory, both as to quality and quantity of the drug, than it had ever
been before.
The number of cases of venereal disease among selective-service
men became so large that in August, 1918, plans of special dispen-
saries in the development battalion of each camp were prepared. In
order to avoid constructing new buildings and to use existing struc-
tures to the best advantage, the standard two-story barrack was modi-
fied to meet the needs of a venereal dispensary. At the same time a
full set of instruments and other equipment for the treatment and
diagnosis of venereal disease was furnished. For some time men
had been under training in urology and venereal diseases at special
schools in Boston, New York, St. Louis, and Fort Oglethorpe, and
a large number were detailed for duty in these dispensaries. It was
not uncommon for them to treat as many as 2,000 cases a day. It
was found that subacute and chronic gonorrhea, under the conditions
prevailing in our camps, was much more amenable to treatment than
had been believed, and approximately 95 per cent of such cases were
returned to duty cured.
The experience of the venereal disease service in the opinion of the
consultants in this office justified a new issue of the " Eed Book," or
Manual of Treatment of Venereal Diseases, which was first published
early in 1917. The second edition was published in 1918, and dis-
*tributed to all the urologists in the service. The publisher (the
Journal of the American Medical Association) reported the existence
of a large civil demand for the book, and early in 1919 a third edi-
tion was prepared and published for civil use and for the benefit of
the United States Public Health Service, which had adopted the
manual for use in its own hospitals and in those which are aided or
supervised by the service. It is believed that in the future as a result
of the activities of the Medical Department of the Army and its sister
services that there will be relatively fewer venereal infections, and
that those which do occur will be diagnosed more correctly and re-
ceive better treatment than was available before the war.
The laboratory railroad cars, MetchnikofF, Reed, and Lister, were
continued in service throughout the year. One was sent to Camp
Wheeler to serve as an extra base laboratory for work in controlling
the study of pneumonia and pneumococcus vaccinations at that camp.
One was used at Camp Funston, Kans., Camp Pike, and Little Rock,
Ark., by the pneumonia connnission in their study of pneumococcus,
strej)tococcus, and influenzal pneumonias. One was used at the Army
laboratory school at Fort Oglethorpe, Ga., and also at the laboratory
school at Fort Leavenworth, Kans., until it was discontinued there
and transferred to Yale University, Kew Haven, Conn. As a pro-
vision for providing for emergency work, they proved superior to
any other mobile or transportable laboratory-, and were very satis-
iU4b KEJfCJKT OF THE .SL'K(JE02s GEJNEK.VL Ui' THE ARMY.
factory agencies in the control of epidemics of infectious disease.
In the future they should be provided with motor cycles and side
cars, since it is often necessary to park them in inaccessible locations
in the camp, and the crew needs some form of transjiortation for
themselves and the materials to be examined to and froni the patients
in the hospitals and the troops in barracks. The distances to be
traveled during a single da}^ amount to many miles.
The sterilization of surgical catgut became a matter of consider-
.tble importance early in the }ear, as the demand increased and new
sources of supply were developed. A standard method of steriliza-
tion and of sterility tests was finally agreed upon, and the catgut
situation at the end of the year was quite satisfactory.
Antitoxins against diphtheria and tetanus had been available in
ample quantity from the beginning, but there was no available supply
of antigas-gangrene serum. At the instance of the chief surgeon.
American Expeditionary' Forces, two medical officers who had had
abundant experience with these products were returned to this coun-
try to instruct and supervise the commercial manufactures in the
preparation of antitoxin against the three commoner causes of gas
gangrene: The bacillus perfringens (Welchi), the bacillus oedema-
tiens, and the vibrion septique. By the 1st of Xovember five firms
had succeeded in producing a potent anti-Welch serum, which passed
satisfactorily the 'requirements of the Public Health Service. The
serum was, in fact, more potent than the majority of the samples
which have reached us from France. The connnercial production of
antisera for cedematiens and vibrion septique was well under way,
although no method of standardization of the latter sera was then
available. The conclusion of the armistice stopped the work, since
there is no commercial demand for antigas-gangrene sera.
The medical war manual on the laboratory methods of the Army
proved extremel}^ useful, and a second edition, considerably enlarged
and improved, was published at the end of the year and distributed
to all laboratory officers and to the laboratory schools.
Infestation by lice was never a serious matter among troops in the
United States ; a series of surveys of limited numbers at ports of em-
barkation showed that only 1 out of every 500 white men were car-
riers of vermin.
Measles investigations were carried out on volunteers at Camp
Devens, Mass., and Camp Meade, Md., but all attempts to reproduce
the disease bj^ the inoculation of volunteers with blood from measles
patients were unsuccessful and the etiologj' of the disease remains
unknown. It is hoped that opportunities for additional investiga-
tions will occur in the future, since measles is one of the most im-
portant diseases which the medical officer is called upon to control.
Studies on the prevalence of hookworm and other intestinal para-
sites were carriecl out at most stations in the Army, but more es-
pecially in the South, particularly at Fort Sam Houston, Tex., and
at the port of embarkation, Hoboken, N. J. At the latter station,
comparative studies were made which showed a much higher per-
centage of infection with intestinal parasites among troops return-
ing from overseas than among men who had not been out of the coun-
try. The findings give additional support to the statements regard-
ing the great amount of pollution of the soil and water in the regions
occupied b}^ our forces. In the battle areas, the soil was everywhere
LABORATORY DIVISION. 1049
polluted and the findings at Hoboken confirm the opinions and re-
ports of sanitary inspectors at the front. This finding helps to ex-
plain the incidence of all intestinal afi'ections and gives a satisfactory
explanation of the prevalence of diarrheas, dysenteries, and typhoid
infection in the Valley of the Marne and at Chateau-Thierry.
Department laboratories have existed in the Southern, Central,
Southeastern, and Northeastern Departments for some time. The
higher grade of work for the Eastern Department has been done at
the laboratory of the port of embarkation, Hoboken, N. J., and at the
Army Medical School ; that for the Western Department at the Let-
terman (xeneral Hospital. The closing in the near future of the port
of embarkation at Hoboken has made it necessary to establish a lab-
oratory under the direction of the chief surgeon of the Eastern De-
partment. The activities of the department laboratories have been
increased by the addition of a representative of the Veterinary Corps,
to perform complement fixation tests for glanders and do other vet-
erinary work in pathology and bacteriology.
The staffs of the department laboratories are being made use of to
an increasing extent by department surgeons for the epidemiological
investigation of local outbreaks of communicable disease in their
respective departments.
Laboratory supplies originally were listed in the Manual of the
Medical Department in paragraph 846; early in 1917 this paragraph
was revised and enlarged and was published as a pamphlet for the
use of supply and laboratory officers. The experience of the past
year has shown the need for another revision and, in cooperation with
the supph' division, a new list of laboratory apparatus, chemicals,
and reagents has been prepared for the printer, and it is hoped will
soon be issued b}^ the supply department. The preparation of de-
tailed specifications for the various articles on the list is under way
and considerable progress has been made.
1. The Section on Epidemiology.
This section was placed in the division of infectious diseases and
laboratories on November 1, 1918. Before that time it had existed
as the section on communicable diseases of the division on sanitation.
The work of the section consisted in the study of disease condi-
tions in the Army and the recommendation of measures for their
better control. These investigations were carried on by means of
epidemiologists located in the camps and by the help of a large num-
ber of reports from camp surgeons, sanitary inspectors, and in fact all
officers charged with the duty of observing sanitary conditions and
reporting the same to the Surgeon General. It was intended that
all reports which dealt with communicable disease should pass
through the section on epidemiology.
The scope of the studies was world wide. Not only was the prog-
ress of disease in the camps in America kept under observation, but
through the cooperation of the United States Census Bureau, the
Military Intelligence Division of the Army, the Public Health
Service', and the Department of State, information was focused in
this section concerning the appearance of epidemic diseases in the
environments of United States troops in America, France, Siberia,
and other parts of the world.
1050 UKPDKT OF THE SURGEON GENERAL OF THE ARMY.
The information which was received by the section was recorded
in the form of tables, abstracts, memoranda, spot maps, and dia-
grams. By these means it was possible at short notice not only to
tell what information had been received on a given subject, but to
compare the present conditions with conditions which had existed
at previous periods and at different points during the war. The
studious of the section went still further in the direction of research.
Kecords as far back as reliable data existed were collected, tabulated,
and analyzed in order the better to understand tlie progress which
had been made in the Army in the control of infection and the dif-
ticulties which liad to be overcome in order to make further progress.
The work of the section found exjn-ession in (a) periodic reports
in which the disease conditions of the Army were vritically reviewed.
(h) special reports which dealt with particular and unusual disease
conditions as they occurred, {c) numerous memoranda reconuuend-
ing action, and (d) many formal reports in which the subjects dealt
Avith were broadly and matureh' considered.
A considerable part of the work of the section was concerned with
the analysis of the records of disease which was sent to the Surgeon
General's Office each week by telegram. These, compiled in the
form of tables, were called current statistics. Much importance
attached to these records, and it was the opinion of the section that
the system employed should, with certain modifications, be estab-
lished as a permanent institution in the Army in the United States:
heretofore if has been for expeditionary forces only. The A^alue
of the current statistics lay in their immediate availability. It was
not indis))ensable that they should possess great accuracy, but it was
a matter essential that the information should come promptlv to
tlie Surgeon General's Office. The telegraphic reports, which fur-
nished the basis of the current statistics, could, in any case of neces-
sity, be readily venfied.
Among the researches carried on by the section, in order the better
to comjirehend Army infections and how they could be more per-
fectly controlled, were the following:
A study of disease (onditions in the Army for 23 years, as indi-
cated in "the annual reports of the Surgeon General, and in many
scientific papers and monographs, showed (1) that the type of
the leading infections has changed from the enteric to the respira-
tory group, (2) that a gradual lowering of the admission and
death rates had occurred, except at various periods of imusual mili-
tary activity, and (3) there was need of concentrating attention
upon the respiratory group of infe -tions.
In order to better understand the changes in the prevalence of
disease which had occurred in the Army, investigations were made of
the vital statistics of many cities and States. Souie of the records
were followed back for many years; in this work the resources of
the Surgeon General's library was of much assistance. It was found
that most of the infectious diseases had everywhere greatly declined
within the last generation or so with the exception of pneumonia.
The influenza pandemic occupied a large share of tlie attention
throughout the section's existence. Various lines of investigation
concerning it Avere carried on ; one sought to obtain from the camps
and other station troops, records of more than ordinary accuracy
regarding the number of cases and deaths and the detailed measures
LABORATORY DIVISION. 1051
of control which had been employed, as well as the opinions of
epidemiologists and others, concerning the efficiencj- of the sup-
pressive measures. Another line of investigation sought to analyze
the individual camp epidemics and to figure them graphically in
order to discover such underlying principles of infection and re-
straint as might thus be brought to light. It was found that the
epidemic curve was typical of influenza and that the disease, as it
existed in the Arm}' camj^s. assumed various aspects, according to
the geogi'aphical position of the camp and other factors. The epi-
demic curves of the camps were compared with the epidemic curves
of upward of two score large cities, with the result that the influenza
epidemics in the camps were found to be far more explosive than
those in civil life. The difference was accounted for, partly upon
the score of the age of the -exposed persons, and partly by reason of
the greater opportunities which were afforded in the camps for the
transmission of the virus. When allowance was made for the age
distribution, the epidemic cur\es for the cities more closely resembled
the curves for the camps.
A feature of the work of the section was the use of diagrams and
other graphic means of handling the great mass of data which came
to the section for assimilation. The diagrams were of three principal
types; one was interested simply to illustrate facts already known
and which needed to be set forth in a striking manner; the second
was intended to bring to light facts which would otherwise be hid-
den in tables of numerical figures; the lliird group consisted of an-
alytical curves, the object of which was to discover conditions which
could not be revealed by an}- other means. In all of this work sim-
plicity, directness, and practical utility were continuously aimed at.
The methods employed by the Army for the control of disease
were constantly under critical stiul}' by the section, the intention
l)eing to discover such need of improvement as the conditions of
warfare revealed, and to meet these needs as prompth' as better
methods could be devised. Particular attention was given to the
practical aspects of the subject, it being remembered that ideal con-
ditions could not be accomplished among troops composed of un-
trained recruits hastily brought' together for rapid, intensive train-
ing.
Many facts and opinions of more than temporary value, which
were arrived at by the section, were published by meml)ers of the
section in current medical journals, and it is to those reports that
llie reader must be referred for detailed information.
It is perhaps desirable to state here that the officers of the section
placed much emphasis upon the need of research concerning the
respiratory group of infection, the desirability of giving attention to
the essential and simi)le things rather than to the new and compli-
cated procedures for the control of disease, and to the necessity of
supervising the activities of all officers charged with the care of the
health of troops.
Among the detailed undertakings of the section on epidemiologs'
some were exceedingly important, some were not essential, and some
could be done by other sections with equal appropriateness. There
are reasons why the section itself should be made a permanent fea-
ture of the Medical Department. The work, which it should do,
can not so well be done otherwise. The section should be the reposi-
1052 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
tory of all information on the subject of infection; it should be a
bureau to which all new circulars respecting the control of infections
should be referred and in which most of them originate. This sec-
tion should be the first to discover errors in the management of in-
fections and originate new methods of control. It should keep
watch of disease conditions wherever our troops are located and
should always be ready to make definite and useful reports thereon.
The head of the section should strive to be the best-informed person
in this or any other country on the subject of epidemiolgy. The
subject of epidemiology should be taught to all medical officers and
some shoukl be especially trained in this direction.
The Yale Army Laboratory School.
The Yale Army Laboratory School was established at Yale
University, New Haven, Conn., for the purpose of training officers
of the JSIedical and Sanitary Corps and enlisted men of the Medical
Department in bacteriological and chemical technique especially ap-
plicable to the service of the United States Army. It was recognized
early in the war by the laboratory division that it would be necessary
to supply both the American forces abroad and in this country with
trained laboratory officers and men. The Yale school developed
from a school first started at Fort Leavenworth, Kans., where a
small number of well-trained laboratory men were ordered to re-
ceive instruction in laboratory methods developed by the Medical
Department of the United States Army. This school was started at
the department laboratory of the Central Department early in 1918
and through the active cooperation of Col. , the command-
ing officer at Fort Leavenworth, buildings were obtained for the
purposes of the school. It" became necessary, as the school increased
in size, to occupy two large Infantry barracks and two sets of offi-
cers' quarters for the work of the school. These buildings were
equipped with workbenches, running water, and other material
necessary for the school by the Quartermaster Corps of the post
without cost to the Medical Department.
It was possible at Fort Leavenworth to train only a limited num-
ber of officers and men, but with the facilities available the school was
able to place in the field 13 mobile laboratories, the personnel of
each consisting of one officer of the Medical Corps, one officer of the
Sanitary Corps, and one sergeant and three privates of the Medical
Department. In addition to these mobile laboratories, one stationary
laboratory was formed, the personnel of which consisted of 2 officers
of the Medical Corps, 4 officers of the Sanitary Corps, and 12 en-
listed men of the Medical Department. In addition to these units,
a considerable number of officers and men were assigned from the
school to the laboratories and camps of this countrv\
It soon became evident that the supply of well-trained laboratory
men would soon be exhausted and that it would be necessary to train
men in the elements of bacteriology and chemistry. This fact, to-
gether with the constant increase of officers and men, rendered it
necessary to secure larger quarters for the work. As no other build-
ings could be obtained at Fort Leavenworth, the writer was ordered
to inspect the medical officers' training camp at Camp Greenleaf,
Fort Oglethorpe. Ga.. in the latter part of May, 1918, it being under-
LABORATORY DIVISION. 1053
stood that money was available for erecting suitable buildings at
this post for the purposes of the school. As a result of this mspec-
tion, it was found that buildings could not be erected at that place
as funds were not immediately available and that Camp Greenleaf
could offer no better accommodations than Fort Leavenworth. The
writer advised that the school should not be moved unless laboratory
buildings could be promptly erected. He was then ordered to New
Haven, Conn., to investigate an offer from the authorities of Yale
University to furnish buildings to the Government for training pur-
poses. The writer found that Yale Universit}- was willing to pro-
vide classrooms and laboratories for the laboratory school in tha
Brad}^ Laboratory, another building known as the surgical labora-
tory, and in Kent Hall. These buildings were offered free of charge
to the Medical Department and were capable of providing class-
rooms for from 50 to 100 officers and from 50 to 75 enlisted men.
Dormitory space was offered by the university for both officers and
enlisted men, the rental of the quarters for the enlisted men being
placed at the sum provided for commutation of quarters by the Gov-
ernment. The university required that the Government furnish all
apparatus, except large apparatus, such as incubators, etc., and all
chemicals and other material used in the teaching of officers and
men. The offer of the university would enable the school to handle
about 300 officers and enlisted men without crowding in the class
rooms, and clinical facilities were given by the New Haven State
Hospital, which was immediatel}'^ adjacent to the Brad}' laboratory.
In view of the facilities offered, the writer recommended that the
laboratory school be moved to the Yale University as soon as pos-
sible, and on July 9, 1918, he was ordered to New Haven to establish
a laboratory school at Yale University. Despite the fact that altera-
tions were necessary to the buildings in order to accommodate so
large a number of students, the school opened on August 1.
1918, the officers and enlisted men on duty at Fort Leavenworth hav-
ing been transferred in the meantime. A large part of the equipment
was brought from the department laboratory at Fort Leavenworth
on the laboratory car. Reed, and requisitions were placed for other
equipment, which arrived promptly, and no time was lost because of
lack of equipment.
It was soon found that the classrooms available would be in-
adequate for the officers and enlisted men who were constantly in-
creasing in number. This matter was brought before President Had-
ley, of the university, and the Yale corporation, and the corporation
voted to erect a temporai\y building without cost to the Government
and adjacent to the Brady laboratory. This building was completed
in 18 days and consisted of two large rooms, one room capable of
holding 100 officers and the other capable of holding 200 enlisted
men at one time. This building cost approximately $40,000 and the
generosity of Yale University in erecting it for the Yale Laboratory
School can not be praised too highly. The building was equipped
with electricity and steam heat and furnished ideal laboratory
classrooms for the school.
From August 1, 1918, until teaching was discontinued at the school
January 1, 1919, a total of 1,016 officers and enlisted men serA'ed at
this station. Of this number 460 were officers, of which 223 were
1054 REPORT OF THE SURGEON GENERAL OF THE ARMY.
officers of the Medical Corps and 237 were officers of the Sanitary
Corps.
The armistice, which was signed on November 11, 1918, brought to
a conclusion the work of the school so far as the organization of
laboratory units was concerned. The officers and enlisted men who
were left at the school were gradually distributed to Army labora-
tories in this country, except those who were discharged on their
own application or for other reasons. Prior to this date there were
organized at the school, from officers and men Avho had finished their
course of instruction, 10 mobile laboratories consisting of a total of
20 officers and 40 enlisted men and three stationary laboratories con-
sisting of a total of 18 officers and 36 enlisted men. These units were
organized for service with our armies in France and practically all
of the mobile laboratories had been ordered to the port of embarka-
tion before the armistice was signed.
In addition to these units the Yale Army Laboratory School sup-
plied laboratory officers and men for base hospitals, evacuation
hospitals, and mobile hospitals intended for service in France. In all
33 medical officers and 18 officers of the Sanitary Corps were assigned
to duty with base hospitals, 12 medical officers and two officers of
the Sanitary Corps to duty with evacuation hospitals, and four
medical officers to mobile hospitals. In addition to the officers
assigned to these hospitals, a total of 239 enlisted technicians, who
received their training at this school, were assigned to these hos-
pitals.
During August, 1918, an understanding was reached with the
Rockefeller Institute wherebj' the Yale Arni}^ Laboratory School was
to furnish ever}' six weeks a class of 40 officers for advanced training
in bacteriology and chemistry. This class in advanced work was
to substitute a similar class in advanced work which was instituted
at the Yale Army Laboratory School. This measure was necessary
in order to keep the Army supplied with officers properly trained in
bacteriolog}^ and chemistry as applied to the prevention of disease
and its diagnosis in the field. Owing to the outbreak of the severe
epidemic of influenza in September, 1918, it was impossible for this
measure to be carried out so that only one class of 32 officers was sent
from the Yale Army Laboratory School to the Rockefeller Institute.
Before the time had arrived for the sending of another class the
armistice had been signed.
The influenza epidemic which continued until December inter-
ferred seriously with the work of the school, as owing to the shortage
of medical officers, it was necessary to order 56 officers of the Medical
Corps who Avere pursuing studies at the school to various camps for
temporary duty. This, of course, interferred with the sending of
anits abroad and the training of officers for these units, - and for
about six weeks the work of the school was practical Iv at a stand-
still.
In addition to the officers and enlisted men already spoken of as
being sent to base hospitals, evacuation hospitals, and mobile hospi-
tals and the Rockefeller Institute, laboratory officers were supplied
to various other institutions connected with the Army, as department
laboratories, Surgeon General's Office, St. Elizabeths Hospital, Bu-
reau of Mines experimental station, the pathological section of the
LABORATORY DIVISION. 1055
Chemical Warfare Service, etc. Enlisted technicians were also sup-
plied to these places as called for.
COURSE OF INSTRUGTIOX.
The subjects taught at the Yale Ariuy Laboratory- School were
bacteriology, pathology, clinical microscopy, and chemistry, so far
as it related to clinical diagnosis and the examination of water,
foods, and the detection of poisons.
BACTERIOLOGY.
Two courses in bacteriology were maintained cvt the school, an
elementary course for those who had little training in the subject
before coming to the school and an advanced course for well-trained
bacteriologists. In addition, a course in bacteriology Avas maintained
for enlisted men in order to qualify them as laboratory teclmicians.
During the early days of the school at Fort Leavenworth, the
officers of the Medical Corps and the Sanitary Corps who were as-
signed for a course of instruction at the school were well-trained bac-
teriologists and the course of instruction was designed to acquaint
them with the special methods found of value in the diagnosis and
prevention of disease in the Army. Owing to shortage of well-
trained bacteriologists, it was soon found that in order to supply
the Army with these specially trained officers, it would be necessary
to train medical officers and officers of the Sanitary Corps, not only
in advanced bacteriolog3% but also in the elements of the science, so
that eventual!}' it was found necessary to divide our officer students
into two classes, those who had received good training before arriv-
ing at the school and those who had received little or no training in
the subject. The first class was placed in the advanced course at the
school and the second in the elementary course and afterwards in the
advanced course.
The preliminary course consisted in instruction in elementary bac-
teriological technique and in milk and water analysis. Three hours
a day was devoted to this work and the course lasted approximately
four weeks. In the advanced course special bacteriological methods
were taken up, especially those found of use in Army practice. This
course was supposed to cover four weeks, but the time varied con-
siderably, owing to the character of the prelin>inary training the
officers had received who were placed in the course. The advanced
course was at first limited to work on typhoid, pneumococcus, strepto-
coccus, and meningococcus. Later special emphasis was placed on the
identification of influenza bacilli. Still later the identification of ana-
erobes was added to the course. Field conditions were duplicated as
far as possible, the students being limited to the apparatus found most
usefid in field work. Three hours a clay was given to the laboratory
work and a daily quiz was given in addition. A series of lectures de-
signed to cover a period of five weeks on subjects of epidemiological
and bacteriological interest was also a part of the course. Mimeo-
graphed notes of technique and information concerning the subjects
taught were distributed to each student and these notes enabled the in-
structors to handle a larger number of officers than would otherwise
have been possible. When the school closed, the course in bacteriology
1056 REPORT OF TPIE SURGEON GENERAL OF THE ARMY.
was bein^ conducted in the new temporary laboratory building and 200
officers were under instruction. 100 in the morning and the same num-
ber in the afternoon.
The course in bacteriology for the enlisted men was intended to
fit them for laboratory technicians. "While the school was at Fort
Leayenworth a total of 105 enlisted men took the course and during
the fiye months in which the school was at New Hayen, -413 enlisted
men finished the course of instruction, making a total of 508 enlisted
men who finished the course in laboratory methods at the Yale Army
Laboratory School since its establishment at Fort Leayenworth.
There was a yery urgent demand for laboratory technicians, and
the course was so conducted as to coyer the greatest amount of work
in as short a time as was compatible with the results desired. It was
decided that six weeks was a sufficient period to train a man with
ayerage intelligence in the work of a laboratory technician, and as
a matter of fact, it was demonstrated that this period is the minimum
to be allowed for this purpose and much better results could be ob-
tained if the course lasted eight weeks. The work consisted of one
hour lecture, two hours of laboratory work, and one hour quiz every
day with the exception of Saturday. On Saturday a review was
held of the work of the preceding week. Owing to the gi"eat num-
ber of men taking the course, the class was divided into two sections,
a morning and afternoon section. The course covered instruction
not only in bacteriology but in clinical miscroscopy.
PATHOLOGY.
A course in pathological technique was instituted at the Yale Army
Laboratory School and selected officers and men attending the school
were given this special course. The instruction covered autopsy
technique, museum technique, and histological, technique. Approxi-
mately 125 officers were given instruction in pathology, but of these
100 were only in the preliminary stage of instruction when the school
closed.
CLINICAL MICROSCOPY.
The course in clinical microscopy was attended only by officers.
It covered a period of five weeks, and all officers attending the school
were obliged to take this course. One week was given to the chemi-
cal analysis and microscopic examination of urine, three weeks to the
blood, and one week to other clinical laboratory methods. As the
class of officers taking bacteriology was divided into two sections, a
morning and afternoon section, it was possible to assign a section to
the course of clinical microscopy when it was not in the bacteriologi-
cal laboratory. Thus the officers who were taking bacteriolog}' took
the course in microscopy one-half of the day and the course in bac-
teriology the other half of the day. As the two courses covered prac-
tically the same length of time, this arrangement was very satisfac-
tory.
CHEMISTRY.
The course in chemistry was conducted in the Kent Laboratory of
Yale University in a laboratory classroom which would accom-
modate 100 students. The largest number of students attending this
LABORATORY DIVISION. 1057
course at one time was 87, and at no time was the work interfered
with for lack of room. Diirina: the time that the s:-hool was in op-
eration at Yale University, 223 officers and 207 enlisted men received
instruction in chemistry. The instruction in this subject consisted
of water analysis, toxicoloiTA', methods of purification of water, and
the identification of heavy nietals and organic and other poisons.
The preparation of Dakin's solution was thoroughly studied, and
every officer and enlisted man was trained in its proper preparation.
At the time that the armistice was signed, nearly 300 officers and
over 500 enlisted men were on duty at the Yale Army Laboratory
School receiving instruction in laboratory methods. At this time
the course had been so perfected that it was estimated that efficient
laboratory officers could be o-raduated from the school in a period of
eight weeks and enlisted technicians in a period of six weeks. It was
the policy of the school to require that all offi'^-ers attending the school
receive not only the course in bacteriology but the course in chemis-
try. This was rendered necessary by the fact that onlv two officers,
one bacteriologist and one chemist, were sent with field laboratories,
and it was thouarht that the bacteriologist and chemist should be
acquainted with both subjects in case of one being unable to attend
to his duties from any cause. It was found that this policy was a
good one. and that even though officers might be ignorant of one of
the subjects required, it was possible in the time allowed to impart
enough instruction of them to attend to the ordinary work in that
subject required in the field laboratory. A large number of chem-
ists were sent to the Yale Army Laboratory School for instruction in
chemistry who had received only very elementary instruction in bac-
teriology. It was found that when these men were placed in the
class in bacteriolog^■ that they took a great interest in this subject
and that many of them became very expert in it. This was not true,
however, of medical officers who had training in bacteriology when
ir came to the study of chemistrv. So that while it was compara-
-tively easy to make n good bacteriolo<rist of the chemist, it was found
that it was difficult to make a good chemist of a bacteriologist.
CONCLUSIOX.
The Army laboi-atory school established at Yale University August
1. 1918, was closed for instruction Januarv 1, 1919. Wliile this rep-
resents a period of five months during which the sr-hool was in opera-
tion, for over a month instruction reased as far as officers of the
Medical Corps were conrerned. as 56 medical offi-^ers were sent to
various camps during the influenza epidemic. At the time of the
armistice the school was in a position to supply the Army with the
necessary laboi-atorv officers and technicians and had the war con-
tinued we would have had no difficulty, it is believed, in keeping the
Army supplied with these specialists. The active cooperation and
enthusiastic support of the president and corporation of Yale Uni-
versity enabled the school to accomplish results that would have been
otherwise impossible. At all times requests of the commanding officer
of the s-'hool for buildincs and dormitories for the use of the school
were promptly complied with, although sometimes with gi'eat incon-
venience to the universitv. At a cost of $40,000 the university erected
a temporary building without cost to the Government and handed it
1058 REPORT OF THE SURGEON GENERAL OF THE ARMY.
over to the school for use as chissrooms, and without this building it
would have been impossible for the school to have properly handled
'he number of officers and enlisted men sent to it for instruction.
Report of Section Combating Venereal Disease.
GENERAL.
Experience in the World War has demonstrated that it is possible
for an army to have and to maintain a low venereal rate. In order
that the incidence of any communicable disease may be largely and
continuously reduced, effective practical measures are necessary.
The preventive measures adopted at tlie beginning and contin-
uously applied with varying degi'ees of efficiency dunng the period
of the wa r were as follows :
1. Measures designed to diminish sexual temptation.
(a) Repression of prostitution and tlie traffic in alcoholic drinks.
(b) Provision for good social surroundings and for wholesome recrea-
tion.
2. Education of soldiers and civilians regarding the dangers of venereal dis-
ease and methods of prevention.
(a) Means used: (1) Illustrated lectures, (2) educational exhibits,
(3) motion pictures, (4) literature, (5) personal conferences.
3. Prophylactic measures : Quarantine ; preventive treatment.
4. Medical treatment and care (in Army and civilian life).
It is believed that each of these measures played an important part
and that each is necessary to secure the best results. The measures
mentioned under 1 (a) may be best carried out through agencies like
the War Department, Commission on Training Camp Activities, or
the morale branch of the General Staff, but it is believed that meas-
ures indicated under 3 and 4 can be carried out satisfactorily only by
the Medical Department of the Army.
It is also considered that No. 2 on tlie education of the soldier can
best be accomplished under the supervision of the Medical Depart-
ment. Medically trained men are best qualified to give the instruc-
tion required, and for this reason this Avork should be continued as
part of the Medical Department's program combating venereal dis-
ease. However, there should be a close liaison between the agencies
used in carrying out recreational and law enforcement measures in-
dicated under No. 1 and the Medical Department agencies used in
carrying out educational, prophylatic, and medical measures. All
four lines of attack are necessary to secure the results desired.
EDUCATIONAL MEASURES USED DURING TRAINING AND DEMOBILIZATION
OF UNITED STATES ARMY.
During the training period, and again during demobilization, the
following methods of instructing recruits and troops about to be
discharged, on venereal-disease prevention, have been followed :
Lectures given by approved, accredited civilian physicians or qual-
ified medical officers. These lecturers have been required to follow
a standard syllabus and use approved motion-picture films or lantern
slides to illustrate their lectures.
Motion-picture films : Motion-picture dramas such as Fit to Fight
and the End of the Eoad have been shown with good results in many
LABORATORY DIVISION. 1059
training camps and durin<i: demobilization in all debarkation and
demobilization camps, and oc casionally in smaller posts-
GrajDliic educational exhibits: Stereopticon slides shown by means
of a stereomotograph (automatic stereopticon). posters and set of
placards have been used in all training and demobilization camps.
These exhibits have been in charge of spe ially trained sergeants
"working under the joint direction of this office and the camp sur-
geons. These exhibits give information regarding venereal diseases
and their prevention, and emphasize continence outside of marriage
as the only sure means of prevention. These exhibits have also given
many opportunities for the educational sergeants to answer questions
on personal matters relating to sex, frequently with very helpful
results.
Pamphlets : In addition to the above suitable instructional pam-
phlets have been written and distributed to a large percentage of
men in training and at time of discharge from the Army.
It is believed that these metliods of instruction have been effective
in giving information and in securing the cooperation of the enlisted
men in preventing these diseases. It is also believed that these meth-
ods should be continued as a definite part of the Surgeon General's
program for combating venereal diseases in the regular standing
Army. A few modifications may be necessary, but for the most part
it is believed that these four general lines of procedure should be
adopted and followed.
HISTORICAL,.
The organization in the Surgeon General's Office, which is now
known as the section combating venereal disease, originated in June
or early July, 1917.
This program was broad and in order to make it effective personnel
and equipment Avas necessary. At the time no existing branch of the
Army was financed, organized, or prepared to carry out this complex
program. To meet this situation a Commission on Training Camp
Activities was organized. The different divisions of this organiza-
tion were charged with the execution of different phases of this pro-
gram. When completely organized this conmiission functioned
through the following divisions. Some of these divisions were sub-
divided into several sections for administrative purposes:
1. Social hygiene division.
2. Law enforcement division.
'■'. Division of athletics.
4. Jlusic.
~). Dramatics.
0. Post exchange committee.
7. Theater division.
In addition to the above, the following organizations were affiliated
with the commission which exercised general supervision over all
their activities as they related to the soldier :
1. Young Men's Christian Association.
2. Yomig Women's Christian Association.
3. War Camp Community Service.
4. National Catholic War Council, represented in camps hy the Knights of
Cohunhus.
5. .Jewish Welfare Board.
6. Salvation Amny.
7. American Library Association.
142.367— 19— voT. 2 6
1060 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Through these affiliated organizations and through funds made
available by other organizations (e. g., the American Social Hygiene
Association), personnel, equipment, supplies, and other expenses of
various kinds connected with the program outlined, were used to
supplement and enlarge the work provided for by Government ap-
propriation.
Association of the various divisions of the commission and the or-
ganizations affiliated therewith with the different parts of this pro-
gram, are indicated on the margin of the pamphlet. Xo attempt will
be made to give detailed information for any of the divisions ex-
cept law enforcement and social hygiene education, and medical
phases of the program as carried out. A few details regarding these
three phases will be given for the reason that the personnel assigned
in carrying out these phases was composed, at least toward the end
of the war, almost entirely of Medical Department men whose ac-
tivities were controlled directly by the Surgeon General's Office or
by officers on the Surgeon General's staff assigned to duty with the
Commission on Training Camp Activities.
At first the personnel was largely civilian, then it was proposed-
that 32 qualified men be selected and commissioned as first lieutenants
to assist in carrving out provisions of sections 1"2 and 13 of the selec-
tive draft act — i. e., one of these men was to be assigned to each of
the 32 training areas to cooperate with the military and civil authori-
ties in the enforcement of the provisions of this act. Where coopera-
tion was not forthcoming from military or civilian authorities, con-
ditions were reported to the Commission on Training Camp Activi-
ties and through the commission directly to the Secretary of War
and pressure was brought to bear in this way to change or remedy
bad conditions. The 32 men authorized were not all in the field
before the first of the year 1918.
It was also proposed to assign to each of the training camps a qual-
ified noncommissioned officer to assist the camp surgeon in carrying
out an educational progi'am for the instruction of recruits as to the
dangers of venereal disease. These noncommissioned officers were
provided with stereomotorgraphs and sets of slides, posters, and
pamplilets. They were also given elementary instructions on the
subject of venereal-disease prevention, in addition to instruction as
to methods of utilizing the educational material supplied. As far as
practicable, college men with proper personal qualifications were se-
lected and given a brief course of training and warranted as sergeants
and sent to a training camp. Here, again, adequate personnel was
not ready before spring, 1918.
Part of the educational work proposed was to be in the nature of
lectures by qualified physicians. In the beginning all of the men
used to give this instruction were civilians, who were sent upon the
invitation of the commanding general or commanding officer, with
the understanding that attendance at these lectures would be con
sidered as part of the military training, and therefore compulsory.
The plan of using civilian phvsicians was followed until about the
1st of May, 1918, when the first medical officers were assigned to
lecture dut3^
"V\niile civilian physicians were utilized to give this instruction to
troops in training, expenses were met for this service in various ways.
LABORATOEY DIVISION
1061
In several cases universities contributed the services of physicians
assigned. In two or three instances salaries and expenses were paid
by industrial organizations. The American Social Hygiene Asso-
ciation supplied the services of one or two men for a time for this
duty. After the assignment of one medical officer, and the plan
proved successful, a total of five medical officers for this duty was
authorized.
Nine medical officers were assigned to this duty at different times
during 1918 and early 1919.
Eeports of attendance at lectures to June 30, 1919, gives a total of
2,196.700.
These lectures were guided by an approved syllabus and used only
lantern slides or films approved by the Surgeon General.
In addition to lectures, instruction of men as to dangers of ve-
nereal disease was carried on by means of motion-picture films. Two
such films were produced and used larjrely in the camps during the
training and demobilization period. These films were entitled " Fit
to Fight." later called " Fit to Win," and the " End of the Road."
Reported attendance at showings of Fit to Win on June 30 was
900,000 and for the End of the Road 256,400. In addition to the
drama films mentioned, a film made up of one reel of animated dia-
grams showing the progress of gonorrheal infection in the male and
female organs, and one reel showing clinical cases was also produced
and used to illustrate lectures by medical officers.
During the training and demobilization periods some 22 different
pieces of literature, dealing with various aspects of the social hygiene
problem, were produced and something over 10,000.000 copies of
these distributed. During the same period 3 different sets of posters,
containing from 16 to 20 posters in each set. were produced and a
total of 3,030 sets were used up to June 30. In addition to the sets
of posters, four separate posters were produced for use during the
demobilization period and to date 11,806 of these have been placed
in Army establishments.
On December 9, 1918, the total personnel assigned to the section
combating venereal disease was as follows :
Activity.
-
Commissioned
officers.
Enlisced
Medical
Corps.
Sanitary
Corps.
men.
Surgeon General's OflBce:
For dut V
3
4
5
"^ Y
39
4
Special dutv
Proph -laxis . . .".
56
Educational work
6
51
Law enforcement
16
Detached service
2
Total
11
55
127
. This represents the maximum number of men assigned to duty
with the section. However, a larger personnel was authorized and if
the war had continued the table of organization approved called for
the following personnel :
1062 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Medical and Sanitary Corps.
Majors 14
Captains 28
First lieutenants 28
Total 70
A total of 87 enlisted men was also authorized for educational
work, as against 51 on duty in December, 1918.
EQUIPMENT.
The following equipment was purchased on requisition from the
War Department funds appropriated for the Commission on Train-
ing Camp Activities :
Cost.
10 stereomotorgraplis appropriated for the Connuission on Training
Camp Activities $2, 500
T^ stereopticous 200
11 copies of the film entitled " The End of the Road " 3, 250
5 copies of film entitled "Fit to Win" (about 20 copies of Fit to Win
were purchased from supplemental funds or acquired otherwise) 1,500
In addition to this the American Social Hygiene Association
loaned for the period of the war about 40 stereomotorgraplis, 20
stereopticous, and several thousand lantern slides, and other mate-
rial developed by this association for educational purposes.
Statistical suinniary of the educational activities section combating venereal
disease for the year ended June 30, 1919.
Attendance at lectures 2,196,700
Attendance at showings of film Fit to Win 900, 000
Attendance at showings of film End of the Road 256, 400
Number pamphlets distributed 1 8,693,600
Number poster sets (Nos. 4, 8, 9) distributed 3,030
Number of posters distributed (Nos. 10, 11, 12, 13) 11,806
4. Army Medical Museum.
During the past year the x\rmy ISIedical Museum has continued its
work of collecting and preparing for the museum specimens of patho-
logical and other material illustrating the diseases of soldiers and
the effects of wounds and various misgiles on the human body. In
addition, the instruction laboratory of the Medical Department, con-
nected with the museum, lias maintained a moving-picture depart-
ment, anatomical art department, still photographic department, and
a wax-modeling department.
The work of the museum during the past year has been divided
among the following sections: Department of pathology and acces-
sions; moving-picture department, department of still photography,
department of Avax modeling, department of antomical art, and de-
partment of entomology.
■DEPARTMENT OF PATHOLOGY AND ACCESSIONS.
The policy of this department during the j'ear has been to record
all the pathological material received and to preserve and exhibit
MEDICAL MUSEUM. 1063
all such specimens as are ^vorthy of exhibition. The aim in the pres-
ervation and exhibition of these specimens is to afford a permanent
source of medical instruction and research, not only to the medical
officers of the Army, but to the o;eneral medical profession.
The recordiujo; of tlie material received has entailed a very large
amount of work upon a ver}^ small clerical force. A complete filing
system was established, arranged in such a way that all data received
with each specimen is so arranged as to be easily obtained for refer-
i;nce or study. The file contains the protocols, clinical histories, pho-
tographs. X-ray photographs, and any other data carefully cross-
indexed for speedy reference.
It was found necessary during the year to instruct pathologists in
the saving of material of interest from autopsies and the methods
of preservation and collection of material. This was accomplished
by a careful follow-up system of correspondence, circular letters,
bulletins, and orders. After this system was established it worked
excellently and all material received was accessioned promptly and
given an accession number. This method enabled the museum and
the laljoratory concerned to trace lost specimens and to check his-
tories and protocols.
The routine work of accessioning and cataloguing has been far
too arduous a task for the present clerical force, and it has only been
with great difficulty that it has been possible to keep up the abso-
luteh' necessary routine work during the last year. This has been
the more difficult because of the constant decrease of personnel and
the constant increase of work due to the material received from
France.
From April 7, 1918, to July 1. 1919, there have been accessioned
9,960 specimens, divided as follows :
Pathological 4,260
Neurological 3, 206
Surgical 524
Ordnance 508
Miscellaneous 1, 462
Total 9, 960
Of the'5e specimens 2.922 were from overseas and were accompanied
by 12,700 protocols with their catalogue cards. These records, to-
gether with those brought over from France by the group of officers
writing the pathological portion of the medical and surgical history
of the war for the American Expeditionary Forces, have practically
doubled the contents of our files.
While 9.9G0 numbers have been used in accessioning the material
received at the museum, these figures only represent about half the
number of articles actually received, as many niunbers cover several
different organs, paraffin blocks, microscopic slides, photographs,
X-ray plates, etc.
In addition to the material receiA'^ed from France the pathological
department has received all pathological material from hospitals in
this country that were closed during the year, and the amount of
clerical work demanded in cataloguing this material, due to the
duplication in records and specimens, has l^een enormous.
A considerable amount of uiaterial received suffered in transpor-
tation and it has been necessary to salvage a large amount of such
1064 RKPUKT Oi' TliE SUKGEON GENERAL OF THE ARMY.
material. This has been especially true of specimens showing the
results of gunshot wounds, but it has been found that most of this
material can be saved for mounting. The storage of this material
is a serious question, owing to the lack of room in the present
Museum building. Practical!}^ the entire basement is now filled with
various kinds of specimens, and the work required in keeping this
material in good condition is considerable.
The pathological material that had been mounted prior to Feb-
ruary 1, 1919, will all have to be remounted to have an}- permanent
value for exhibition purposes. This work has been held up because
of delay in securing proper museum jars for the mounting of speci-
mens, and it has been impossible to place on exhibition a large num-
ber of valuable specimens on this account. The method recently
adopted at the museum for mounting is the use of rectangular jars,
the specimens being made to stand out by means of black painted
backgrounds. This method was devised by the present preparator,
and a large number of valuable specimens have been prepared for
permanent exhibition in this manner.
During the year over 5,000 microscopical slides have been pre-
pared and catalogued for the museum collection. In addition, 3,400
slides have been made for instruction purposes at the Army Medi-
cal School, being placed in class sets for this purpose, and 2,125
slides are in process of identification, description and cataloging,
making a total of 10,525 microscopical preparations made during
the past year. Much of this material has been stained by special
methods for demonstrating bacteria, connective tissue and nerve
cells, and this has entailed a large amount of work. In addition
to the slides prepared at the museum, 7,000 slides prepared else-
where have been accessioned.
In addition to the special work of preparing pathological ma-
terial for exhibition and accessioning it, the department of pathol-
ogy has had charge of the arrangement of all other material con-
tributed to the museum, as ordnance material, sanitarj^ models and
sanitation apparatus, and apparatus used in the prevention and
treatment of the diseases of the soldier. This material had to be
carefully accessioned and arranged for displaj^ and it is believed that
the collection, when completed, will prove of inestimable value in
future years to Army surgeons and the medical profession in gen-
eral. Owing to lack of room in the present Museum building it is
impossible to place much of this material on exhibition and we have
been forced to pack and store a large part of it. This is most un-
fortunate and it is hoped in the near future that room will be pro-
vided for the proper exhibition of the valuable collections that have
come to the museum as one of the results of the World War.
DEPARTMENT OF MOVING PICTURES.
During the year the department of moving pictures has continued
its work of producing moving picture films on instructional and
medical subjects and approximately 900,000 feet of film was pro-
duced during this time. Among the more important moving pic-
tures that have been produced are the following: Fit to Fight,
Diagnosis of Tuberculosis, Fighting the Cootie, Mosquito Eradica-
tion, Reconstruction, Training of a Medical Officer, the Regimental
MEDICAL MUSEUM. 1065
Detachment, the Field Hospital Unit, the Ambulance Company, ^^ot
Charity but a Chance.
Owing to lack of funds and personnel the moving-picture de-
partment was closed March 1, 1919, as it was impossible to continue
operations under existing conditions. Owing to the danger of fire,
always conne. ted with the manufacture of moA'ing pictures, it is be-
lieved that, should it be decided to continue this department of the
museum, the plant should not be located in the museum building.
The collections at the museum are so valuable that the chance of their
being lost by fire owing to an accident in the moving-picture depart-
ment is too great to warrant the production of pictures in the build-
ing occupied by the museum. The curator believes that the moving-
picture department should be continued as an integral part of the
Medical Department and proper quarters be provided for this pur-
pose. From the standpoint of instruction to the officers and enlisted
men, the moving picture is most valuable, as well as in recording op-
erations, sanitary conditions and methods, and actual work in the
field. It is greatly to be regretted that lack of funds and personnel
has closed this very valuable department of the Army Medical
Museum.
DEPARTMENT OF STILL PHOTOGRAPHY.
A very large amount of work has been accomplished in the depart-
ment of still photography during the past year. The following is a
tabulation of the amount of work done in this department for the fis-
cal year ending July 1, 1919 :
Negatives :
5 by 7 1,709
6i by 8i 1,471
8 by 10 1,809
4,989
Prints :
4 by 5 248
5 by 7 4,802
6^ by 8^ 6,929
8 by 10 4,763
10 by 12 2, 426
19, 168
Enlargements :
5 by 7 2,069
6i by Si 30
8 by 10 177
11 by 14 87
2, 36b
Lantern slides 13, 639
Photostats - 13,702
Identitication photographs 1 — 703
Film rolls . 43
Total 54,607
The department of still photography has done a large amount of
work for all divisions of the Surgeon General's Office, as well as other
divisions of the War Department, including The Adjutant General's
Department, Statistical Department, Ordnance Department, Signal
Corps, and INIilitary Information Division. For a considerable part
of the time this department was undermanned and the work accom-
plished under difficult circumstances. The museum has but one pho-
106G KEPOKT OF TllK SUKUEON GENERAL OF THE AKMY.
tographer officially assigned, and it is earnestly recommended that if
this department is expected to continue the production of material
for divisions of the Surgeon General's Office and War Department,
three trained photographers be assigned for this purpose. When the
Army is demobilized it will be impossible for the one photographer
assigned to tlie museum to take care of the work that is demanded of
this department.
DEPARTMENT OF WAX ^fODELING.
This department has produced ma)iy wax models of .conditions
arising through wounds, gassing, and accidents connected with the
prosecution of the late war. In addition to these models, valuable
models have been produced of dermatological lesions and other dis-
ease conditions. The following tabulation shows the character and
number of wax models produced during the past year :
Gas experiments upon aniiuals, clogs, monkeys, and goats 1-
Experimcntal pas burns upon human subjects 4
Gas burns, accidental 8
Thermic burns, high explosives .5
War injuries from different causes 8
Dermatological lesions 30
Venereal specimens 8
Patholoi;:ical specimens : 9
X-ray burns 1
Total 85
DEPARTMENT OF ANAT0:MICAL ART.
This department has produced during the year approximately •^)0
painted illustrations of pathological conditions observed in specimens
received at the museum and a large number of drawings illusti'ating
various stages in surgical operations performed at the Walter Reed
General Hospital and other ]3laces. In addition, this department has
had charge of the cataloguing and filing of paintings, drawings,
charts, etc., received from the museum unit operating in France. This
unit has transmitted to the museum several hundred colored and un-
colored drawings illustrating wounds and disease conditions observed
with the American Expeditionary Forces. These drawings were ac-
companied by protocols describing the conditions illustrated, and they
have been filed in such a manner as to be available for research or for
inclusion in the Medical and Surgical Plistory of the War.
DEPARTMENT OF ENTOMOLOGY.
The department of entomology has had charge of the collection,
identification, and classification of mosquitoes received from the vari-
ous posts and camps established in this country and in our insular
possessions. During the year many thousand mosquitoes have been
classified and reports sent to those sending them for identification.
The work of this department is most valuable from an epidemiologi-
cal standpoint,
SPECIAL EXHIBITS.
During the year special exhibits illustrating the activities of the
Medical Department of the Army were prepared by the museum. An
MEDICAL MUSEUM. 1067
exhibit of the medical activities of the y^a.r was held at the museum
during April, 1919. This exhibit illustrated the activities of all divi-
sions of the Surgeon General's Office and the Medical Department.
It was afterwards greatly enlarged and exhibited at the meeting of
the American Medical Association at Atlantic City during June,
1919. When exhibited at that place it attracted a great many visitors
and very favorable comments wtre received regarding it. A portion
of this exhibit was sent to Caldwell. N. J., for exhibition at the rifle
contest held by the Army, Navy, and Marines. It is believed that
these special exhibits are of great service to the Medical Department,
attracting attention to the department and instructing the public in
the work of the Medical Corps.
AR:MY medical museum unit with the AMERICAN EXPEDITIONARY
FORCES IN FRANCE.
It was early recognized that if the museum was to profit from
material received during active operations in France it was necessary
to send a unit equipped to collect such material. Accordingly a unit
was organized under the direction of a colonel of the Medical Corps
who had charge of the department of patholog}' at the central labora-
tory of the Army in France. This unit was equipped for making
moving pictures of active operations in the field and to it were as-
signed several artists and photographers. The unit collected a large
amount of material, the greater portion of which has already been re-
ceived. This material will be of the greatest educational value to
medical officers and the medical profession at large as soon as it can
be prepared and placed on exhibition. Several thousand specimens
illustrating pathological lesions have been collected by this unit and
sent to the museum. In addition a large amount of ordnance mate-
rial illustrating weapons and missiles used in modern warfare was
collected and forwarded to the museum. Most of the latter material
has been placed on exhibition and is of great service in the stud}' of
wounds produced by modern weapons. The photographic section of
the unit collected over 10,000 negatives and made twice as many
prints illustrating every phase of medical activities. The unit cov-
ered practically every hospital in the Army and secured views charac-
teristic of tlie work of each hospital. In addition, hundreds of views
were taken of actual operations in the field.
RECOMMENDATIONS AND CONCLUSIONS.
Prior to the 1st of Ma}'^ of the current year all collections in the
Army Medical ^Museum were open to the public. It is thought that
this policy is not to the best interest of the service in that the exhibits
of pathological material, very largeh' secured from autopsies upon
soldiers, is not believed to be suitable for general public exhibition.
The public at large is unable to understand the nature of the lesions
shown and therefore can derive no benefit from their observation.
In addition, it produces unfortunate effects in securing autopsies.
A consideral)le part of the collections of the museum, aside from
the collections of pathological material, consist of specimens which
are not suitable for the general public, such as monstrosities, ana-
tomical })repa rations, etc. Accordingly it was considered best to
1068 REPORT OF THE SURGEON GENERAL OF THE ARMY.
segregate, as far as possible, such specimens in the gallery of the
jiiain museum room and in rooms on the first floor, and to open them
only to medical students, research workers, and the medical profes-
sion. The space vacated l)y these specimens on the floor of the main
museum will be filled with the material illustrating general sani-
tation as relating to civil communities, ordnance, and other material
collected during the recent war which is of general public interest.
It is planned to include in the exhibit open to the public models of
sanitary apparatus used in the Army and in the prevention of in-
fectious diseases in civil communities. Models, paintings, photo-
graphs, and diagrams illustrating the diseases common to military
and civil communities, as typhoid fever, dysentery, tuberculosis,
influenza, etc., can be shown in such a collection, accompanied by
explanator}' legends, and the general public will thus understand
and appreciate the importance of the prevention of these diseases.
For the use of physicians, dentists, sanitarians, and research
workers it is planned to have type collections of normal and patho-
logical specimens, instruments, and apparatus arranged in such a way
that they can be easily studied by the group method and placed so
that they will not be open to public exhibit. For this purpose nearly
all of the large rooms on the first floor of the museum have been
vacated and prepared for the reception of these collections.
It is planned to use the ba?ement rooms for the storage of study
and research specimens and for duplicates of those exhibited in the
nmseum. A very large amount of material that has been collected
by the museum can be utilized b}^ medical schools and medical socie-
ties of the United States for teaching purposes and plans are being
considered to place this material at the service of these institutions.
For this purpose it will be necessary that a special assistant be as-
signed for the purpose of overseeing the shipment of specimens and
the proper filing of receipts, etc.
During the year copies of the various moving-picture films pre-
pared at the nmseum have been circulated among medical schools
and scientific societies. This has entailed a large amount of work on
a small clerical force, and it was recognized that as soon as demobili-
zation of the Army was commenced it would be impossible to keep
the circulation of mOving pictures going with the reduced force. '
Accordingly all duplicate films that could l3e used for public instruc-
tion in medical schools and medical societies were turned over to the
bureau of visual instruction of the Department of the Interior for
circulation. At the present time the museum has on file all negatives I
of films prepared here and, in addition, enough copies for use in the j
Army, and these are kept in circulation b}^ the museum force.
RECOMMENDATIONS.
The lack of room in which to display the valuable collections
which have accumulated since the beginning of the recent war con-
stitutes one of the most serious obstacles to the proper use of the
Army Medical Museum. The museum now possesses enough mate-
rial to fill a building twice the size of the present one, and it is ear-
nestly recommended that a building be erected for this purpose at
as early a date as is possible. Plans have been made to erect a suit-
able museum building on land Congress has authorized purchased
MEDICAL MUSEUM. 1069
near the Walter Reed General Hospital, and if a building can be
erected on this land in the near future the needs of the museum will
be subserved.
In addition to the personnel alread}' on the staff it is most impor-
tant that the museum be furnished with an expert in the preparation
of gross specimens. This is an art in itself and few medical men arc
trained in this line. In addition to such an expert the museum
should be furnished with a qualified technician for the preparation
of microscopic specimens. This work has heretofore been done bv
civilian technicians, but these will have to be dispensed with in a
short time.
The clerical force at present assigned to the Army Medical Mu-
seum is totally inadequate. Before the recent war there were five
clerks assigned to the museum when part of the library division and
these were on the permanent list. At present only three clerks are
assigned to the museum and these are temporary, so that it was nec-
essary to request that the library let the museum use two of the
library clerks in order to keep up the routine work. If the speci-
mens received during the war are to be properly accessioned and de-
scribed, and the catalogue prepared which is to form a part of the
medical and surgical history of the war, it is absolutely essential
that the museum be furnished with more clerks than are detailed
here at the present time. For this purpose at least three clerks will
be required in addition to the clerks assigned to the museum, and it
is recommended that as soon as possible three additional clerks be
unsigned for this purpose.
An enlisted detachment of at least 20 men should be assigned per-
manently to the museum to act as assistants in the various depart-
ments and to aid in caring for the valuable collections, as the number
of civilians assigned to the museum is entirely inadequate for this
purpose. The enlisted men would receive valuable training here in
pathological technique and in photography and, as trained, they
could be replaced by others who in turn would receive training.
III. DIVISION OF INTERNAL MEDICINE.
1. Tuberculosis Section.
The care exercised in the elimination of tuberculosis from our
Army has been rewarded by the absence of any extensive prevalence
of the disease among our troops in France, where, on the whole, the
tuberculosis problem has been one of no magnitude. It having been
noted that a considerable percentage of cases returned from France
as tuberculous upon arrival in the United States were found to
present no evidence of any clinical tuberculosis, a medical officer,
who is an experienced and skillful tuberculosis specialist, was sent
abroad in the early part of 1918 with a view to instituting methods
which should insure more care and accuracy in the diagnosis of pul-
monar}' conditions. This was important both to prevent unnecessary
expense and also to avoid unwarranted reduction in the fighting-
force abroad, in view of the fact that many of the soldiers returned
with the diagosis tuberculosis were found to have no disease which
justified removal from their organizations. Following the example
of the French and Italian xVrmies, three centers w^ere established
lOTU UKPUUT OF THE SURGEO^' GENERAL OF THE ARMY.
where cases diagnosticated as tuberculous could be carefully studied
and the diagnosis confirmed before their return to this country was
permitted. All soldiers in whom the existence of tuberculosis was
susj^ected were sent to one of these centers, so far as it was prac-
ticable to do so. These centers were at Base Hospital No. 8^ Save-
nay; Base Hospital Xo. 20, Chatel Guyon; and Base Hospital
No. 3, \'auclaire. As a further check, it was directed that only cases
in which tubercle bacilli were found to be present should be diag-
nosticated as tuberculous, all others being classed as tuberculosis
observation. Msits were made b}' the tuberculosis specialists to
nearl}^ all the base hospitals with a view to standardizing the clinical
diagnosis of tuberculosis. These measures rapidly improved the
situation. The number of cases returned to this country as tuber-
culous which ultimatelj' proved to be negative v\'as reduced abnost
to zero. It is believed that, however carefully a cojumand has been
examined for tuberculosis, a certain so-called " unavoidable " per-
centage of cases will develop, and there are epidemiological prob-
lems ni tuberculosis which can best be studied in large aggregations
of men living under the same conditions of food, hj'giene, etc., of
which aggregations an army in the field is a conspicuous example.
It is thought, therefore, that there Avas an ample field of A^ork for
a tuberculosis specialist with each mobile division of the Army.
But it having been learned that the tuberculosis specialists who
accompanied many of the divisions to France were detached upon
arrival for other work not directly connected wdth tuberculosis, the
practice of send tuberculosis specialists with embarking divisions
was discontinued. It was soon noted that while the percentage of
incidence and mortality from tuberculosis were small, the cases of
the disease that did occur were sometimes of a rather acute type.
This was to be expected in a command from which nearly if not quite
all of the individuals who had a clinically apparent tuberculosis of a
chronic type or at all extensive obsolete or quiescent tuberculous
lesions had been eliminated — the relatively small percentage of cases
in which the course of the disease is more rapid would practically
be all that remained. But it was learned that latent lesions of tuber-
culosis were not found at autopsy by some pathologists in more than
25 per cent. Although the percentages varied for each observer and
were based on too small numbers to be relied upon as indicating
the true condition of the Army, still this fact, taken in connection
with the acuity of the types of fatal tuberculosis, led to the con-
clusion that 75 per cent of our Army was made up of individuals
who had had no previous contact with tuberculosis. So sweepino- a
generalization is not believed to be justified by the facts in the case.
If It were indeed true there would not be simply a small number
of cases of relatively acute tuberculosis, but enormous numbers of
soldiers would fall a prey to acute and primary tuberculosis under
the stress of warfare. The question whether the soldier becomes in-
fected with tuberculosis during his military service is an important
question, which has been answered in the negative by Sir William
Osier, with whom some of the most prominent German specialists
agree as the result of their experience in the war which has iust
terminated, and such also is understood to be the experience in the
Jj^rench Army. Others, however, are led to the opposite conclusion
Ihe tacts upon which such opinions are based are not yet fully
INTER?? AL MEDICINE. 1071
accessible. The interpretation of the facts, however, will naturally
depend largely upon the view of the student as to the communica-
bility of tuberculosis to the civilized adult and as to the patholog]^'
of tuberculosis in general. The total number of cases up to August 1,
1919, of pulmonary tuberculosis that have been returned to the
United States from Europe is 6,693. Upon arrival in this country
patients with tuberculosis are evacuated to General Hospital Xo. 8.
Otisville, N. Y., or to Xo. 16, Xew Haven. Conn., if they come
through Xew York; and to General Hospital Xo. 19, Oteen, X. C,
or Xo. 42, at Spartanburg, S. C, if they disembark at Xewport Xews.
After signing the armistice the sick abroad were sent to this
country with the least practicable delay. The former regulations in-
tended to prevent the loss of men who were fit to bear arms were
no longer observed, and men only slightly or temj^orarily indis-
posed were included in the shipments as tuberculous. This prac-
tice was not, of course, as objectionable as it would liave been if
hostilities had continued, but it increased largely the number of
supposed cases of tuberculosis, the diagnosis of tuberculosis being
confirmed at the tuberculosis hospitals in the United. States in only
about 50 per cent of the patients received from abroad. General
Hospitals Xos. 8, 16, 19, - and 42 have thus practically taken the
place of the diagnostic centers previously maintained in France.
From the foregoing it will be seen that the ratio of tuberculosis
incidence in returning troops if based upon all cases arriving in
this country with the diagnosis of tuberculosis would be much too
high to correspond with the actual facts. The work of elimination
of the clinically nontuberculous is proceeding as rapidly as possi-
ble at the tuberculosis hospitals, but since it demands careful reex-
aminations and a period of observation with repeated examinations
of tlie sputum, etc., in the apparently negative cases, the time has
not yet arrived when even a close approximation as to the true
ratio of incidence of tuberculosis can be made.
The tuberculosis examiners of the large Army camps have con-
tinued their work of examining for pulmonary conditions the
newdy arriving registrants under the draft, as a portion of the
examination for entrance. They have also been engaged in the
same work in connection with demobilization. Of 2.500,662 men
examined for demobilization up to June 30, 1919, 1,356 were found
to have tuberculosis and were retained for treatment in tuberculosis
hospitals, a rate of .542 per 1,000.
This A'ery small number is sufficient evidence that infection dur-
ing Army service is practically a negliirible factor, if it occurs at
all. There have been 1,607 deaths from tuberculosis in our Army
at home and in Europe in the period from September, 1917, to June
25, 1919. The average strength of the Armv being computed as
2,121.396 on May 1, 1919. this gives a death rate of .758 per 1,000
for the whole period. But since tuberculous patients are kept in
the service after their organizations are domoliilizecl the deaths have
really occurred in a strength of over 3,000.000 men, so that the
rate just given is too high. On the other hand, some of the tubor-
culous soldiers who have been discharged have died or will die of
their disease: the rate would be somewhat increased on their account,
if there were any possilnlity of ascertainintr just what tlieir num-
ber is. The figures given are therefore only a very rough approx-
1072 REPORT OF THE SURGEON GENERAL OF THE ARMY.
imation of the actual facts, but they at least show that there has
been no epuleinic of tuberculosis among our soldiers.
When the Army was rapidly increasing in size and there was no
reason to anticipate an early termination of the war. it was decided
to enlarge some of the hospitals under construction. Accordingly
new construction was authorized with a view of increasing the capac-
ity of General Hospital Xo. 21. at Denver, to 2.000 beds and that of
General Hospital Xo. 19. at Oteen (formerly Azalea). X. C to 1,500
beds. Additional buildings were also erected at the general hospital.
Fort Bayard. X, Mex., which has enlarged the capacity of this hospi-
tal to 1.000 beds for tuberculous patients, the buildings being of a
temporary nature. The signing of the armistice made it evident that
additional provision would not he needed. Accordingly some of the
buildings at General Hospital Xo. 21, vrhich were intended for use as
wards but were not at the time completed, were finished for use as
barracks for the Medical Dei>artment of enlisted men, thus saving
tlie cost of the new barrack buildings which had been contemplated
but the construction of which had not begun. This reduced the num-
ber of beds at that hospital to 1.500. its present capacity. For the
same reason the construction of unfinished buildings at General Hos-
pital Xo. 20 at Whipple Barracks, Ariz., was stopped and the ca-
pacity of that institution was left at 500 beds instead of the 1.000 beds
which it was originally planned to provide. This post will probably
be relinquished as a hospital in the near future. The hotel at Wayiies-
ville. X. C. and the sanatorium at Markleton. Pa., known, respectively,
as General Hos]:)itals Xo. 18 and Xo. IT. were originally leased as a
temporary expedient for accommodating tuberculous patients until
such a time as the hospitals which were planned could be occupied.
These institutions have given good service so far as the successful
treatment of tuberculosis is concerned, but they were relatively small,
not constructed for the purpose for which they were used and not in
good repair. When, therefore, the larger tuberculosis hospitals were
ready for the reception of patients General Hospitals Xos. 17 and 18
were given up.
The larofe number of tuberculous patients which were at one time
returned from France requiring additional hospital accommodations
the base hospital at Camp Wadsworth, Spartanburg. S. C. was taken
over temporarily as a tuberculosis hospital. It is known as General
Hospital Xo. 42 and has a capacity of 1.000 beds. The total number
of beds available for the treatment of the tuberculous is 6.650, the ca-
pacity of the hospitals now under operation being as follows :
United States Army General Hospital — Beds.
No. 19, Oteen. N. C 1,500
No. 21, Denver, Colo 1, 500
Fort Pavarrl, N. IVIex 1,000
No. 20, Whipple Barracks, Ariz 500
No. 8, Otisville, N. Y 650
No. 16, New Haven, Conn 500
No. 42, Spartanburg, S. C 1,000
Total 6,650
The total number of cases of pulmonary tuberculosis under treat-
ment at the tuberculosis hospitals in the United States on June 30.
1919, was 4,882.
Instruction in the physical diagnosis of lung diseases has been con-
tinued at the Army Medical School and has been given in some of the
INTERNAL MEDICINE. 1073
camps on the Pacific slope and in the hospitals of the Southwest by
a traveling instructor. A school for teaching the diagnosis and treat-
ment of tuberculosis and hospital administration has been sue ess-
full}' conducted at General Hospital Xo. 16, New Haven. Conn.
Some of the medical officers of the Permanent Establishment have re-
ceived this course of instruction which is more comprehensive and
of longer duration than the earlier courses in diagnosis. Nearly all
of the medical officers now on duty at tuberculosis hospitals have had
the benefit of this course, either at New Haven or in some of the
Army camps. Instruction after this method has been highly appre-
ciated by those who have received it. Its success has been due to the
high professional qualifications, assiduity, and unselfish cooperation
of the medical officers who have acted as instructors. The benefit aris-
ing from the standarization which such a course effef^'ts has been
great. "Wliile there is no attempt to force the pupils to take up uni-
form views as to the pathology, they learn to know the exact meaning
of terms employed, the way in which diagnoses should be made, the
interpretation of physical signs, and last, but by no means the least
important, they learn a common method of treatment which is a
necessity if patients are to be moved from one hospital to another,
and the instructors become familiar with the attainments and ca-
pacity of their pupils, a knowledge which greatly facilitates the
proper assignment of medical officers.
2. Section of Psychology.
Possibilities of psj^chological service that had become clearly de-
fined and definitely established during the preceding year were,
within the past year, put into practical and extensive operation in the
building of an emergency army. The essential purpose, in accord-
ance with General Orders No. 74, War Department, 1918, was to
provide an immediate and reasonably dependable classification of
recruits according to general intelligence. Revision and refinement
of methods in the Office of the Surgeon General parallel the practice
of intelligence classification in the field.
Among various aids to the expanding military organization re-
sulting from the classification of the general intellicrence of recruits,
the following specific instances may be cited: (1) Discovery of men
whose superior intelligence suggested their consideration for ad-
vancement; (2) prompt selection and assignment to development
battalions of men who were so inferior mentally that they were suited
only for selected assignments; (3) forming organizations of uniform
mental strength where such uniformity was desired and of superior
mental strength where such superiority was demanded by the nature
of the work to be performed: (4) selectino- suitable men for various
Army duties or for special training in colleges or technical schools:
(5) early formation of training groups Avithin regiment or battery
in order that each man might receive instruction and drill propor-
tional to his intellectual capacity; (6) early recognition of the men-
tally slow as contrasted with the stubl)orn or disobedient: and (7)
early discovery of men whose low-grade intelligence rendered them
either a burden or a menace to military service.
Among the methods for securing reliable classification of recruit
intelligence, three standardized systems were univeivally used in the
psychological service:
1074 REPORT OF THE SURGEON GEXERiVL OF THE ARMY.
1. Alpha. — This is a group test for men who read and write
En<xlish. It requires only 50 minutes, and can be ^iven to groups
as large iis 500. The test material is so arranged that each of its
•212 questions uiay be answered without writing, merely by under-
lining, crossing out, or checking. The papers are later scored by
means of siencils, so that nothing is left to the personal judgment
of those who do the scoring. The mental rating which results is
therefore wholly objective.
2. Beta. — This is a group test for foreigners and illiterates. It
may be given to groups of from 75 to 300 and require^ approximately
50 minutes. Success in beta does not depend upon knowledge o'f
English, as the instructions are given entirely by pantomime and
demonstration. Like alpha, it measures general intelligence, but
does so through the use of concrete or picture material instead of by
the use of printed language. It is also scored bv stencils and yields
an objective rating.
3. individual ^es^^.— Three forms of individual tests have been
used : The Yerkes-Bridges point scale, the Stanford-Binet scale, and
the performance scale. An indiAidual test requires from 15 to 20
minutes. The instructions for the performance scale are given by
means of gestures and demonstrations, and a high score may be
earned in it by an intelligent recruit who does not know a word of
English.
All enlisted men were given either alpha or beta according to their
degree of literacy. Those who failed in alpha were given beta, and
those who failed to pass in beta were given an indi^ddual test.
As a result of the tests each man was rated as A. B. C-f , C, C— ,
D, D— , or E. The letter ratings were reported to the interviewing
section of the personnel office, where they were copied on the quali-
fication cards. The ratings were then- forwarded to the mustering
section of the personnel office to be copied on the soldier's service
i-ecord. A copy of the psychological report was also sent by the
psychological examiner to the company commander for use in the
organization of his company.
The psychological staff in a camp was ordinarily able to test
2.000 m,en per day and to report the ratings to the personnel office
withm 24 hours. Cooperation was maintained with the personnel
adjutants in arranging the schedule for handlino; draft quotas so as
to secure maximu.m value from the psychological examinations.
With the cessation of the draft and the consequent curtailment of
professional psychological service, a new problem has arisen in con-
nection with methods of classifying recruits on the basis of their
intelligence. Arrangements having^been made to accept for enlist-
nient illiterates and non-English-speaking citizens and aliens it is
often a difficult matter to determine whether a man has the intel-
lectual capacity to perform the duties of a private soldier. In order
that only men with sufficient intelligence be accepted by recruiting
agencies, the section of psvchologv'has been instructed to prepare
a psychological test for this class of applicants. It has been stipu-
lated that the test be simple and readily usable by examiners who
have h.ad no professional training in psychology, "and at the same
time determine whether or not an applicant possesses the necessary
degree of intelligence to permit him, with proper training and
thorough instruction in English, to meet the requirements of the
Army. The test is not to be an intelligence scale, but merely the
INTEKNAL. MEDICINE.
1075
most simple and reliable device possible for separating the inapt
candidates for enlistment from those who are capable of carrying
on in the Army. Preliminary work has been completed in the prep-
aration of this test. It will be made available at once for the use
of recruiting agencies.
On July 1, 1918, ps}'chological examining had been recently organ-
ized in 28 arm}' camps and approximately 600,000 examinations had
been made. Seventv-nine physchological officers with commissions
in the Sanitary Corps were on duty in these stations and in the
Office of the Surgeon General. Approximately 100 enlisted men in
the Medical Department had received training in the school of mili-
tary psychology established at Camp Greenleaf, Fort Oglethorpe,
Ga., and had been assigned to duty in examining stations. Somewhat
more than 100 enlisted men were also in training in the school of
psychology.
The psychological service had reached its maximum development
when the armistice became effective. Subsequent to the armistice
and the cancellation of the draft the demand for ps^'chological serv-
ice in the field as originally established was suddenly removed. On
November 9, 1918, examining staffs had been organized in 33 sta-
tions. The total personnel included 97 officers and 424 enlisted men.
After assembling all reports of examinations it was found that
1,151,552 examinations had been made during the year. The attached
summary indicates the types and results of examining done during
the year ending June 30, 1919. Practically all of this work was com-
pleted prior to November 15, 1918.
Since November, 1918, psychological service has been distributed
among various affiliated lines of service. The greater portion of the
personnel, both commissioned and enlisted, was taken over by the
Division of Physical Keconstruction. A smaller number was tem-
porarily assigned to the neuropsychiatric service. A few psycholo-
gists were detailed to morale problems.
Some of the more striking results may be indicated as follows :
The figures below give the percentage distribution of the mental
ages of 94,004 white recruits and 18,891 negro recruits. The values
are approximate only, although the error is not greater than 3 or 4
per cent at the extremes of the distributions and is less than 1 per
cent in the middle of the range.
Mental age.
White
draft.
Negro
draft.
Less than 20. .
Less than 19..
I^ess than 18..
Less than 17..
Less than 16..
Less than 15. .
Less than 14..
Less than 13..
Less than 12.
Less than 11.
I.>ess than 10.
I/ess than 9. . .
Less than 8...
Less than 7. . .
Less than 6. . .
Less than 5...
Median mental age.
Number of cases
Per cent.
100.0
98.0
96.0
92.0
86.0
77.0
63.0
47.0
30.0
IS.O
10.0
5.0
2.0
Per cent.
13.1
94,004
100.0
99.0
97.0
94.0
89.0
79.0
64.0
48.0
32.0
17.0
8.0
3.0
1.0
10.1
18,891
142367— 19— VOL 2-
1076 REPORT OF THE SURGEON GENERAL OF THE ARMY.
It will be obsei-Aed that the median mental age of the wliite draft
is only a little over 13 years. It has been customary to define a moron
(high-grade feeble-minded person) as a person with a mental age
from " 7 to 1*2 years/' This definition has sometimes been interpreted
as meaning that anyone with a mental age less than 13 years was
feeble-minded. It appears, on any such basis, that 47 per cent of the
white draft was *' feeble-minded '■ and 89 per cent of the negro draft.
These figures should, however, not be taken uncritically, although
they are undoubtedly correct with respect to mental age. It is pre-
sumably true that the current notion that the average adult intelli-
gence is about 16 years will now have to be revised. It may be that
average adult intelligence is more properly represented by a mental
age of 15 or even 14 years. In the light of such a revision it appears
that the draft is not so much lower in intelligence than the population
of the country as the figures would at first indicate. On the othei*
hand, it does appear that intelligence of the country is much lower
than had been supposed and that " feeble-mindedness " as previously
defined is of very much greater frequency than sociologists and psy-
chologists had been led to suppose. It would be manifestly impossible
to propose the rejection of all men from the Army under 13 years
mental age. The placing of the limit for enlistment at IQ years
mental age would have caused the rejection of 10 per cent of white
recruits. This figure is more practicable, and experience in the Army
seems now to indicate that men with a mental age of 10 or more can
make satisfactory soldiers. It is not plain just what limit should be
set for negro recruits. Presumably the same point could be held to
with advantage to the Army, although almost 50 per cent of the
negro draft would have been rejected on this basis.
The average mental age of white officers examined is about 18,
which is very much higher than the average of the draft or even than
the supposed average of the country at large. Higher levels of in-
telligence can not, however, be so accurately represented in terms of
mental age as can lower. For this reason the officers are compared
with the white and negro drafts in terms of the percentages receiving
different intelligence grades : A, B, C, etc.
Number
of cases.
A
B
c+
c
c-
D
D-
White officers
15,385
94,004
18,891
55.9
4.1
.1
28.5
8.0
.6
12.5
15.2
2.0
3.3
25.0
5.7
0.4
23.8
12.9
White draft
17.0
29.7
7.1
49.0
Xegro draft
It will be seen that 56 per cent of officers make A and 28 per cent B.
Only 16 per cent are graded C+ or lower. Ordinarily officers grading
-f are adequate to their Mork on other grounds than intelligence.
Their efficiency should, however, be given special consideration.
The average mental age of f oreign-^born recruits is as follows :
Tears.
Canada 23 29
Great Britain 23. 00
Scandinavian 12. 95
Germany and Austria 19* §5
Greece I'l::::::::::::: n. m
Russia 11 28
Italy 11. 19
INTERNAL MEDICIXE.
1077
It appears that Canadian and British recruits are at the same
level as American, and that Scandinavian and Teutonic recruits are
a little below. The Latin and Slavic soldiers are. however, consid-
erably inferior. The full dilference of a year mental age that oc-
curs between these two groups is highly significant and should not be
overlooked.
The section of psychology' has no data on illiteracy in the Army.
The practical necessity of separating out, however, the men between
the alpha and beta examinations gives a rough measure of literacy
at a higher level. Men who were obliged to take tlie beta exan^ina-
tion may be considered as those who were approximately of only
iifth-grade literacy or le.ss. In the white draft 29.7 per cent were
lequired to take beta ; in the Xegro draft TO per cent. These figures
are based on the samples referred to above, viz.. 94,001 white recruits
and 18.891 Xegi'o recruits.
It is of interest to note that the intelligence of disciplinary cases
of the more serious order — i. e,, those that were sent to Fort Leaven-
worth— is no less than that of the white draft. Minor offenders, as
indicated by the reports on disciplinary cases from Camps Dix and
McClellan. are very considerably inferior in intelligence. It appears,
then, that the dependence of crime on intelligence in the military
situation holds only for offenses of less serious, nature. The follow-
ing distributions of intelligence grades illustrate this point:
Number
of cases.
A
B
c+
C
C-
D
D-
White draft
94,004
3,368
1,004
4.1
5.8
2.1
8.0
8.8
3.4
15.2
16.0
8.3
25.0
23.8
18.9
23.8
20.8
21.6
17.0
18.8
25.5
7.1
Disciplinary cases, Fort Leaven-
worth
6.0
Disciplinary cases, Camps Dix and
McClellan
20 6
Figures are now available showing a comparison between sam-
ple gi'oups of certain arms of the service. The more important of
these results appear in the following table :
Number
of cases.
A
B
c+ '
C
C-
D
D-
Field Sienal Battalions...
1
992
741
4,392
1.007
5,266
14.9
9.7
7.7
8.4
5.4
25.9
12.7
12.3
10.9
11.7
24.0
22.8
21.0
22.8
20.5
21.1
26.1
28.6
23.3
27.9
9.9
14.3
18.0
19.3
18.6
3.0
8.5
9.1
10.3
11.8
1.2
5.9
Artillery . .
3.1
5.0
4.0
Data bearing on the relation of intelligence to rank among white
officers are as folio avs:
Rank.
Officers not in Med-
ical Department.
Officers in Medical
Department.
Number
of cases.
Mean
score.
Number Mean
of cases. score.
Second lieutenant
5,382
3,371
1,874
342
131
142
139
139
138
143
217 114
2,389 1 125
1,148 128
Maj or
174 1 142
27 1 151
1
1078 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
It will be seen that among officers not in the Medical Depart-
ment there is no significant difference in intelligence among the
various ranks. In the Medical Department, ho^Yever, where com-
missions are granted from civil life, the lower ranks (lieutenants
and captains) are distinctly inferior to the average intelligence of
officers. In the higher ranks in the Medical Department, which are
filled for the most part by promotion, no such inferiority occurs.
3. REroRT OF Cardiovascular Section.
Of the first million recruits 11,562. or 1.15 per cent, were rejected
and 8.772. or 0.88 per cent, were accepted for limited service by reason
of presence of cardiovascular disease.
Of the 11,562 rejected, 40 per cent were for chronic valvular dis-
ease, an additional 19 per cent were for other organic diseases, in-
cluding myocarditis, cardiac hypertrophy, congenital defects, aortic
aneurysm, etc., while the remaining 32 per cent were for functional
disorders, including irritable heart or effort syndrome, tachycardia,
hyperthyroidism, etc.
The rejections for diseases of this group were 13.1 per cent of the
rejections for all causes, and were greater than for any other group,
affections of the bones and joints following with 12.3 per cent, eye
defects with 10.6 per cent, and pulmonary tuberculosis with 8.7 per
cent.
Of 8,990 valvular lesions recognized, 5,652, or 62 per cent, were
rejected and 3,338. or 38 per cent, were accepted. Of 6,523 func-
tional cardiac conditions, 3,667, or 56 per cent, were rejected and
2,856. or 44 per cent, were accepted.
Of the 8,990 organic valvular heart cases, 5,549, or 61.72 per cent,
were diagnosed as mitral regurgitation; 1,414, or 15.72 per cent, as
mitral stenosis: 1.217, or 13.53 per cent, as combined mitral stenosis
and insufficiency; 637, or 7.48 per cent, as aortic regurgitation; 128,
or 1.42 per cent, as aortic stenosis; 5 or 0.05 per cent, as pulmonic
lesions.
Of congenital lesions, there were 42; of aneurysm, 20; or hyper-
thyroidism, 854 ; of arteriosclerosis, 63 ; of hypertrophies without val-
vular lesions, 1,262. Of the arrhythmia group there were of
paroxysmal tachycardia, 25; of auricular fibrillation, 29; of auricu-
lar flutter, 4; of premature contraction, 401 : and of heart block, 7.
With the dual purposes of affording special facilities for the treat-
ment of diseases of this group and of concentrating material which
would make possible the investigation and solution of some of the
problems of cardiacvascular disease, General Hospital No. 9, Lake-
wood, N. J., was designated a special institution for cases falling in
this group, and also for cases of renal diseases and of chronic
arthritis. Special studies were here made in electrocardiogi-aphy
and teleoroentgenography, metabolic determinations were made with
a view to ascertaining the relations between hpyerthyroidisrn and
the effort syndrome, a successful scheme of graded exercises for func-
tional cases was developed, and the functional cases were found to
fall etiologically into several distinct classes. A course of instruction
in cardiovascular disease was here organized, and from time to time
small numbers of officers, intended to serve as specialists in cardio-
vascular examination, were here assigned for study.
INTERTiTAL MEDICINE. 1079
At Lakewood also were made special studies in chronic arthritis
and in diabetes.
At base hospital, Camp Jackson, a school for chiefs of medical
service was organized and did good work.
4. Sectiox of Xetjropsychiatry.
At the time of the reorganization of the office of the Surgeon Gen-
eral the division of neurolog}" and psychiatry which was organized
in July. 1917, became a section of the Division of General Medicine.
In all other respects the neuropsychiatric work has been conducted
in a manner^imilar to that of the previous year.
As the war progressed, the problem of supplying additional
trained personnel, which was one of the chief functions of the sec-
tion, became more diffcult. As a result of this difficulty younger
men with less experience in neurology and psychiatry were selected
for the work and sent to the educational institutions for instruction,
where the coui-ses were extended and altered to suit their particular
needs.
Courses of instruction in Army neuropsychiatry were given at
the following institutions: Boston Psychopathic Hospital, Boston,
Mass.: Neurological Institute, New York City; Philadelphia Gen-
eral Hospital, Philadelphia, Pa. : Phipps Psychiatric Clinic, Balti-
more, Md.; St. Elizabeth's Hospital, "Washington, D. C: State
Psvchopathic Hospital, Ann Arbor, Mich. ; Mendocino State Hospi-
tal', Talmage, Calif.
At times when the demands for personnel were extremely urgent
it was necessary to call on the State insane institutions for the assist-
ance of some of their medical officers. These were given contracts
and assigned to duties which could be performed in a short period
of time.
State hospitals for the insane employing female nurses and all
training schools for nurses were called upon to furnish for the neuro-
psychiatric service as many nurses as possible, who by reason of
training and experience were particularly qualified for the care of
the insane and other nervous disorders. Social workers and recon-
struction aides were assigned to the general hospitals for duty with
the neuropsychiatric service. Persons particularly qualified for this
work were carefully selected, many of them being chosen from mem-
bers of special training courses which were given at Smith College,
Northampton, Mass.
As long as the system of induction and transfers were in opera-
tion, employees of the State hospitals for the insane were inducted
into or transferred to the medical department and assigned to duty
in the psychiatric wards of the hospitals and with the camp exam-
ining boards. When inductions and transfers were discontinued
for class 1-A men, and the demand for additional enlisted men in-
creased, it was necessary to send inexperienced men to General Hos-
pital No. 6, Fort McPiierson, Ga., and to St. Elizabeth's Hospital,
Washing-ton, D. C, for training.
1080
REPORT OF THE SURGEON GENERAL OF THE ARMY.
At the time the armistice was signed the neuropsychiatric person-
nel was ai)pr()xiniately as folh)\vs:
On duty
United
States.
On duty
American
Expedi-
tionary
Forces.
Total.
430
200
28
993
263
125
17
200
693
Nurses
325
45
1,193
During the demobilization of the Army one of the greatest diffi-
culties has been the retaining of trained personnel for duty with
the demobilization boards. As many of this class of specialists
were on leaves of absence from State and endowed and private in-
stitutions for the care of the insane, there was a general call after
the armistice was signed for the return of their much-needed services
to the institutions. The demands were met as rapidly as pos.sible
by concentrating the neuro])sychiatric cases in fewer hospitals and
by assisting the Bureau of AVar Risk Insurance in every possible
manner in its efforts to provide for the treatment of cases of ps}^-
choses and psychoneuroses.
To meet the needs of the permanent Arm3\ officers of the Regular
Army who have had training in neuropsychiatry have been noted
and, when possible, theii" assignment made. Also, Regular Army
officers who desired to be trained have been assigned when these
assignments did not interfere with the other divisions of the Medical
Department. There is now a good nucleus of officers in the Regular
Army trained or being trained in neuropsychiatry to develop a good
neuropsychiatric personnel.
Beginning with the second draft, the neuropsychiatric examina-
tions Avere conducted as a part of the physical examinations for all
drafted recruits and applicants for enlistment. In the cantonments
the neurop.sychiatric work was directed by the camp or division
psychiatrist, who usually was with the headquarters and under the
control of the camp or division surgeon. In the recruit depots and
other posts the neuropsychiatrists were assigned as assistants to the
post surgeons. These examinations, Avhich were conducted at all
points where registrants or volunteers were being mustered in,
usually required the services of from three to five psychiatrists at
each post, depending on the number of men examined."
The limited number of specialists and the irregular intervals at
which the recruits arrived was only met by an almost constant
change of station for all neuropsychiatrists on duty in the camp
and recruit depots, except tho.se in charge of the examinations and
the neurop.sychiatric wards of the base hospitals.
As a result of the neuropsychiatric examinations at the time of
mustering in, from one-half to 1 per cent of all men examined were
found to have some form of nervous or mental disease or defect.
Xearly 90 per cent of the cases discovered were those having con-
ditions which were primarily mental as opposed to organic diseases
or defects of the nervous system.
INTERNAL MEDICINE.
1081
Among the 69.394 cases reported by neuropsychiatrists to this
office, part of which were reported the previous year, there were —
Cases.
Per cent.
Mental deficiency
Ps ychoneuroses "
Psychoses
Organic nervous disease or injury. .
Epilepsy
Constitutional psychopathic states
Endncrinopathies
Drug addiction
Alcjholism
21,858
11,443
7,910
6,916
6,388
6,196
4,805
2,020
1,858
31.5
16.5
11.4
9.9
9.2
8.9
6.9
2.9
2.8
It is not believed that most of the cases would have been recognized
by the general medical officers, as the individuals were usually physi-
cally robust and denied disease or had little knowledge or insight
into their condition. It will be observed that many of these cases
were of a class which are likely to require custodial care and that
their elimination and detection at the source was very essential to
the formation of a strong army. Twenty-five per cent of the cases
were picked as so-called shell-shock possibilities. The elimination
of this large number is a partial explanation for the small number
of cases of this type which have been returned from abroad. If
these cases were found before mustering in was completed, the men
were rejected and returned to their homes or to State institutions.
Cases which were not able to leave the camps were sent to the
psj^chiatric wards of the base hospitals.
Each cantonment base hospital was provided with one or more
neuropsychiatric wards, which were specially designed and equipped
to care for nervous and mental cases for a short period, after which
time they were discharged, or, if necessary, transferred to one of
the general hospitals which had adequate facilities for the continued
treatment of such cases.
"With the speedy evacuation from the cantonment base hospitals
of all cases presenting mental symptoms, it was possible for the
nervous and mental work in most of the cantonment base hospitals
to be performed by one medical officer.
In order to provide ior the disposition of mental cases which could
not be given continued treatment in the psychiatric ward of the
cantonment base hospitals, special neuropsychiatric services were
established at the following places :
General Ho.spital Xo. 1, including :\ressiah Home, Bloomingdale Hospital (offi-
cers only).
General Ho.spital No. 2 (officers only), including Sliepard and Enoch Pratt
H()si)ital (luu-ses only).
General Hospital No. 4, exclusively for mental cases.
General Hospital No. 6.
General Hospital No. 13, exclusively for mental cases.
General Hospital No. 2.5.
Geaeral Hospital No. 26.
General Hospital No. 28.
General Hospital No. 30, exclusively for cases of psychoneuroses.
General Hospital No. 34, exclusively for mental ca.^es.
General Hospital No. 43, exclusively for mental cases.
With the exception of General Hospitals Nos. 4, 30, 34, and 43 the
special neuropsychiatric services were established in these hospitals,
1082 REPORT OF THE SURGEON GENERAL OF THE ARMY,
first, because they would reduce transportation to the minimum in
providing facilities near all camps; second, because they would enable
all cases to be treated in the vicinity of their homes; third, the system
was the most economical utilization of the existing facilities.
(leneral Hospital No. 4 was for the past year devoted almost entirely
to cases of insanity returned from American Expeditionary Forces.
As the bed capacity Avas soon taken up, it was necessarj'^ for General
Hosi)itals Xos. 13 and 34 to be taken over for the care of insane cases.
As the number of cases returned from abroad decreased and the popu-
lation of these hospitals diminished, all the cases were transferred to
the Soldiers' Home for Disabled Volunteer Soldiers, Hampton, Ya.,
which had been previously Debarkation Hospital Xo. 51. On May 1,
1919, it was made General Hospital No. 43 for the care and treatment
of mental cases. At the time of the transfer of these cases General
Hospitals Nos. 13 and 34 were closed.
This change has proven very satisfactory because all cases of insan-
ity are now returned from American Expeditionary Forces through
the port of debarkation at Newport News and taken directly to the
hospital without long travel and economy of personnel has resulted,
as the patients are now treated in one hospital instead of three. The
home is particularly adapted for the treatment of mental cases.
Here every facility for the modern care and treatment of insane is
provided, the hospital being staffed with highly trained specialists,
experienced attendants, nurses, and reconstruction aids.
General Hospital No. 30 was established especially for the treatment
of cases of psychoneuroses. Most of the cases treated there were
returned from American Expeditionary Forces, This hospital has
been a decided success, as evidenced by the fact that this class of cases,
which were a source of so much trouble to other countries, were han-
dled without any unusual difficult3\
On account of the thorough neuropsychiatric examinations w'hich
were given the drafted men and applicants for enlistment, the ef-
fective treatment of cases of psychoneuroses near the battle front
and the successful treatment of cases returned to the United States,
it was necessary to devote but this one hospital to the treatment to
this class of cases in this country. The number of such cases has
diminished to the point that they may all be adequately cared for
in the future at General Hospital No. 4, where the bed capacity is
much smaller than at General Hospital No. 30, this latter hospital
being desired for medical and surgical cases.
Cases were transferred to and from these hospitals by attendants
experienced in the transportation of insane and neurotics. Eeports
of the elopement of patients and injuries received while in transit
have been few, and complaints as to condition of patients arriving
liave been almost negligible.
The patients were treated in these centers for periods of at least
four months unless cured, or there is special reason for their dispo-
sition earlier. In this manner Army Regulations governing the dis-
position of the insane are not resorted to until satisfactory period of
observation and treatment has elapsed, and if the patient recovers
quickly they need not be resorted to at all. In the latter event, the
patient and his friends have the satisfaction of knowing that he has
not been sent to any but a military hospital and has not been officially
declared as insane.
INTERNAL, MEDICINE. 1083
Cases which do. not recover in four months and require treatment
for an indefinite j^eriod, are turned over to the War Risk Insurance
Bureau. Arrangements liave been made for the transfer in such a
manner that there will be no interval between discharge from the
military service and the commencement of the continued care in
hospitals near their home provided by the bureau.
The efficiency of these special centers has been gratifying. Exten-
sive arrangements were made and carried out for occupational ther-
apy work and for electro and hydro therapeutic treatment. As a
result of these efforts the recovery rate has been high and the period
of residence of most cases brief.
All cases of insanity are considered unfit for military service,
regardless of an}' subsequent improvement or apparent cure under
treatment. When such cases recover to a degree which warrants their
release on the soldier's own responsibility, they are not sent to the
demobilization camps, but are discharged on Form IT, A. G. O., which
results in a record being made on discharge papers that the soldier
had been discharged for disability. By this procedure the Army is
safeguarded in case the dischai'ged soldier applies for subsequent
enlistment as the recruiting officer will look up his record.
Special neuropsj^hiatric services have been maintained for the
treatment of officers and nurses. Fifty beds, which are under the
jurisdiction of General Hospital Xo. 1, were maintained at the
Bloomingdale Hospital, White Plains, X. Y., where insane officers
were provided with private rooms and the very best of medical atten-
tion. When General Hospital No. 43 was devoted to neuropsychiatric
cases, facilities for the care of officers were provided. General Hos-
pital Xo. 2 has control of 15 beds at the Shepard and Enoch Pratt
Hospital exclusiveh' for insane nurses.
To insure the speedy evacuation of the neuropsychiatric cases
which are returned from abroad, a consultant in neuropsychiatry was
added to the staff of the surgeons, ports of debarkation at Hoboken
and Xewport Xews. Cases have been immediately classified upon
arrival and evacuated to the proper hospitals as soon as possible. To
July 1, 7,828 nervous and mental cases were classified by the psychi-
atrists assigned to duty at the ports.
There was a substantial increase in the amount of disciplinary
work done in the past year by the neropsychiatrists. The psychiatric
work done at Alcatraz and Fort Jay was brought into closer har-
mony with that done at United States Disciplinary Barracks, Fort
Leavenworth, Kans. This was brought about through a special
course of instruction in disciplinary work which was given at Fort
Leavenworth. Officers who attended the course of instruction have
been assigned to duty at the recruit depots. As a result of their
experience and training it is hoped to prevent the enlistment of a
class of individuals who in the past have been a source of trouble in
the Army.
This office has on several occasions investigated the problems pre-
sented by the conscientious objectors. A memorandum was prepared
which set forth at length the psychiatric problems which may arise
and be considered in the disposition of this class of persons.
The section of neuropsychiatry has cooperated in every possible
way with the aviation research laboratory at Mineola, Long Island,
N. Y., in solving the psychiatric problems allied with aviation.
1084 REPORT OF THE SURGEON GENERAL OF THE ARMY.
A director of iieuropsychiatric work was appointed and nnder his
jurisdiction the problems were approached from all angles. Psychi-
atrists were assigned as consultants to flight surgeons and to the med-
ical examining boards at all aviation fields.
Since the signing of the armistice considerable time has been spent
in the study of the records of neropsychiatric cases found in the
Army. A very complete study of the cases of psychoneuroses which
were treated in this country has been finished. The information
concerning the psychiatric cases which was obtained from examina-
tions of drafted men and treatment of the cases in hospitals in this
country is nearing completion. The result of these studies will be
published in the medical history of the war. The information which
has been compiled will no doubt be of considerable assistance in
approaching future psychiatric problems which may be presented to
the medical department.
IV. DIVISION OF SURGERY.
1. Orgaxizatiox.
The division of general surgerv^ organized early in the emergency
in 1017 continued to function as one of several surgical divisions
until November 30, 1918, when, complying with Office Order No. 97,
the division of surger}^ was made to embrace all sections representing
surgical activities, including general, orthopedic, heacl surgery,
urology, and dermatology, and roentgenology. The head section
was divided into subsections of ophthalmology, otolaryngologj^, oral
and plastic, and brain surgery.
During most of the year these sections operated under section
heads through the chief of the division of surgery. Xear the close
of the year, with the discharge of many of the temporary officers,
all details were assmned by the division chief and assistants.
2. Maintexaxce of Surgical ErriciExcY.
With the urgent need of more medical officers for surgical work
overseas, the domestic hospitals were stripped of their more expe-
rienced personnel, to be replaced continuously by those who more
recently entered the service. From July to the time of signing the
armistice, with the rapidly changing personnel, efficiency could be
maintained only by untiring vigilance. With the signing of the
arinistice large numbers of the best qualified surgeons retained bj^
this division were discharged from the service without reference to
the Office of the Surgeon General. This caused much confusion and
a marked break in the efficiency in all the hospitals by disorganizing
the staffs. War Department orders quickly stopped this, however,
and staffs were reorganized as rapidly as possible.
Effort was made to train as rapidly as possible the new officers by
the establishment of schools for intensive instruction.
3. School for Chiefs or Service,
At Camp Custer the surgical service was administered with a view
to the training of professionally well-qualified officers in administra-
SURGERY. 1085
tion of such a service. Later a second school was established at
Camp Jackson. To insure confidence in his ability to administer
a service an acting chief of service was named, who, under the guid-
ance of the chief, performed all the administrative duties of the
service. The surgical service was divided into units of four wards
and an assistant chief placed in charge of each unit. He was
charged with all details of professional care and administration and
was permitted to show his initiative in solving the problem of this
unit service.
As an acting chief became capable of assuming full charge of a
s-ervice he was ordered away and the most competent assistant re-
placed him. It was the custom to allow each student to serve as
acting chief for one week as a minimum.
At many of the cantonment hospitals it was found expedient to
organize special classes in professional instruction for the benefit of
substandard officers. Ward classes, lectures, and personal instruc-
tion to officers who did not gi^ade up to standard saved the service
many who would otherwise have been discharged.
4. IXSTRUCTIOX.
•
At the medical officers' training camj) at Fort Oglethorpe,
Ga., an exceptionally well-qualified staff of instructors in
surgery and its specialties was placed. Officers on acceptance
of commission were sent to this cainp for extensive training. Here
special surgical instruction was given in addition to other .training
and an estimate made of the officers' qualifications, with a view to
proi:)er assignment.
The various schools which were established in 1917 in the large
cities for instruction in the treatment of fractures and war surgery,
Carrel-Dakin technique, orthopedic surgery, roentgenology, treat-
ment of empyema, and neuro surgery, continued actively in opera-
tion up to the signing of the armistice, when all were discontinued
with the exception of the one in Carrel-Dakin technique at the Rocke-
feller Institute. This instruction continued liere until April. 1919,
when it was transferred to Walter Reed General Hospital.
All hospitals were encouraged to keep their ])ersonnel familiar
with the latest information on Avar surgery. This was done by
furnishing the hospitals with outlines of lectures, lantern slides, ab-
stracts, and reprints for use in the courses of instruction which all
were directed to establish.
In March, 1919, a postgraduate course in surgery and its special-
ties was inaugurated at AYalter Reed General Hospital for the bene-
fit of officei^ of the Regular Medical Corps. Only a few junior offi-
cers of the corps had been engaged in clinical surgical work during
the period of the w ar, and with the discharge of large numbers of
temporary officers the surgical work in the many hospitals would
naturally fall to the Regular. Selected officers were recommended
for this instruction, and though few were available and assigned be-
fore June 30 a fair nucleus had been reserved for this work and the
course developed was a most excellent one.
5. Monthly Surgical Reports.
Early in July, 1918, the main energies of certain officers of the
division were directed toward making a complete detailed survey of
1086 REPORT OF THE SURGEON GENERAL OF THE ARMY.
the character of surgical work being: done in all the camps and hos-
pitals. Each ofeneral. base, and post hospital was recpiired to furnish
at the close of each month a report including the details of each
operation, each death, and each infection of a clean Avound. These
reports were carefully studied and any defect of technique or judg-
ment noted. It was" possible as a result of this work to institute
corrective measures where necessary. It was the policy of the division
at all times to allow the widest possible latitude of judgment to all
surgical chiefs on purely surgical matters, but it was necessary at
all times to have a thorough knowledge of the professional and tem-
peramental qualifications of the various chiefs of service. A care-
fully considered and well-worked-out plan for running the standard
surgical service was devised. This plan was never forwarded to the
hospitals as an official document because it was felt that it might
conflict with the normal initiative of various chiefs. It was, however,
used for the benefit of commanding officers and surgical chiefs who
visited the division Avhile in Washington or were seen by surgical
consultants who visited the various hospitals.
6. Consultations.
In August, 1918, a comprehensive system of consultation tours
was inaugurated. This system was planned after mature consider-
ation and after a formal and extended conference held in Wash-
ington with certain surgical chiefs wdio had been called in from
the field and who presented their views before the Acting Surgeon
General, tlie division of surgery, and representatives of all divisions
in the Office of the Surgeon General. It was brought out at this
conference that these consultation tours were of great advantage
to commanding officers and chiefs of service as well as to this
office in that it encouraged the mutual exchange of ideas, the con-
sultant being prepared to give all the information which he had
gathered from various hospitals visited and he in' turn was able
to carry away much that was helpful in the perfection of the
system of careful professional administration. Most of the defects
found on these visits by consultants were due to a lack of knowl-
edge by the surgical chiefs as to the necessity for certain require-
ments of the Surgeon General's Office and were easily corrected
by such conference. Consultants were assigned groups of camps
in geographic relation and were instructed to cover all possible
topics pertaining to every phase of surgery. Each consultant on
his return submitted a report covering his consultation, appending
the special estimate of the professional qualifications of the surgical
personnel of the various camps visited. On the basis of these reports
measures were instituted to strengthen weak spots wherever they
occurred.
7. Publications.
Another important factor in the maintenance of surgical effi-
ciency during the last year of the war was the distribution of sur-
gical literature. The activity of the division of surgery along
this' line took on a very definite form and adhered throughout to
the policy of avoiding the academic and practicing only the most
SURGERY. 1087
utilitarian method. The exigencies of the situation left little time
for extensive or intensive reading; therefore, a carefully prepared
digest of all important American, English, French, Italian, and
German (where procurable) contributions to surgery was sent out
to the camps and overseas monthly. This digest was in the form
of a 64-page Eeview of War Surgery and Medicine. There was
also prepared for distribution a Manual of Surgical Anatomy, which
was a volume made up of appioximately 400 anatomical plates
without text but with clear legend and a full explanatory- index.
The drawings were selected solely from the point of view of their
use in war surgery. In September after correspondence with the
British war office there was published 20,000 copies of the British
official manual of Injuries and Diseases of the War and a wide
distribution of this most invaluable treatise was made. At about
this time there was delivered from the press, Abstracts of War
Surgery, a book of 400 pages furnishing abstracts topically ar-
ranged of all the important surgical articles published by the Allies
from the declaration of the war up to time of American partici-
pation. During September arrangements were completed for pub-
lishing in pamphlet form the conclusions adopted by the four In-
terallied Conferences on War Surger3\ These pamphlets unfor-
tunately were not ready for distribution until after the armistice.
In June, 1919, there was ready for distribution a Manual of Neuro-
surgery which had been in the course of preparation for some time
and was a valuable contribution to the neuro-surgical section. In
addition many reprints of articles of interest to Army surgeons
were purchased and distributed to the various hospitals. All of
the above detailed literary activity of the division of surgery had
a dual purpose; in the first place the aim was to maintain a high
degree of professional proficiency in the actice Marine Corps; and
in the second place it was the purpose of the division to see to it
that the various publications should serve as fundamental texts in
surgeiy for the Student Army Training Corps (medical section).
The signing of the armistice nullified the latter purpose.
8. Anesthesia.
Fifteen special schools for anesthesia in the various camps were
established in the fall of 1918. With the cooperation of the Inter-
state and American Association of Anesthetists it was found pos-
sible to place several of the leading exclusive anesthetists of civil life
as instructors in these schools and in a short time the Surgeon Gen-
eral was prepared to send overseas monthly from 15 to 30 speciallv
trained anesthetists (officers, nurses, and enlisted men). The train-
ing received by these pupils was confined to the drop ether, gas oxy-
gen, and gas ox^-gen-ether method.
9. Conservation and Reclamation.
Early in the year the gauze situation became rather acute. In an
effort to forestall any serious shortage in surgical dressings, a re-
usable knitted gauze was developed. After trying out many types
of yarn and fabric, a knitted gauze was finally developed that can
1088 REPORT OF THE SURGEON GENERAL OF THE ARMY.
{ulvantaffeously be substituted for woAen gauze and which can be re-
claimed with greater ease. This was knitted in tubular form in ap-
propriate size and shape and was supplied to all base and general
hospitals in the country. A separate laundry unit providing ade-
quate washing, drying, and reforming facilities had been arranged
for at each hospital, the installation of which and instructions rela-
tive to the reclamation of gauze were under the supervision of the
sanitary officer designated by the supply division for that purpose.
In addition to reclaiming the "reuse" gauze, most hospitals were
enthusiastic about the reclamation of all mesh gauze as well as ab-
sorbent cotton. In the early chiys of haste and the period of organi-
zation there was little time or inclination to conserve, but as organi-
zation proceeded it was possible to emphasize the idea of rational
economy to the point that some of the camps showed a cost per op-
eration of -20 to 30 cents as compared with an earlier cost of $2 or $3.
In addition to the reclamation of gauze and cotton, the reclamation
of alcohol and iodine and the economic use of catgut and adhesive
plaster were ail elements in most pronounced reduction of cost.
10. Overseas Wouxded.
The arrival of overseas wounded necessitated that all tlie energies
of the division be directed toward providing adequate surgical care
and definitive treatment of these cases. Tliis particular problem was
bound up in several essential fundamentals. The port hospitals
were destined to serve only as clearance hospitals where an adequate
number of beds would ahvays be available for the reception of pa-
tients. From these port hospitals patients were distributed with a
clue regard for the sentiment of the public Avhicli prompted the desire
that their own wounded should be housed near home. The equally
important consideration had to be met of caring for the special
cases, ophthalmic, neurosurgical, fractures, maxillofacial, amputa-
tions, orthopedic, etc., which were distributed to special centers
equipped to afford the best type of specialized treatment. The Sur-
geon General succeeded in working out a plan that met both these
considerations, and the division of surgery provided adequate per-
sonnel and maintained, efficiency by frequent conferences through
consultants as well as by letters of instruction. A special commis-
sion was created to devise and control methods of handling all neuro-
surgical cases. The empyema commission continued along its field
of special activity, instructions were drawn and circulated concern-
ing the fundamental principles underlying the treatment of osteo-
myelitis, special consultation visits were made to check up on the
(luestion of preventable deformity, detailed survey was maintained
over the various artificial leg-fitting centers, and the consultants de-
voted much time to the survey of the treatment of fractures. Along
such lines of intensive correlation, control, and supervision the di-
vision of surgery was working at the close of June, 1919.
11. Empyema.
At the beginning of the fiscal year 1918-19 empyema had in many
respects ceased to be the burning question it had been during the
preceding six months. In most, if not all, of the cantonments the
SURGERY. 1089
discharges outnumbered the admissions, and there were indications
that the epidemic was in its final stage.
The preliminary report of the empyema commission appeared in
the Journal of the American Medical Association during the month
of July, 1918. It is very gratifying to note that concommitantly or
subsequent to the publication of this report, many of the surgeons
attached to the hospitals arrived at conclusions which were very much
in accord with those advocated by the commission. Eeprints of this
report were placed at the disposal of the staifs of all the hospitals;
in spite of this it is noted with regret that the lessons taught were
not more fruitful, or were so rapidly forgotten. This became evident
during the fall of 1918 with the advent of the influenza epidemic,
which Avas followed by a recrudescence in the incidence of empyema
cases, and an unwarranted increase in the mortality; it is but right to
add, however, that by no means to the extent attained in the previous
epidemic.
In order to continue the intensive study of the empyema cases
begun at the base hospital. Camp Lee, by the empyema commission,
all of the emjDyema cases (about 125) both the draining and the
healed, were transferred en bloc June 22 to General Hospital Xo.
12, Biltmore, X. C, accompanied by some of the medical officers of
the commission. The preliminary report of the commission having
dealt mainly with the acute stages of empyema cases it was now the
intention of the commission to continue the study of the cases at
Biltmore and, when the proper time arrived, to report upon the
treatment of the chronic cases, and to a very large extent also upon
the end results.
The material at hand was not very large (125 cases), but in some
respects this was an advantage, because it enabled the commission to
give to each case the most exacting personal attention.
The medical and surgical care of the cases is not discussed at this
place, as it will be the subject of a special report; suffice it to say,
that the method of treatment finally adopted as a routine measure,
and the one suitable in the greatest number of cases was that of the
institution of perfect drainage; sterilization of the cavity by the
Carrel-Dakin technique, and allowing the external opening to close
with the formation of a sterile pneumothorax.
• The results obtained by this method were most gratifying, and so
entirely devoid of danger that after an investigation by several
members of the staff of the Surgeon General's Office it was tentatively
decided to establish at General Hospital Xo. 12 not only a hospital,
but also a school for the care and treatment of empyema cases. At
just about this time the influenza epidemic made its appearance at
Camp Devens and subsequently spread through the various military
hospitals, engrossing everybody's exclusive attention, so that the plan
above outlined was held in abeyance. At this time also the few mem-
bers of the empyema commission still remaining at General Hospital
No. 12 were ordered for duty at other hospitals, on account of which
the plan was ultimately dropped entirely.
During September, October, and Xovember, 1918, as a sequela of
the influenza epidemic there occurred, as was to be expected, a re-
crudescence of empyema cases. Fortunately this group of cases was
by no means as virulent as the previous epidemic, Avhich was due
almost entirely to a particularly virulent strain of hemolytic strepto-
1090 REPo]^'^ ^^ ^^^ *^ EON GENERAL OF THE ARMY.
COCCUS. It is c ^ocj^tioii /io that the reducod mortality was due to
both a lesser vii .^^^^ p^' ^vell as improved treatment.
The exigencies'" r^^I^^^vice were such that during the fall months
of the 3^ear nothii?^l^?J^'^| :^. itensive character could be done with the
empyema problem. rn\^u time to time, however, new (?) methods
of treatment were suggested and were being tried at various hos-
pitals. Particular mention is made of the various methods, which
have received the somewhat ambiguous name of " Treatment by in-
termittent drainage " and to which the names of Diederich and of
Mozengo are attached. Owing to their simplicity, unstinted praise,
and at least a promise of success the method soon gained quite a
number of adherents and is even now being used by a few enthusiasts.
This method, however, did not prove of great vahie in the long run
an lis being discarded by surgeons of experience.
., fter rendering their preliminary^ report the exigencies of the
sen /;e demanded that the members of the empyema commission be
dei.|-|V^d to other more pressing duties. Not until the beginning of
tht i^jj'fir 1919 was it possible to make a systematic and concerted effort
to ,gr up the old chronic cases of empyema, which existed in the
hosi ^als of the various camps. In order to make this possible one of
the . .lembers of the commission was ordered for duty to the Walter
Eeec Hospital, to report upon a method of treatment which was
bein^ tried there, and subsequently to the office of the Surgeon
General.
Primarily it appeared of importance to make a complete survey of
all cases of empyema in the service. Stress was laid particularly
upon the duration of the individual case and upon the number and
nature of operations which had preceded the date of the survey.
At just about this time there was an influx of empyema cases from
overseas, most of which were upon a traumatic basis. Owing to fre-
quent changes and transfers of the latter it was exceedingly difficult
to obtain absolutely reliable data. As near as could be ascertained,
however, there were present in the larger and more important base
and general hospitals approximately 1,200 cases of empyema in
various stages of healing and convalescence ; some of the cases dating
back even to the earliest epidemic in the winter of 1917 to 1918.
After careful deliberation of the question of the most suitable
treatment of these cases it was agreed that the treatment which
promised the greatest amount of success with the least danger from
an operative viewpoint was that Avhich was evolved by the members
of the empyema commission at General Hospital No. 12. The salient
points of this method are the following :
1. Careful study of the empyemic cavity by all physical means,
including the X ray.
2. Sterilization of the cavity by the Carrel-Dakin technique.
3. After sterility has been maintained for at least one week, and
controlled by daily bacteriological cultures, to discontinue all treat-
ment and to permit spontaneous closure of the external wound.
This was a radical departure from all hitherto known methods.
Examination revealed the fact that while the external wound closed,
a sterile pneumothorax forms within the thorax. In the course of
time the air contained in the pneumothorax becomes absorbed and
concommitantly the lung expands and occupies the entire chest.
SURGERV. ^ 1091
It is self-evident that the entire tre , ^ around our
ability to sterilize the cavit.y. Experience.; ancl forw ? not only that
this is possible, but also when apparently Army ca/-^, that there is
usuall}^ a very definite underlying cause w'ell as th^'^^ts the steriliza-
tion, and Tvhich can usually be remedied -/sfr-'uV ^paratively trivial
operation. The entire treatment presumes ac the ver}' outset a per-
fect Carrel-Dakin technique on the part of the personnel, and the
necessary enthusiasm for fully carrying it out. It is true that a
large number of officers had had the Carrel-Dakin course at the
Rockefeller Institute; but most of these officers were promptly sent
overseas, or were detailed to other duties. Before this intensive
treatment could be instituted therefore, it was necessary to train the
personnel particularly in the treatment of empyema. In order to
carry out this plan three requisites were necessary, first, hos} '(;^al
facilities; second, competent teaching personnel; and, finall;^' a
group of empyema cases of various kinds. It was finally decide^^ to
institute a post-graduate school for the treatment of empyema, ^j-^ lis
was done at the Walter Reed General Hospital, with the coopcg b on
of the commanding officer and the chief of the surgical servi(gj.p It
was the design of the school to have detailed to it, at the req(^i;i' of
the commanding officers of the various hospitals, such officers, .vho
showed particular fitness and interest in the work, for a shor, but
intensive course, at the completion of which these officers we^e to
return to their proper station and to institute the treatment. -The
course consisted of lectures and practical demonstrations b}^ some of
the former members of the empyema commission, and were received
with enthusiasm. (It may also be added that in addition to the
treatment of empyema, that of osteomyelitis was taught at the
school.) The duration of the course was very short, only two weeks,
but it was sufficient to demonstrate the possibilities of the treatment,
and all the officers who were detailed for the course left the better
for it, and subsequently were able to continue it at their respective
hospitals with gratifying results.
One of the great drawbacks with which the office of the Surgeon
General had to contend in the problem of empyema was that the
cases were scattered in the various hospitals throughout the coimtry.
There was hardly a hospital but had some cases, the number varying
from two or three up to as high as a hundred. There were several
drawbacks attached to this state of affairs. First, that most of the
cases had been permitted to lapse into a state of chronicity, and in
consequence, as is usually the rule, they did not receive the very best
of care and attention; second, that even with the existence of the
postgraduate school at the Walter Reed General Hospital, it was
difficult to supply the required competent and highly trained per-
sonnel to all the institutions; and, finally, it was very difficult to
keep supervision over all the cases from the central office. With the
contraction of the hospitalization program it was decided in the
spring of 1919 to create empyema centers, so called, the object being
to concentrate in these centers the cases of empyema from a certain
territory, and to send to these centers the highly trained and inter-
ested personnel which is a requisite sine qua non. The plan was not
only feasible but was very readily carried out, as many of the hos-
pitals were then in the process of being closed, involving the transfer
of all patients.
142367— 19— VOL 2 8
N
1092 REPORT OF THE SURGEON GENERAL OF THE ARMY.
GeograiDhical location ^vas one of the decidin|>: elements in the
selection of the centers, the following hospitals being selected :
Walter Keed General Hospital.
General Hospital No. 12, Biltmore, N. C.
General Hospiial Xo. 6, Fort McPherson, Ga.
Departmental Base Hospital, Fort Sam Honston, Tex.
Letterman General Hospital, San Francisco, Calif.
General Hospital Xo. 26, Fort Des Moines, Iowa.
General Hospital Xo. 28, Fort Sheridan, 111.
After transferring a sufficient number of patients to these em-
P3^ema centers and permitting them to become accustomed to their
ilew surroundings, and after supplying these hospitals with the
piioper personnel, a surgical consultant was sent upon a tour to the
hofspitals, with orders to report upon the working of the plan. An
>fldiditional object of this tour was to instruct the personnel in the
us^ of the modern chlorine antiseptics, and in the treatment of
yema and of osteomyelitis. It is believed that the tour was
ly successful from every viewpoint. A rapid diminution in the
ber of the cases followed the installation of the plan.
1^ problem of empyema has been a verj- important one ever since
its appearance in numbers sufficiently large to assume an epidemic
form. It is the belief of the division of surgery that appreciable
progress has been made in its administration during the fiscal year
just ended.
12. Fractures.
During the early period of the war, 1911—15, the British reported
that the results obtained in the treatment of fractures were deplor-
able ; during a later period when fractures were treated in groups, in
sections of a hospital set aside from them, some improvement was
noted: the most marked improvements were observed at a later date
when these cases were treated by skilled surgeons in hospitals particu-
larly devoted to their care. Thus it was demonstrated that while
fractures were the most numerous of the severe injuries, yet skilled
surgery could be expected to yield brilliant results in their treatment.
Following the reports of these observations the surgical advisory
committee of the Surgeon General recommended that a special hos-
pital foi- fractures be organized and assigned to the American
Expeditionary Forces, to be located in close proximity to the
front; that all splints be standardized similarly to those used by
the British. The Surgeon General approved these recommenda-
tions. In working out the plans for this special hospital attention
was not confined to the buildings only but also to the adoption of
standard methods of treatment and to the training of meclical of-
ficers in the use of standard splints and appliances. At the same
time similar attention was being given to this subject in France, a
board having been appointed by the chief surgeon American Ex-
peditionary Forces, to select splints and dressings for the purpose
of standardization. The report and recommendations of this board
were embodied in the Manual of Splints and Appliances, which was
published and widel}^ distributed. The first step in the standardizing
of treatment for fractures was the adoption of a set of about
12 splints to be used as a routine. These splints are shown in the
Military Orthopedic Manual. The supply department secured the
SURGERY. 1093
manufacture of a number of these splints and forwarded a complete
set to the base hospital of each National Army cantonment and Na-
tional Guard camp for instructive, as well as therapeutic, purposes.
For training the medical officers in the standard methods fracture
classes were establishel in Boston, Chicago, Cleveland, New Orleans,
New York, Philadelphia, and Pittsburgh, in charge of eminent sur-
geons, each one selected because of his proven abilit}^ as a teacher
of wide experience, as a surgeon, and also on account of the clinical
material at his disposal ; to these classes medical officers were sent
from the training camps and base hospitals. Upon completing
the courses, these officers returned to their stations and instructed
other officers. A syllabus of the desired course of instruction was
supplied to each one of the instructors in order that each class
should receive practically the same instruction. The central purpose
was to teach the standard methods and to establish a spirit of team-
work from the firing line to the base hospital, so that unbroken con-
tinuity in the methods could be maintained. The first course began
November 5, 1917, there were 8 classes with 68 medical officers and
each class continued about 3 weeks. These classes continued up to
the signing of the armistice.
The organization of the special-fracture hospital advanced so
rapidly that on November 22, 1917, it was given an official designa-
tion as Base Hospital No. 116, and notified to be ready to embark in
January, 1918. It was thus the first special hospital to be organ-
ized in the Surgeon General's Office and was intended to become a
center in which fracture cases should be treated by standard methods,
by specially skilled surgeons, and to utilize this as presenting an
ideal toward which all should work. Its personnel comprised medi-
cal officers who had been very carefully selected, were a group well
ffualified to perform all functions required of any base hospital,
and, in addition, it was specially organized and equipped to most
efficiently treat fractures, which comprise so large a proportion of
all casualties. Base Hospital No. 116 was mobilized December 20,
1917, and embarked for American Expeditionary Forces March 24,
1918. Segregation of fractures into special wards within Base
Hospital No. 116 was carried out, and it was clearly demonstrated
that the best results were obtained by those officers who had been
specially trained and so were qualified to treat fractures. This
was most particularly marked in dealing with those difficulties
associated with the severe fractures of the lower extremit3\
In the American Expeditionary Forces attempts were made to
retain very many of the serious cases of fracture, especially those
of the lower extremity, in the hospitals in the advance section until
they recovered sufficiently so that without undue risk they could
be evacuated to the hospitals in the intermediate section. In these
hospitals they were treated for longer periods, then gradually evac-
uated to the debarkation hospitals at the base ports. The largest
nimiber went to Savenay, where the,v were carefully reexamined and
held until it was thought safe to make the homeward voyage. While
there shortenings, angulation, and deformities were frequently cor-
rected and new splints applied. Much care was given to this selec-
tion, as is evidenced by the fact that reports of January 13, 1919,
show that among the 55,059 casualties already evacuated to the
United States there were only 3,951 fractures (0.07 per cent), whereas
1094 EEPOKT OF THE SURGEON GENERAL OF THE ARMY.
among the 35,790 casualties repiaining to be evacuated there an ere
7,600 fractures (21 per cent).
After arriving at the ports of debarkation in the United States —
Hoboken and XeAvport News— fracture patients were sent to the hos-
pitals nearest their homes, to general hospitals and base hospitals
of National Army and Guard camps. January 11, 1919, Circular
Letter No. 21 was sent to all hospitals requesting a semimonthly
report of all overseas cases. February 15, 1919, reports from 39
general, 23 base, and 3 department hospitals showed that there were
4,901 fractures; 3,750 cases in which healing has occurred or will
occur without further operation and with satisfactory function of
the extremity; 628 cases Avill require operation for osteomyelitis;
526 cases will require operations for nonunion or malunion.
In order to locate these widely distributed important cases with a
view of treating the more serious cases in special hospitals where
special personnel and adequate facilities for treatment were available
it was decided to obtain accurate data regarding all cases of fractures
of the long bones. March 4, 1919, Circular Letter No. 117 was sent to
all hospitals with an inclosed-fracture blank similar to the one used
in England, France, and the American Surgical Association; this
letter directed that as soon as a patient with a fracture of a long
bone entered the hospital the blank must be filled out at once by a
competent officer and sent to the Surgeon General's Office. A con-
sultant in surgery, who was interested especially in fractures, was
assigned to dutj^ in the Surgeon General's Office to carry out this
survey and to supervise the treatment of fractures, through reports
of the chiefs of surgical service in special hospitals; by conference
visits at these hospitals, to observe the progress of patients under
treatment, especially those with osteomyelitis and delayed union ; to
secure full, sympathetic cooperation between the various chiefs of de-
partments, surgical, orthopedic, radiographic, and physiotherapeu-
tic: to aid in preventing the prolonged detention of cases in the de-
barkation hospitals; to inspect and secure adequate special fracture
equipment; to encourage the organization of special wards for
Carrel-Dakin treatment.
The survey showed that there was a very large group of severe
fractures of the long bones, with osteomyelitis, delayed union, and
malunion, scattered in the general and base hospitals throughout the
United States ; many of these hospitals were not suited for the treat-
ment of these difficult cases, being neither properly equipped, nor
supplied with the competent qualified personnel. It was evident that
unless fractures could be given more care than was customary on a
general surgical service they would drag slowly along, during the
exact period when they should be treated with much more than the
usual care, needing radical operations, skilled physiotherapeutic
treatment, special series of exercises while protectee! with suitable
apparatus and braces. If these methods could be carried out by in-
terested qualified personnel, under careful supervision and consulta-
tion, the amount and duration of disability with compensation would
be verv greatly reduced. Such results had been obtained in England
where the above methods were employed. They demand the full
cooperation of a surgeon skilled in fracture treatment, an orthopedist,
and a well-developed phj^siotherapeutic department. Therefore, to
give these serious important fractures, especially those of the lower
SUKGERY. 1095
extremit,y, the benefit of special professional skill and experience, on
March 28, 1919, it was ordered that these above cases be distributed to
15 special hospitals where particular care had been given to provide
staffs skilled esi3eciall_y in the treatment of fractures and equipped
with a well-developed physiotherapeutic department; Walter Reed
General Hospital, Letterman General Hospital, General Hospitals
Nos. 2, 3, 6, 10, 24, 26, 28, 29, 31, 36, 38, base hospital Fort Sam
Houston. In these special hospitals more rapid improvement was
quickly observed through better organization with skilled personnel
and adequate equipment, wounds healed more quickly, enabling the
patients to receive earlier the advantages of the physiotherapeutic
and occupational therapy. Convalescence was materially accelerated.
13. End Results.
In connection with the survey, comprehensive reports were inaugu-
rated and will be continued until the patient has been restored to
health and function as fully as possible. It is hoped that later it
will be possible to determine the amount and duration of disability
of a large group of fractures, which can be used as a basis for
standards for future treatment. In England and France a vast
amount of work and study is being given to this subject, and it is
hoped that equally valuable information can be secured from our
own records. It is now too early to give the end results of fracture
treatment during the war. That the mortality and amputation rate
has decreased enormously is obvious, and that the functional results
will be infinitely better than seemed possible even two years ago is
certain. The treatment of gunshot fractures of the femur is one of
the subjects which has benefited the most from the progress which
has been realized in the course of this war. An examination of end
results one year after the war will give invaluable information not
only as to the respective value of different methods, but also of the
whole policy of the treatment of fractures.
14. Peripheral Nerve Injuries.
As a result of the experience of the Allies, it was well known
that we would receive a large number of peripheral nerve injuries.
At first these cases were scattered from the port to all of the gen-
eral and base hospitals, but owing to the scarcity of certain per-
sonnel, particularly neurologists, the division of surgery initiated
the policy of segregating the peripheral nerve injuries into hospitals
especialh^ designated for their treatment. It would have been pref-
erable if only two or three such special hospitals had been formed,
but owing to the popular demand to have the wounded soldier
as near to his home as possible, it was deemed expedient to estab-
lish a sufficient number of hospitals to satisfy this demand. It
was also realized that manj^^ problems connected with this highly
specialized branch of surgery and neurology would arise ; and ac-
cordingly, on January 31, 1918, the Surgeon General established a
peripheral nerve commission to investigate and collect data bearing
upon lesions of the peripheral nerves. The duties of this commis-
sion were to include (a) classification of cases, (&) standardization of
methods of examination and recording of findings, (<?) collection of
1096 REPORT OF THE SURGEON GENERAL OF THE ARMY.
clinical data bearing upon the diagnosis, (d) the perfection of
methods of operative procedures, (e) minute histological study of
operative material, and (/) the determination of the end riisults.
The commission included 16 medical officers and two contrac; sur-
geons.
Following the issuance of Circular Letters Xos. 13 and 100, the
peripheral nerve injuries were gradually transferred until all were
assembled in the special peripheral nerve hospitals. These hospitals
were Walter Reed General Hospital, Washington, D. C. ; Letterman
General Hospital, San Francisco, Calif.; base hospital. Fort Sam
Houston, Tex. ; General Hospital Xo. 2, Fort McHenry, Md. ; General
Hospital Xo. 3, Colonia, X. J.; General Hospital Xo. 6, Fort Mc-
Pherson, Ga. ; General Hospital Xo. 11, Cape May, X. J. ; General
Hospital Xo. 2G, Fort Des Moines, Iowa; General Hospital Xo. 28,
Fort Sheridan, 111. ; General Hospital Xo. 29, Fort Snelling, Minn.
At first, General Hospital Xo. 1, Williamsbridge, X. Y., was so des-
ignated, but in the late spring the peripheral nerve cases Avere trans-
ferred to General Hospital Xo. 41, Fox Hills, X. Y., which was thus
established as a peripheral nerve center. General Hospital Xo. 10,
Boston, Mass., was allowed to retain its peripheral nerve cases, and in
addition received quite a few cases from the Xew England group.
On June 1 all of these cases were transferred to General Hospital
Xo. 41. General Hospital Xo. 11 continued to functionate to the end
of the fiscal year, but was then abandoned. It is not possible at this
time to state definitely the number of peripheral nerve injuries re-
ceived b}' these hospitals. On May 1, 1919, in answer to a query, these
hospitals reported a total of 2,347 patients suffering from 2,707 nerve
injuries. It is probable, however, that nearly 30 per cent additional
were on furlough or had been discharged. Xineteen different nerves
were mentioned. In addition to the cervical, brachial, and lumbar
plexi, the ulna (589), musculo-spiral (529), and median (433) nerves
were tlie most frequently injured in the upper extremity; the sci-
atic (349) and external popliteal (283) in the lower extremities.
There were 147 cases of brachial plexis injury reported.
15. Peripheral Xerve Operations.
The operative work on the peripheral nerves began in October, and
by January 1, 84 operations had been reported, equally of which were
located in two hospitals, namely. Fort McPherson, Ga., and Cape
May, X. J. Month by month the operation total increased until the
high-water mark was reached in May, when 242 operations were per-
formed. On July 1, 1919, there were records of 1,217 peripheral
nerve operations, of which 1,146 had been done in the special periph-
eral nerve hospitals and only 71 in other institutions. It is probable
that only 50 per cent of the peripheral nerve injuries will require
operations. These operations consist of simple exposure and the re-
lease of adhesions: angulations, or compression from scar, etc. (neu-
rolysis) ; hereage; and resection of a portion of the nerve for neu-
roma, followed by end to end suture. In some cases the gap has
necessitated a nerve transplant or graft, but this has been avoided
wherever possible, owing to the limited success attending its use.
The method so much used before the war, namely, restoration of the
SURGERY. 1097
continuity b}' flap splitting from the proximal and distal ends, has
been totall}' abandoned.
At operation, the various causes which interfere with the possible
conduction of emboluses in the nerve are removed, but in addition it
is necessary to maintain the circulation and tone of the tissues of the
limb during the long period that must elapse before the regeneration
of the nerve can occur. Ever}^ effort was made, therefore, by this
di^^sion to collaborate with the reconstruction division in organiz-
ing a physiotherapy department in each of the i^eripheral nerve
hospitals. Heat, baths, massage, and electrical treatment are essen-
tial for the proper recovery of these cases.
Following recommendations of the peripheral nerve commission,
the division of surgery has provided for the proper recording of the
findings of the neurologists and others engaged in the diagnosis and
treatment of these cases. In addition to the usual forms prescribed
by the Manual, a special peripheral nerve register was issued and
ordered to be filled out, copies of which must be sent to the Surgeon
General's Office upon the discharge of the patient. While every
encouragement has been given to individual investigators, experi-
mental and clinical, it is believed that a collective report has a value
transcending the individual report. Therefore it is the intention of
the division of surgery, with the aid of the peripheral nerve com-
mission, to issue a collective report of the work done in all peripheral
nerve hospitals. Finally, plans have been laid whereby the wounded
soldier will be followed up at a period of approximately one year
from the date of his discharge from the hospital and the end result
noted.
16. Neurosurgical, Laboratory.
a. peripheral nerve.
The laboratory for research on peripheral nerve lesions was es-
tablished at the University of Michigan, Ann Arbor, ^lich., in
February, 1918. The laboratory is still operating and is engaged
in the investigation of specimens removed at operations on peripheral
nerve injuries and upon the completion of special problems.
The series of experiments undertaken ancl carried to a partial or
final conclusion are as follows:
Senes No. 1. — The injection of absolute alcohol into the distal end
of a nerve stump as a simple and efficient method for preventing the
formation of amputation neuroma.
Series No. 2^. — When alcohol is not injected an amputation neuroma
was noted in every experiment after section of a nerve, even when
strict asepsis was observed and primary union of the wound ob-
tained.
Series No. 3. — The injection of absolute alcohol into a living nerve
causes fragmentation of the neuraxes and m^^elin in the field com-
ing under the immediate influence of the alcohol. Therefore, in
cases of severe causalgja in which section of the nerve is contem-
plated, injection of absolute alcohol without nerve section should be
considered.
Series Nos. 4, •5, 6, and 7. — Acetone was found to produce slightly
more connective tissue formation. Absolute alcohol is to be pre-
ferred. The experiments with nerve transplants lead to the follow-
1098 REPORT OF THE SURGEON GENER^VL OF THE ARMY.
inw conclusions: The cable aiitonerve transplant presents a method
for brid^in^ nerve defects which gives every promise of favorable
result. AVithin a few days after the operation the several segments
of nerve transplanted become surrounded by connective tissue, so as
to form an cpineural sheath, binding them together in one nerve
trunk in which the funicular arrangement of the several nerve seg-
ments transplanted is fully maintained. Down-growing neuraxes
coming from the central stump penetrate and pass through the sev-
eral funiculi to reach the distal segment which in time becomes pene-
trated by new neuraxes. These experiments have been carried on
for a time of sufficient length to obtain new motor nerve endings in
the calf and plantar muscles and evidence of sensory regeneration.
It is admitted that this operation is tedious, requires care and some
skill, and necessitat<es the making of a second wound. However, the
experimental results justify its recommendation. In surgical practice
the cutaneous radial and the cutaneous portion of the musculo-
cutaneous of the arm, the lesser sciatic, and especially the sural of
the leg may at convenience be selected as the nerves from which the
segments for a cable autonerve transplant may be taken. Experi-
ments also show that a fresh homonerve transplant may be em-
ployed to bridge a nerve defect with every promise of success. It
was also determined that neurotization of the distal stump through a
hetero-nerve transplant is experimentally possible. However, the
results obtainable are not as certain and not as favorable as when
auto or homo nerve transplants are used, and the resultant distal
regeneration not as complete. Therefore, this procedure can not be
recommended as an operation of choice in surgical practice.
SeHes Nos. 8, 9, and 10. — This series deals with the use of de-
generated auto homo and hetero-nerve transplants. The results
justified the statement that regeneration of the distal stump of a
resected nerve through a degenerated autonerve transplant is pos-
sible, but that such regeneration is not more favorable nor more
rapid than when a nondegenerated autonerve transplant is used.
Likewise, regeneration of the distal stump of a resected nerve may
be obtained through a degenerated homonerve transplant. The pos-
sibility of using a degenerated nerve as a homonerve transplant in
surgical practice is warranted by these observations. On the con-
trary, the results of degenerated hetero-nerve transplants were so
uncertain that the adoption of this procedure in surgical practice
was not warranted.
Series Nos. 11, 12, 13, H, and 15. — These were devised to test the
possibility of storing homonerve transplants for a period of several
weeks before use as nerve transplants. The possibility of obtaining
human nerve under asceptic precaution, from amputation stumps,
and storing them until operative procedure demands their use,
would obviate the difficulty experienced in surgical practice of ob-
taining fresh human nerves on demand. These experiments have
not been concluded. The results so far obtained justify the state-
ment that the use of homonerve transplants which have been stored
in vaseline or in liquid petrolatum deserves consideration in surgical
practice.
Series No. 16. — Autonerve transplant with nerve transplant and
the suture lines wrapped in several layers of Cargile membrane was
found deserving of consideration.
SURGERY. 1099
Senes No. 17. — Autonerve transplant wrapped in autofacial
sheath. The experiments of this series admit the general conclusion
that an autofacial sheath is very slowly absorbed, evidence of its
persistence havino- been observed three months after operation.
However, even in the asceptic wounds made in normal tissue, where
use could be made of the fascial j^lanes for exposing the nerves, there
is observed a distinct connective tissue proliferation about the fascial
sheath to such an extent as to prejudice against this procedure in
surgical practice, especially in operations where nerve repair is
made thorough and in cicatricial tissue.
Series No. IS. — Autonerve transplant with nerve wrapped in a
formalized arterial sheath. This method deserved consideration in
surgical practice because of the fact that formalized arterial sheaths
are easily prepared and may be kept on hand in a sterile condition
in 70 per cent alcohol.
Series No. 19. — Autonerve transplant with completely detached
autofat sheath. Definite conclusions based upon this single experi-
ment seem hardly warranted. However, the result obtained argues
against the use of a completely detached fat sheath, even when this
is taken from the same animal, since the fat membrane is replaced
by dense fibrous tissue.
Series No. 20. — Tubular suture by the use of formalized artery.
This method can not be recommended for adoption in surgical prac-
tice, since other methods for bridging nerve defects offer greater
assurance of success.
Central nervous system. — The Army Xeurosurgical Laboratory
was established at Johns Hopkins Medical School, Baltimore, Md.,
to investigate certain problems arising from infections and injuries
of the central nervous system in the war. It was opened in Septem-
ber, 1917, and continued to operate until May 12, 1919. The follow-
ing papers have either been published, are in press, or have been
completed and ready for publication.
The production of ^Meningitis by Release of Cerebro-Spinal Fluid during an
Experimental Septicemia.
A Note on Intravascular Fat in Relation to the Experimental Study of Fat
Embolism in Shell Shock.
The Effect of Intravenous Injections of Various Concentrations upon the
Central Nervous System.
Pathology of Experimental Traumatic Abscess of the Brain.
The Method of Obtaining Cerebro-Spinal Fluid by Puncture of the Cisterna
Magna (Cistern Puncture).
The Experimental Production of an Internal Hydrocephalus.
The Formation of Macrophages by tlie Cells Lining the Subarachnoid
Cavity in Response to the Stimulus of Particulate Matter.
Pressure Changes in the Cerebro-Spinal Fluid following Intravenous In-
jections of Solutions of Various Concentrations.
Experimental Alteration of Brain Bulk.
Encephalitis Lethargica.
A Note on Experimental Cranioplasty.
Experimental Irrigation of the Subarachnoid Space.
The Effect of Subarachnoid Injections of Antiseptics upon the Central
Nervous System.
Analysis of Cerebro-Spinal Fluid of Cats with Meningeal Infections.
Experimental Prodiiction of Panophthalmia by Infection from the Blood
.Stream.
The Intrameningeal Virulence of Micro-organisms.
The Influence of Certain Experimental Procedures upon the Production of
Meningitis by Intravenous Inoculation.
Experimental Hematogenous Meningitis — Pathological Study.
1100 KEPOET OF THE SURGEON GENERAL OF THE ARMY.
Lumbar Puncture as a Factor in the Causation of Meningitis.
Tlie Production of P^xperimental Meningitis by Direc-t Inoculation into tlie
Subaraclinoid Space.
I'athological Study of Experimental Meningitis from Subarachnoid Inocula-
tion.
Cerebro-Spinal Fluid in Experimental Compression of tlie Spinal Cord.
17. Plastic and Oral Surgery {MaxUJo- facial).
A. COURSES OF INSTRUCTION.
The course of instruction for medical and dental officers assigned
to the section of plastic and oral surgery which had been given in
certain civilian institutions were discontinued in the spring of 1918.
Instead, plans were drawn up in August, 1918, for four weeks" courses
in plastic and oral surgery to be given as part of the instruction at
the Medical Officers' Training Camp, Camp Greerileaf, Ga. Two
courses were given, the first ending November 16, 1918, and the sec-
ond December 14, 1918. The signing of the armistice held up any
further work along these lines.
B. CARE OF MAXILLO-EACIAL INJURIES FROM OVERSEAS.
From data available up to June 30, 1919, it is estimated that there
were between 2,000 and 2,500 battle injuries classified as maxillo-
facial. These include injuries of the bones of the face or jaws,
wounds of the face, mouth, or neck, or any defects resulting there-
from, with the excepion of the thyroid, the nerve trunks, the eyes and
their adnexa. Of these, 694, or about 35 per cent, were returned to
hospitals in the United States for treatment. During the last three
months of 1918 cases of maxillo-facial injury began to arrive from
overseas and were sent to General Hospital Xo. 11, Cape May, X. J.,
in accordance with special provisions made in the Surgeon General's
Office. It soon became evident that one hospital for the care of these
cases would be inadequate, and by February, 1919. the following hos-
pitals were designated as maxillo-facial centers: Walter Reed Gen-
eral Hospital, Takoma Park, D. C; General Hospital Xo. 2, Fort
McHenry, Md. : General Hospital Xo. 11, Cape May, X. J. April 1,
1919, General Hospital Xo. 40, St. Louis, Mo., was added to the list,
and in June, 1919, the service at General Hospital Xo. 40 was trans-
ferred to the post hospital Jefferson Barracks, Mo.
At each of these hospitals the service consisted of a chief of a
maxillo-facial service, a number of ward surgeons and surgical as-
sistants, and several dental surgeons and prosthethists. The success-
ful treatment of these cases does not depend upon one man alone, but
close cooperation and teamwork between the surgical and dental
departments is absolutely essential. Of the 694 cases of maxillo-
facial injury received in these hospitals from overseas, the records
show that 320 had been discharged by June 30, 1919, leaving 374
still under treatment at Walter Reed General Hospital. General
Hospital Xo,. 2, and Jefferson Barracks. The maxillo-facial cases
from overseas belong in general to the following groups: (1) Com-
pound comminuted fracture of the mandible in process of consolida-
tion. These may or may not have been splinted before arrival and
require observation until union is complete. (2) Compound com-
SURGERY. 1101
minuted fracture with delay in union and healing of the soft parts
due to the presence of sequestra, infected teeth in or near the line of
fracture, foreign bodies, etc. These cases require incision and drain-
age, removal of sequestra, teeth, foreign bodies, etc., in addition to
splinting. (3) Ununited fracture with loss of substance. In many
of these cases the tissues have been complelely healed for some time,
and there is evidence that union, is not going to take place spon-
taneously. These require grafting. In others, where the nonunion
is due to infection or lack of fixation, the application of splints and
removal of all sources of infection vrill often result in new bone
formation and eventual solid union. (4) Another class of cases
presents healed scars involving the soft tissues alone, requiring
plastic operation, excision of scar tissue and obliteration of the de-
formity by flap sliding, fat and fascia lata transplantation, etc. (5)
There are also cases in which there has been a fracture, associated
with more or less destruction or laceration of the soft tissues of the
cheek, lips, or chin. These, of course, require fixation of the fracture
and correction of the soft-tissue deformitv. Frequently the upper
and lower buccal and labial sulci are partially obliterated by adhe-
sions of the mucous membrane of the bone. These are best treated
by division of the bands of scar tissue and the covering of the raw
surfaces with epidermic grafts placed on modeling compound inlays
attached to prosthetic appliances. Many of these injuries are ac-
companied by trismus, which requires treatment bv jaw stretching
and other measures. Cases presenting perforation of the hard palate
or having openings between the buccal cavitv and the maxillary sinus
require operative or prosthetic closure. (6) Miscellaneous cases of
injury of the nose, orbit, external ear, etc., requiring operation.
In every case a thorough survey of the mouth is made, clinical Iv
and radiographically, to eliminate^my factors which may be keepin'g
up infection. All teeth in or near the fracture lines are extracteth
bone cavities drained, and sequestra and foreign bodies removed.
For fixation of fractures, splints attached to the teeth are relied upon.
In some cases, owing to absence of teeth or marked displacement of
fragments, the ingenuity of the dental officer is taxed to the utmost.
Of a total of 365 gunshot fractures of the mandible. 81. or 22 per
cent, required grafts to replace the lost bone. The followino- table
shows the portion of the mandible involved:
Body
Symphysis
Angle
Ramus, coronoid and condyloid.
Total
In general three methods of grafting have been emploved: (1)
Thick free grafts from the rib, tibia, or^other bones: (2) tliin osteo-
periosteal grafts from the tibia; (3) pedicled graft from one of the
fragments of the mandible itself. There are various indications
leading to the adoption of one method at the expense of the others.
1102 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The free rib or tibia method has been employed as the method of
choice at General Hospital Xo. 11, and the indications are that the
results will be ojood. At Jefferson Barracks the pedicled graft is
used in the majority of cases. At General Hospital No. 2 about an
equal number of pedicled grafts and osteoperiosteal grafts have
been made. At AA'^alter Reed General Hospital the osteoperiosteal
method has been used in the large majority of cases. The pedicled
graft, first described by Cole, of London, is most successful in frac-
tures involving the body of the mandible with not more than 3 cm.
loss of substance. It consists of the removal of a piece of the lower
border of the anterior fragment, with a pedicle of muscle and fascia
attached to it below for nourishment, and sliding it back to fill the
gap, attaching it to the ends of the fragments by silver wire. The
osteoperiosteal method of Delageniere is more suitable in cases of
greater loss of substance or where the fracture extends below the
angle of the jaw. It consists of first exposing the ends of the frag-
ments and the preparation of a pocket beneath and over each by
stripping back the periosteum and soft tissues for a distance of
1 cm. The graft is made hj removal of a thin shaving from the
antero-internal sui'face of the tibia with the chisel, leaving the over-
lying periosteum attached to the graft. One piece of graft is in-
serted in the pockets under the ends of the fragments and the other
over the fragments, with the bony surfaces of the graft facing each
other. It is necessarj' that the grafts be in contact with the pre-
viously' freshened bone ends. Xo fixation is used beyond suturing
the deep tissues over the grafts, the jaws having been previously
splinted and locked with the teeth in occlusion. This method fur-
nished a thin, flexible graft, containing all of the elements for new
bone formation, its flexibility permitting easy adaptation. Union
should occur in these cases in three to five months.
Free abdominal subcutaneous fat or fascia lata and fat from the
thigh have been emploved a great deal to fill in marked depressions
left bj' excision of adherent scars or where underlying bone has been
lost. Costal cartilage transplants are used for the correction of de-
pressed nasal bridges or deformities due to loss of bones of the face.
As a rule the entire thickness of the sixth costal cartilage is used.
The treatment of these cases is long drawn out, several operations
being often required. The following estimates of time will be neces-
sary for the completion of the more serious remaining cases: 92
cases, 2 months; 82 cases, 4 months; aO cases, 6 months; 11 cases. 8
months; 7 cases, 12 months; 1 case, 18 months.
C. MUSEUM RECORDS.
An important feature in connection with the care of maxillofacial
injuries is the making of special photographs, drawings, plaster and
wax models, which, when (Complete and ai^embled. will give the
Army Medical Museum a most valuable historical and scientific col-
lection. At the three hospitals mentioned, there is a complete staff
of artists, photographers, and wax modelers, who are carrying on
this work.
18. Ophthalmology.
During the year the records of all qualified ophthalmologists were
carded and kept up to date. When officers were ordered overseas the
SURGERY. 1103
chief consultant in ophthalmology of the American Expeditionary
Forces was furnished with the rating of the officer's professional
qualifications.
A. OPTICAL UNITS.
On September 12, 1918, as the result of a cablegram from head-
quarters of the American Expeditionary Forces, the organization of
auxiliary optical units 9-11 was begun. This organization and its
equipment were completed on Xovember 7, 1918, and these units
sailed on November 12, 1918.
B. SCHOOL FOR OPHTHALMIC TRAINING.
On Jul}' 23, 1918, the senior consultant in ophthalmology' was
directed to begin the organization of the school for ophthalmic train-
ing at the Medical Officers' Training Camp, Fort Oglethorpe, Ga.,
and was in charge until this organization was completed. This work
was finished and the school fully equipped with teaching personnel
on August 7, 1918. It was formally opened on August 12, 1918, and
continued in operation until the close of the year 1918. (The organ-
ization and development of this school was described in article in
American Journal of Ophthalmolog}'. December, 1918.)
C. CONFERENCES.
Numerous conferences other than those occurring during routine
work were held: (1) On the disposition of trachoma patients in
the base and general hospitals and a letter formulated for the guid-
ance of the commanding officers. (2) With the division of aero-
nautics on the visual requirements of aviators at reexaminations (Oct.
11, 1918). (3) With the sanitary division on ocular conditions to
be recorded in the examination of soldiers at the time of demobiliza-
tion, on the revision of the ophthalmic diagnosis for the code book,
on the classification of ophthalmic operations, on the ocular examina-
tions of registrants, on forms for taking ophthalmic histories. (4)
With the*statistical division on the ophthalmic diseases on which sta-
tistical data are desirable. (5) With the medical section of the
Bureau of Railway Administration on the practical methods of test-
ing color blindness. (6) With the finance and suppl}^ division on the
distribution and purchase of artificial eyes, on the equipment for
" eye-centers," and on the instruments and drugs for overseas hos-
pitals, as well as for newly established hospital centers in this coun-
try. (7) With the legal department on the percentage of disability
to be allowed for the loss of one eye, the other eye remaining perfect.
D. LECTURES.
The following lectures were delivered by the senior consultant in
ophthalmology at the Medical Officers' Training Camp, Camp Green-
leaf, Ga. : Ophthalmic emergency surgery in warfare, Ophthalmic
examinations in general surgery. Focal infections in ophthalmic and
oto-laryngologic practice. Ocular interpretations of intracranial com-
plications in ear and sinus surgery, St. Dunstan's and refitting of
blinded soldiers. Ophthalmic war surgery and practice.
1104 EEPOET OF THE SURGEON GENERAL OF THE ARMY.
Tlie followino; papers were published : Blepharoplastic surgery in
warfare, Military- ophthalmic surgery, Concussion and contusion in-
juries of the eye in warfare.
19. Orthopedic Surgery.
An accurate card catalogue and cross-reference file of the ortho-
pedic personnel was constantly maintained in the Surgeon General's
Office. On these cards, in addition to the necessary data, all changes
in stations and the estimated ability and record of the officers were
noted.
Not until April, 1919, was it possible to supply all the requests for
orthopedic medical officers for base and general hospitals.
A. EQUIPMENT.
The medical officer on duty in the Surgeon General's Office in
charge of orthopedic supplies and equipment prepared and con-
stantly revised numerous lists of supplies and equiments and facili-
tated the shipment to the hospitals and camps overseas and in the
United States. Special monthly allotment of funds were arranged
through the division of finance and supply for the purchase by the
commanding officers of the different Army hospitals of special ortho-
pedic equipment and supplies.
B. IIsSTRUCTION.
The course of instruction began at Camp Greenleaf in 1917 was
continued and the period of instruction increased to six weeks. At
the Army Medical School all regidar officer students in attendance
i^eceived instruction by lectures and dissections at the school and by
clinical work at Walter Reed Hospital. Plans were completed for
instruction in all S. A. T. C. camps, but were halted during the in-
fluenza epidemic and abandoned after the armistice. Speciijl courses
were given at Walter Reed Hospital, the Children's and Massa-
chusetts General Hospitals in Boston, and the Ruptured and Crip-
pled and Orthopedic Hospital in Xew York.
At the request of the Surgeon General of the Navy, special instruc-
tion in splinting was given to the medical officers of the navy serving
on transports. Instruction in the manufacture of splints and appli-
ances was given at the expei'imental appliance shop of the Army
Medical School. In addition to the above, orthopedic courses were
given to officers at Philadelphia, Oklahoma City, Chicago, Los An-
geles, Fort Riley, and Fort Benjamin Harrison.
C. EXPERIMENTAL APPLIANCE SHOP.
There has been in operation at the Army Medical School an ex-
perimental appliance laboratory. Between 30 and 10 enlisted men
have been constantly on duty receiving instruction in the manufac-
ture of splints and appliances. Much equipment has been furnished
to the Army base and general hospitals.. This laboratory with its
excellent equipment has been of service to other branches of the
Medical Department. In addition to Base Hospital No. Ill, which
SURGERY. 1105
sailed in the late sprino- of 1918, five additional special orthopedic
hospitals were authorized on September 20, 1918. These hospitals
were authorized to provide additional personnel to include an officer
in charge of curative workshop, to provide for shop instructors, and
hydro and electro therapeutists. The organization of these hospitals
was well under way at the time of the armistice.
D. CAMP ACTIVITIES.
There has been an orthopedic surgeon in charge of the camp work
on duty in the Surgeon General's Office from July 1, 1918, to July,
1919. Up to t-he signing of the armistice there were five assistant
supervising orthopedic surgeons who visited the different Army-
camps and reviewed the work of the Army surgeons in the camps.
The duties of these surgeons were to examine the mobilizing troops
for orthopedic defects, and after the signing of the armistice to ex-
amine the troops awaiting demobilization.
A request was received at the Surgeon General's Office for an
orthopedic inspection of the troops in the coast defense. Much
useful work was accomplished by this inspection.
Orthopedic surgeons have been assigned to the development bat-
talions and the convalescent centers in the camps.
It was estimated that the services of two orthopedic surgeons were
necessary for 10,000 troops and seven for 60,000 troops in any camp.
Instruction was given in these camps to commissioned and non-
commissioned officers in the minor foot ailments. A pamphlet was
prepared, published, and distributed on this subject.
E. BASE AND GENERAL HOSPITAL ACTIVITIES.
In Jul}', 1918, an orthopedic surgeon was appointed as consultant
to the general and reconstruction hospitals. Numerous consultation
visits were made by him and assistant consultants to all the general
and almost all the base hospitals. The organization of orthopedic
sections of these hospitals was standardized in accordance with a
plan which was mimeographed and distributed with the approval
of the hospital division and the commanding officers of the hospitals.
A standard operative technicjue was prepared, mimeographed,
and sent out with the approval of the hospital division to all the
commanding officers for the use of the chiefs of the orthopedic sec-
tions in the hospitals.
After careful consideration it was decided that an orthopedic
service of 250 beds should be officered by 1 chief and 7 assistant
medical officers; a service of 500 beds by 1 chief and 12 assistants.
This estimate was approved by the Surgeon General. In the hos-
pitals designated as amputation centers the amputation section con-
sisted of 1 chief of the section and 1 medical officer to 50 patients.
On June 27, 1919. the section of orthopedic surgery ceased to exist
as a separate section of the division of surgery.
F. ARTIFICIAL LIMBS.
The problems of supplying artificial limbs to soldiers who had
lost arms or legs came up early during the war. and the first cases
1106 REPORT OF THE SUEGEOX GENERAL OF THE ARMY.
were fitted in the summer of 1918. Previous to the ado]Dtion of the
war-risk insurance act artificial limbs had been supplied by the
Medical Department. This act provided for the supplying of arti-
ficial limbs to soldiers discharged on or after October 6, 1917, the
date the war-risk insurance act went into effect. Owing to the fact
that the soldiers were under the jurisdiction of the Medical De-
partment until discharged some adjustment was necessary between
the Bureau of War Risk Insurance and the Medical Department.
The results of other nations in handling amputated ca^es had
clearly shown that the earlier the patient with an amputated limb
Avas out of bed the better in every way was his future outlook. The
^ledical Department, therefore, arranged to supply a temi^orarj^ ar-
tificial leg or ann to be worn until after the soldier's discharge and
until such time as his stump had ceased shrinking and had reached
the final condition where a permanent limb could be adjusted without
making immediate adjustments and changes necessary. "Wlien he
was ready for the permanent limb it was to be supplied by the
Bureau of War Eisk Insurance. Peg legs were Avidely used abroad
and were tried in this country, but the two principal objections
fceemed to make it necessary to make other provisions. These two
objections were the api^earance of the peg leg and the faulty habit
acquired in walking without knee, ankle joint, and foot. After some
research had been made and various expedients considered the plan
v.as adopted of supplying a temporary artificial limb which would
conform more to the human leg than the peg leg, which could easily
be supplied in large quantities, which was not so expensive as a
permanent leg and which served every purpose needed to allow the
soldier the opportunity of getting early on his feet, and of becoming
early accustomed to an artificial leg. This arrangement gave the
soldier's stump time to shrink and become toughened and gave him
an oiDportunity of learning about artificial limbs before acquiring
a more expensive and permanent one from the War Risk Insurance
Bureau some months after his discharge. Although the plan was a
new one and entered into, perhaps, with some hesitancy, it proved to
be practicable, feasible, efficient, and satisfactory. It would have
been even more so if the war had continued and there had been a
much greater number of amputation cases.
The total number of amputation cases during the war was about
3,800 of which 2,700 were legs (including thigh, below the knee, and
foot amputations) and 1.100 arms (including forearms, upper arms,
shoulder, and hand amputations) . These cases were fitted with tem-
porary artificial arms and legs, similar in design and construction
to the permanent type of Avood, excepting that the shell was made
of tough fiber board.
It was early demonstrated that the amputation cases would have
to be concentrated into a rather limited number of General Hospitals.
Rather elaborate fitting and adjusting shops Avere necessary as Avell
as a specially trained personnel. The folloAving hospitals Avere
designated to receive amputations: Walter Reed General Hospital,
Takoma Park. D. C : Letterman General Hospital, San Francisco,
Calif. ; General Hospital No. 3, Colonia, N. J. ; General Hospital No.
0, Fort McPherson, Ga. ; General Hospital No. 10, Boston Mass.;
General Hospital No. 26, Fort Des Moines, Iowa, and General Hos-
pital No. 29, Fort Snelling, Minn. OA'erseas amputation cases which
SURGERY. 1107
arrived sit port of Hoboken were transferred to General Hospital
Xo. 3, Colonia, X. J., to be distributed from this center to the other
amputation centers where indicated. Overseas cases arriving at the
port of Newport Xews were sent to Walter Reed General Hospital,
some to be later transferred to other amputation centers
Artificial limbs were at first purchased and supplied from the
central organization in the Surgeon General's Office, but later the
different centers w^ere given authority to secure their artificial appli-
ances, direct, but under directions to conform in general to the poli-
cies outlined b}^ the Surgeon General.
Outside of the Letterman General Hospital and General Hospital
Xo. 26, at Fort Des Moines, where special features were developed,
the general plan of fitting these temporary legs was as follows : For
below-the-knee amputations a plaster socket, carefully molded to
fit the stump, was made and fitted into the fiber shell of the arti-
ficial leg; in thigh amputations a leather socket was used and the
thigh shell adjusted to fit the stump as accurately as possible. At
the Letterman General Hospital a very satisfactory type of artificial
leg, which was more permanent in character than the temporary
appliance, was manufactured complete in the appliance or artificial-
limb shop. At Fort Des Moines a paper socket for below-the-knee
amputations was devised and used.
At all of these amputation centers a fitting or appliance shop was
early established and administered by an officer of the Medical or
Sanitary Corps, \vorking in cooperation with the surgeon in charge
of amputations. All artificial-limb fittings, adjustments, and re])airs
were made in these shops in addition to the manufacture and fitting
of orthopedic braces, appliances, and special splints. Each shop
occupied a building in the hospital grounds, and, in effect, was a
completely equipped, though small, machine shop and leather shop
combined. The ninnber of enlisted men employed in this work varied
from 10 to 30 at each shop, and nearly all were trained in this special
work after their entrance into the Army.
In connection with the work of the Bureau of War Risk Insurance
arrangements were made whereby they could return discharged sol-
diers to these centers, if necessary, for readjustment and replacements
of temporary limbs. After having worn a temporary limb for a
certain number of months, varying from 2 to 10, the soldier in the
meantime having been discharged from the Army, makes applica-
tion to the Bureau of War Risk Insurance and secures a permanent
limb. During this interval he has been wearing a temporary
limb, an inexpensive appliance which has given liim an opportunity
of becoming accustomed to wearing a limb and of becoming familiar
with the types of limbs, and time has also been given for the shrink-
age and hardening of the stump before a permanent limb is selected
and fitted.
The total number of amputation cases in England as a result of
the war was 35,771 on Xovember 30, 1918; the total munber in
Canada about 2,600.
Artificial arms : An artificial arm made of tough fiber and leather
with a metal frame and end plate was devised and issued. This
end plate was so made as to allow an artificial hand or hook, or other
practical appliance to be attached, each of these latter appliances
142367— 1»— VOL 2 9
1108 REPORT OF THE SURGEON GENERAL OF THE ARMY.
liavino; a spindle at tlie end which coukl be inserted into the end
phite, thus making it possible to use any number of kinds of appli-
ances desired.
20. Urology and Dermatology.
The committee on genito-urinary diseases and syphilis appointed
by the Surgeon (xeneral was active at the beginning of the fiscal
year. A member of the committee was present on duty in the office.
In July, 1918, every camp in the country Avas visited by a member of
this committee and the genito-urinary and skin service carefully in-
spected. Following this inspection a meeting of the entire committee
was held in the Surgeon General's Office and plans drawn up for
venereal infirmaries of a standard type. These plans were sent out
September 11, 1918, and work begun immediately. At the time of
the signing of the armistice many of the buildings had been com-
pleted and had been successfully operated.
The development of the i^ersonnel in them was upon the same plan
as that adopted in the base hospital. In manj^ cases a specialist was
detached from the hospital, and in others they were sent in. In many
of the camps an officer was detailed as camp urologist, and this offi-
cer had professional superAision of the cases, both in the base hos-
pital and in the venereal infirmary. In those camps Avhere this was
done the situation seemed to have been better handled than in those
with separate heads of these departments. At various times during
the year recommendations for the handling of the venereal situation
Avere made by this committee, the aim of these being to obtain as
much uniformity in the treatment of A'enereal diseases as practicable.
The effect Avas more perceptible in the treatment of syphilis. In
XoA'ember, 1918, the section of urology and dermatology was trans-
ferred from the diA'ision of infectious disea«ps to the division of
surger}'.
Before the armistice the committee had been in consideration of the
A'enereal problem of demobilization and had presented several recom-
mendations on this subject which were approA^ed by the Surgeon
General. Upon the signing of the armistice, there being no apparent
further need for the formal continuance of the cammittee.it was dis-
banded on Xovember 19. 1918. The Avork of the section thereafter
during the fiscal year consisted largely in recommendations with
reference to assignment of urological surgeons and acting as profes-
sional adA^sers in this specialty.
21. Roentgenology.
During the year 1918 there had been designed the various types of
military X-ray apparatus required for field service, together with an
X-ray ambulance and bedside unit. Schools of roentgenology had
]>een established and a large number of officers of the ReserA^e Corps
trained. Great quantities of X-ray apparatus and supplies had been
shipped to the American Expeditionary Forces.
During the fiscal year beginning July 1, 1918, the instruction of
medical officers continued, being concentrated at Fort Oglethorpe,
where a very complete school, Avith an output of 100 officers per
SURGERY. 1109
month was established. X-ray ambulances to the nmnber of 55 were
sent overseas. The increase in the size of the American Expedi-
tionary Forces required additional apparatus and supplies in enor-
mous amount, which were promptly forthcoming.
Officers returning from overseas were detailed as instructors at the
school, bringing the latest methods of foreign body localization, etc.
The military hospitals in the United States were fully equipped with
apparatus and staffed with competent operators. Enlisted men were
trained in large numbers as laboratorv^ assistants. Every military
hospital was in possession of an operating X-ray laboratory before
the arrival of its first patient.
During the epidemic of influenza many thousands of patients were
examined without removing them from their beds. 4,000 such exam-
inations being made at Walter Reed Hospital alone. A sufficient
number of trained officers were sent overseas so that at no time was
there any shortage of roentgenologists or apparatus where needed,
and it can be stated that no American soldier at any time suffered
from need of X-ray work. Fifty-four and one-tenth per cent of
patients admitted to Army hospitals in the United States were exam-
ined by X-ray; each roentgenologist served an average of 364
patients.
During the period from February to June, inclusive, a statistical
study showed 258,881 total admissions to hospital, 140,205 patients
Avere examined by X-ray, a total of 161,612 examinations being
made; 4,877 foreign bodies were localized; 35,414 chests examined,
5,283 gastrointestinal, 36,950 teeth, 3,504 cardiovascular, 43.245 bones
and joints were examined during this period.
The X-Ray school at Fort Oglethorpe was closed January 1. 1919,
having fulfilled its function. A course of instruction for officers of
the Regular Corps was instituted at the Army Medical School in
May in which two classes of officers, numbering 26, have been trained
in roentgenology. Practical tests of all sorts of apparatus and sup-
plies have been made in the testing laboratory established at the
Army Medical School. Data were collected for the personnel division
covering the attainments of all officers trained in roentgenology.
There were in service 998 roentgenologists. A second United States
Army X-Ray Manual was published. This was a volume of 500
pages.
Exhibits of Army X-ray work and apparatus were made at At-
lantic City during the meeting of the American Medical Association
in June. Permanent exhibits have been installed at the Army Medi-
cal Museum and Xational Museum in Washington. The Army X-ray
ambulance was driven to Canada and exhibited to the Canadian
Medical Society' at Hamilton. An enormous collection of X-ray
plates showing pathological conditions were collected for a permanent
library at the Army Medical Museum.
Statistics covering X-ray work were furnished the General StaiT
from time to time. Many valuable publications were made by roeni -
genologists in Army hospitals, copies of which are on file. Complete
data covering every phase of military roentgology have been pre-
pared and are on file.
1110 REPORT OF THE SURGEON GENERAL OF THE ARMY.
V. MEDICAL DEPARTMENT.
Persoxxel Division.
The developnient of the organization of the personnel of the
Medical Department for the fiscal year 1918-19 is divided into three
phases. The period between June 30, 1918, and August 7, 1918,
when the Reserve, National Army, and National Guard automati-
cally ceased to exist by changing the designation to the Medical,
Dental, and Veterinaiy Corps. The period between August 7, 1918,
and January 1, 1919, when the Reserve Corps was reestablished, and
the period of reorganization, January 1, 1919, to June 30, 1919.
During the first period the Medical Corps consisted of the Medical
Corps (permanent establishment), the ^Medical Reserve Corps (active
and inactive status), and medical officers of the National Army and
National Guard. During the second period all medical officers were
carried in one corps, the officers comprising the corps being desig-
nated as temporary and permanent. The third period noted the
discharge of temiwrary officers and the reorganization of the Medical
Officers' Reserve Corps from among discharged temporary officers.
The jDersonnel resources of the department were taxed in pro-
viding medical officers and enlisted men to meet the great emergency
produced by the influenza epidemic during the fall and winter of
1918-19. The estimated morbidity rate, amply jorovided for at all
military camps, posts, and stations, was without warning rapidly
increased beyond any anticipation. The situation was adequately
met and the medical personnel was quickly distributed throughout
the country and organized to meet the situation. During this period
the normal war activities of trainino; were temporarily restricted
in order that temporary hospitals for the care of influenza cases
might be adequately and efficiently manned and staffed. In most
camps the bed capacity of hospitals was tripled or quadrupled and
the personnel demand increased proportionately.
The greatest increase in the corps was during the latter fortnight
of October. During this period there was an increase in the Medical
Corps of 2,020 medical officers. It is interesting to note that this
was the period when the great epidemic reached its peak. The in-
crease in the corps was progressive up to November 15, after Avhich
date, as the result of progressive demobilization, the number of
medical officers progressively decreased until on June 30, 1919, there
remained in service 11,691. Eighteen thousand eight hundred and
ninetv-eight officers were discharged from service between Novem-
ber 15, 1918, and June 30, 1919.
PERSONNEL, 1111
1. Strength of Personnel, Medical Department.
a. increase in strength of personnel.
Strength icheu icar icu-'^ declared and greatest nuniher in service {about JVov. 15,
1918); also July 1, 1918, and June 30, 1919.
Apr. 6,
1917.
July 1.
1918.
Nov. 15-30, 1918.
June 30,
1919.
(X
a
P3
o
P.
B
o
1
2
o
a
3
o
Eh
3
2
o
i
13
o
Medical Department:
491
342
833
6,619
86
0
62
0
0
181
403
•450
867
20,096
20,963
1 154,556
2,957
1,389
1,547
11,640
168
120
12,186
9,238
989
29,602
30,591
1 264,181
948
11,783
12, 731
1 98,396
Dental Corps: ComTTiissioned. .
Sanitary Corps: Commissioned
Veterinary Corps:
86
0
62
0
0
0
0
0
0
0
181
211
0
118
97
• 0
0
2,000
2,746
1,389
1,429
11,543
168
120
10,186
229
0
115
4,391
2,919
1,887
4,620
2,919
2,002
17, 160
209
220
0
112
1,999
1,817
905
2,219
1,817
1,017
Enlisted
Ambulance Service: Commis-
sioned .
209
0
0
111
42
111
•
Oct. 30, 1918.
939
3,52417,956
939
21, 480
10,695
42
Army Nurse Corps
233
170
2,084 7,532
9,616
5,820
1
!
Including enlisted Sanitary Corps.
B. CHANGES IN REGULAR MEDICAL CORPS.
Major
general.
Brigadier
general.
Colonel.
Lieu-
tenant
colonel.
Major.
Captain.
Lieu-
tenant.
Total
June 30, 1918 .
1
1
0
2
64
60
112
109
296
349
394
264
867
June 30, 1919...
154
939
Losses:
Deaths. . . .
0
0
0
0
0
0
0
0
4
5
"2
5
21
9
Resignations
28
Retirements
1
0
1
1
2
1
0
12
Discharges
0
0
0
0
0
1
3
4
Declinations
0
0
0
0
0
0
20
20
Other causes
0
10
' 1
0
0
0
0
3
Appointments
0
0
0
0
0
0
145
145
1 Col. Ireland made Surgeon General, Col. McCaw made brigadier general, and Lieut. Col. Noble made
brigadier general.
Regular.
Temporary
Aug. 1, 1918: 2
Overseas
301
365
7,698
United States
14,963
Total
866
338
603
22, 661
June 30, 1919:
6,217
United States . ... . •
5,578
Total ...
941
11,795
2 Figuresfor July 1, 1918, will not be known until the records of the chief surgeon, American Expeditionary
Forces, are transferred to the Surgeon General's Office.
1112
REPOET OF THE SURGEON GENERAI. OF THE ARMY,
31.000
30,000
29,000
28.000
27.000
26.000
25.000
24,000
23,000
22,000
21.000
20.000
19.000
18.000
17,000
16,000
15,000
14.000
13.000
r2,ooo
11.000
(0,000
9.000
8.000
7,000
6.000
5,000
4.000
3.000
2.000
WIMAV JUN. JUL «. SEPIOCT NOV OEC- JAN. fER WD. APR. MAY m. JUL NjCSfPT. (tl NW. DEL JAN. EEB.MAfi. W» tWr JUN.
191V 1918 (919
Fig. 134. — Strength of the Medical Department. U. S. Army (not including
enlisted personnel, ambulance corps, and contract surgeons).
/
T
59
1
STRENGTH
MEDICAL DEPT
U.S. ARMY
BY MONTHS
APRIL. 1917- JUNE. I9IS
/
f
1
1
1
1
1
1
1
1
)
'medical 1
CORPS 1
MEDICAL CORPS
wiiRcsF rnspc;
1
1
1
1
1
1
I
\
CIVILIANS
DENTAL
SANITARV
V£TERINARY
1
1
\
\
/
1
1
\
/
/
z
1.490
t 1
\
\
<
/
L
\
\
\
#
1
/
nurse\.
\
1
1
1
1
}
CO
?p
;
\
I
1
/
1
/'
\
\
\
f
/
/
f
\
\
\
-
/
I
1
\
\
1
/
1
i
\
\
\
\
1
1
j
j
\
\
\
1
1
/
1
\
\
\
1
f
/
f
-i(
l.(
9!
> ~
\
\
1
1
1
'
\
/
1
1
1
y
■'
'^N
\
1
1
!
j
/
/'
c
IVI
LIA
NS
^.
1
1
1''
■"v
s^
1
I
/',
V
^^\
K
\
/
/
-'
"^
1
1
/
/
\
\
/
/
r
/
/
^
/oentalN
2 .9 IT
\
^
/
f
,
/
/
^
'Sanitary'
.
^
\
\
/
/
/
y
^/
^=^
^
-^
^^_
-^
^
■^
V
■"a.ooa;--
ETERINARY
--
-
.^.
>'
^
—
""
PERSONNEL.
1113
MEDICAL DEPARTMENT USA.
(commissioned)
AT>EAKOFLOAD"NOV-DEC.,I9I8
209 U.SARMY CORPS
Fi<;. IS").
C. STRENGTH OF :MEDI(AL OFFICERS RESERVE CORPS BY AVEEIvS. JANUARY
10 TO JUNE 3 0, 1910.
The medical section, Officers* Reserve Corps, was reorganized
January 1, 1919. Officers of the Medical Corps who served on ac-
tive duty and those who were commissioned or applied for commis-
sions prior to the operation of the armistice were eligible. The
weekly strength of the Reserve Corps by grades follows :
1114 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Colonel.
Lieuten-
ant
colonel.
Major.
Captain.
I Lieuten-
ant.
Total.
RemiLning (Melioal Offleer.s'
Reserve Corp.s not called to
active dutv)
Jan. 10, 1919
Jan. 17, 1919
Jan. 24, 1919
Jan. 31, 1919
Feb. 7, 1919
Feb. 14, 1919
Feb. 21, 1919
Mar. 1,1919
Mnr. S. 1919
Mir.15,1919
M;ir. 22. 1919
Mar. 29.1919
Apr. 5, 1919
Apr. 12.1919
Apr. 19, 1919
Apr. 26. 1919
Mav.3, 1919
Mav 10, 1919
Mav 17, 1919
Mav 24, 1919
June 2, 1919
June9. 1919
June 16, 1919
June 24, 1919
June 30, 1919
0
0
0
0
3
4
6
14
16
19
24
30
36
37
44
55
68
86
97
108
124
138
162
177
201
212
2
0
0
2
21
33
44
100
119
137
161
191
225
232
265
329
387
445
499
567
605
655
733
Grand total.
172
0
0
5
87
118
167
451
504
609
743
879
1,010
1,053
1,139
1,316
1,452
1,592
1,710
1,811
1,864
1,919
1,999
2,063
2,169
2,214
363
2
2
4
26
56
105
218
248
325
422
484-
553
578
620
728
766
827
883
902
908
921
934
943
948
949
537
2
2
11
138
212
323
787
891
1,099
1,362
1,601
1,847
1,926
2,105
2,467
2,715
2,994
3,234
3,436
3,5.52
3,686
3,885
4,026
4,249
4,336
4,336
4,873
D. STRENGTH OF MEDICAL CORPS, JULY 1, 1018, TO JUNE 30, 1919.
The regular Medical Corps ; Medical Corps, National Army ; Medi-
cal Corps, Xational Guard; and the Medical Reserve Corps were
consolidated into the Medical Corps. United States Armv, by Gen-
eral Order No. 73 August 7. 1918.
For convenience, the various corps have been consolidated for the
entire vear.
Date.
Major
general.
Brigadier
general.
Colonel.
7
65
/
150
(
151
7
151
7
157
7
157
7
160
10
160
9
179
8
179
8
199
7
219
7
221
/
221
/
222
6
203
6
206
6
201
6
192
6
190
5
197
0
191
5
190
0
197
3
221
3
219
Lieuten-
ant Major,
colonel.
Captain.
First
lieuten-
ant.
Total.
Julv 1, 1918
Julv 15, 1918
Julv 31, 1918
Aug. 15, 191S
Aug. 31, 1918
Sept. 15, 1918
Sept. .30, 1918
Oct. 15, 1918
Oct. 31. 1918
Nov. 15, 1918
Nov. .30. 1918
Dee. 15, 1918
Dec. 31, 1918
Jan. 15. 1919
Jan. 31, 1919
Feb. 15, 1919
Feb. 28, 1919
Mar. 15, 1919...-
Mar. 31, 1919
Apr. 15, 1919
Apr. 30, 1919
Mav 15, 1919
Mav 31, 1919
June 15, 1919
June 30, 1919
Per Adjutant Gen-
eral's OlBce rec-
ord.«, June 30, 1919.
216
392
393
393
396
397
402
404
353
370
420
460
470
482
491
460
437
427
441
486
489
466
447
414
437
1,970
1,992
2,005
2,045
2,056
2,090
2,125
2,134
2,066
2,157
2,282
2,418
2,398
2,340
2,328
2,226
2,160
2,061
1,944
1,976
2,050
1,924
1,877
1,774
1,847
5,625
6,052
6,538
6,923
7,176
7, .343
7,762
8,050
9,056
9,522
9,805
10,048
9,453
8,523
8,216
7,732
7,523
7,225
6,835
6,376
6,455
5,848
5,965
5,669
5,504
13,079
13, 732
14,432
14,828
15,172
15,303
15, 866
16,483
17,597
18,353
17,693
17,068
15,806
13,297
12, 159
11,677
11,212
10, 759
10,237
9,711
8,916
7,405
6,821
5,872
4,718
1,715 5,009
20, 963
22,326
23,527
24,348
24,965
25, 298
26,323
27,243
29,263
130,592
30,408
30,222
28, 357
24, 872
23,425
22,306
21,546
20,680
19,656
18, 746
18, 113
15,840
15,306
13,932
12,736
11,694
' 30. .592 larpe-it number in corps during the war.
persons; X EL.
1115
E. STRENGTH OF DENTAL CORPS, JULY 1, 1918, TO JUNE 30. 1919.
The Refriilar Dental Corps, Dental Corps, National Army : Dental
Corps, National Guard : and the Dental Reserve Corps were consoli-
dated into the Dental Corps, United States Army, by General Order
No. 73, August 7, 1918.
For convenience, the various corps have been consolidated for the
entire year.
Date.
July 1,1918
July 15, 1918
July 31, 1918
Aug. 15, 1918
Aug. 31 , 1918
Sept. 15, 1918
Sept. 30, 1918
Oct . 15, 1918
Oct. 31, 1918
Noy. 15, 1918
Noy. 30, 1918
Dec. 15, 1918
Dec. 31, 1918
Jan. 15, 1919
Jan. 31 , 1919
Feb. 15, 1919
Feb. 28, 1919
Mar. 15, 1919
Mar. 31, 1919
Apr. 15, 1919
Apr. 30, 1919
May 15, 1919
May 31, 1919
June 15 , 1919
June 30. 1919
Per Adjutant General's Office records,
June 30, 1919
Colonel.
Lieuten-
ant
colonel.
9
16
9
17
9
17
9
20
9
22
9
24
9
26
9
26
Major.
80
81
80
81
81
81
84
84
88
91
102
103
103
108
110
108
104
104
101
111
114
115
128
151
179
163
^^Ptain. ^e'l^f -
222
232
245
254
261
276
284
284
288
292
368
389
391
431
436
430
431
427
419
418
454
484
506
614
706
2,624
2,714
2,809
2,952
3,046
3,171
3,730
3,740
3,800
4,101
4,124
4,045
3,853
3,290
2,983
2,681
2,554
2,446
2,348
2,210
2,088
1,871
1,774
1,546
1,300
1,168
Total.
2,957
3,058
3,165
3,318
3,420
3,559
4,129
4,139
4,205
4,510
1 4, 620
4,563
4,373
3,855
3,554
3,244
3,114
3,002
2,893
2,765
2,682
2,499
2,439
2,344
2,220
1,977
' 4,620 largest number in corps diu'ing the war.
F, STRENGTH OF DENTAL RESERVE CORPS ENDING JUNE 30, 1919.
Number of officers in Reserve Coi^ps who were never on active duty
now automatically placed in new Reserve Corps 1, 410
New appointments in new Dental Reserve Corps by months as
follows :
November, 1918, none.
December, 1918, none.
.January, 1919 259
February, 1919 ' 1, 367
March, 1919 110
April, 1919 ' 343
May, 1919 128
June, 1919 48
Total 2, 255
Grand total 3, 665
' 2 colored officers. - 1 colored officer.
11 If) REPORT OF THE SURGEON GENERAL OF THE ARMY,
MEDICAL DEPARTMENT
COMMISSIONED AND ENLISTED. U.S. AND A.E.F.
AT "peak of load." NOV.- DEC, 1918
DENTAL (COM.) 2.671
SANITARY (COM.) 1.691
VET. CORPS (COM.) 1.086
U. S.AMB. CORPS JCOm 184
CONTRACT SURGE(^S(COMj 93 I
iSQ^JPENTAL (COM.;
1. 18 1 SANITARY (COM.)
[877 VET CORPS (COM.)
22 U. S. AHB. CORPS (COM.)
8 CONTRACT SURGEONS (COM.)
Fig. 136. — Strength of the Medical Department at the maximum, not inehiding 21.480
nurses, 10,695 civilians, 591 Medical Corps, 147 Dental Corps. 47 Sanitary Corps,
39 Veterinary Corps, and 17.160 enlisted men. Veterinary Corps.
PERSONNEL.
1117
TOTAL MEDICAL DEPARTMENT
At'pEAKOFLOAD," N0V-DEC..I9I8
COMMISSIONED, ENLISTE D AND CIVILIAN
2,002VETERINARY CCOM.X
209U.S.AMB.SERV.(CO
2,919SANITARYCC0MJ
39CONTRACTSURGE0NS
\
^^^MEDlC^"^
Fig. 137.
1118 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
G. STRENGTH OF VETERINARY CORPS (BI-WEEKLY), JULY 1, 1918, TO
JUNE 3 0, 11) lit.
The regular Veterinary Corps ; ^"eterillary Corps, National Army ;
Veterinary Corps, National Guard; and the Veterinary Reserve
Corps were consolidated into the Veterinary Corps, United States
Army, by General Order No. 73, August 7, 1918.
For convenience, the various corps have been consolidated for the
entire vear.
Date.
July 1. 1918
JululS, 1918
July 31,1918
Aug. 15, 1918
Aug. 31, 1918
Sept. 15, 1918
Sept. 30, 1918
Oct. 15, 1918
Oct. 31, 1918
Nov. 15, 1918
Nov. 30, 1918
Dec. 15, 1918
Dec. 31, 1918
Jan. 15, 1919
Jan. 31, 1919
Feb. 15, 1919
Feb. 28. 1919
Mar. 15, 1919
Mar. 31, 1919
Apr. 15, 1919
Apr. 30, 1919
May 15, 1919
Mav31,1919
Juiie 15, 1919
June 30. 1919
Per Adjutant General's Office
records, June 30, 1919
Colonel.
Lieuten-
ant
Major.
colonel.
• 1
46
1
46
2
49
2
49
3
56
3
56
3
59
3
59
4
59
4
62
4
64
4
71
3
71
3
78
3
84
3
82
2
80
2
80
2
80
2
//
2
75
2
75
2
75
5
74
4
70
4
67
Captain.
96
96
106
106
119
119
122
155
159
152
150
183
185
176
169
163
192
175
175
176
170
193
186
173
First lieu-
tenant.
Second
lieuten-
ant.
397
397
447
447
490
490
504
505
505
628
644
642
637
633
.597
572
559
538
509
483
473
455
443
430
388
354
1,017
1,024
1,217
1,286
1,236
1,269
1,247
1,247
1,248
1,133
1,131
1,127
1,096
957
799
721
685
647
592
542
519
501
501
424
369
321
Total.
1,547
1,554
1,811
1,880
1,891
1,924
1,932
1,933
1,938
1,982
> 2,002
1,996
1,958
1,855
1,669
1,555
1,495
1,430
1,375
1,279
1,244
1,209
1,171
1,126
1,017
919
' 2,002 largest number in corps during the war,
H. STRENGTH OF SANITARY CORPS (BIWEEKLY) JULY
JUNE 30, 1919.
1, 1918,
Date.
Lieu-
Colonel. tenant
colonel.
Major.
I First
Captain. | lieuten-
ant.
Second
lieuten-
ant.
Total.
July 1, 1918
July 15, 1918
Julv31, 1918
Aug. 15, 1918
Aug. 31, 1918
Sept. 15, 1918
Sept. 30, 1918
Oct. 15,1918
Oct. 31, 1918
Nov. 15, 1918
Nov. 30, 1918
Dec. 15, 1918
Dec. 31, 1918
Jan. 15,1919
Jan. 31, 1919
Feb. 15,1919 ,
Feb. 28, 1919
Mar. 15, 1919
Mar. 31, 1919
Apr. 15, 1919
Apr. 30, 1919
Mav 15, 1919
May 31, 1919
June 15, 1919
June 30, 1919
Per Adjutant General's Office
records, June 30, 1919
45
47
47
53
58
58
61
61
63
69
83
83
81
82
80
74
74
74
71
68
71
67
69
81
108
106
334
345
356
374
378
396
425
431
451
495
497
496
490
484
453
442
433
425
415
407
419
409
406
418
487
464
919
947
1,032
889
904
936
939
951
1,049
1,080
955
949
940
880
803
825
813
794
767
740
708
637
624
565
529
506
138
240
432
621
705
804
931
1,151
1,245
1,378
1,368
1,331
1,173
1,028
903
886
1,027
1,029
1,005
976
901
876
826
089
649
1,388
1,480
1,677
1,751
1,964
2,098
2,232
2,377
2,717
2,893
» 2, 917
2,900
2,846
2,623
2,368
2,247
2,210
2,324
2,286
2,224
2,178
2,018
1,979
1,893
1,810
1,728
' 2,917 largest number in corps during the war.
PERSONNEL.
1119
I. STRENGTH OF AMERICAN AMBULANCE CORPS (BI-WEEKLT), JULY 1,
1918, TO JUNE 30, 1919.
Date.
Colonel.
Lieu-
tenant
colonel.
i First
Major, j Captain, lieuten-
ant.
Total.
July 1, 1918
July 15, 1918
Julv31, 1918
Aue. 15, 1918
Aug. 31, 1918
Sept. 15, 1918
Sept. 30, 1918
Oct. 15, 1918
Oct. 31, 1918
Nov. 15, 1918
Nov. .30, 1918
Dec. 15, 1918
Dec. 31, 1918
Jan. 15, 1919
Jan. 31, 1919
Feb. 15, 1919
Feb. 28, 1919
Mar. 15, 1919
Mar. 31, 1919
Apr. 15, 1919
Apr. 30, 1919
Mav 15, 1919
MaV 31, 1919
June 15, 1919
June 30, 1919
Per records of Adjutant General's Office,
June 30, 1919
133
134
150
1-50
151
152
151
151
175
174
174
174
174
169
168
169
168
167
165
165
149
138
132
115
87
168
169
184
185
186
185
184
184
207
206
1209
206
206
204
204
207
207
205
203
203
191
162
153
132
111
95
1 20? largest number in corps during the war.
2. Casualties, Commissioned Personnel (see p. 1435).
3. Casualties, Enlisted Men in the Medical Department, Ameri-
can Expeditionary Forces to June 30, 1919,
Classification.
Total.
Killed in action
Died of wounds received in action .
Died of accident
Lost at sea
Total direct casualties ' .
"WOVNDED.
Wounded in action
Wounded accidentally .
Total wounded . .
Prisoners of enemy, wounded
Prisoners of enemy, not wounded .
Total prisoners
Missing in action, yet unaccounted for .
314
206
1 Does not include deaths from disease, suicide, or unknown causes.
- Died of wounds while prisoner in Germany.
1120 REPORT OF THE SURGEON GENERAL OF THE ARMY.
4. Awards and Citatioxs in the ^Medical Department.
Classification.
Nurses. Total.
Disting:uished Service Cross
Distinguished Service Medal
Distiajniished Conduct Medal
Distinguished Ser\ice Order
Military Cross
Military Cross, Bar to
Lesionof Honor
Miiitarv Medal
Croix de Guerre with Palm
Croix de Guerre with Silver Star . .
Croix de Guerre with Gilt Star
Croix de Guerre with Bronze Star.
Medailles des Epidemics
Medaille de Honneiir en Bronze . . .
Total awards of honor emblems.
CITATIONS.
Ordre Corps d'Armee
Order of the Brigade
Order of the Division
Order of the Regiment
Ordre de Service du Sante
Trench Fever Investications
Other citations (or particular bravery or distinguished conduct.
Total citations to Army Orders
Total awards and citations for year
1,349
1,205
Ambulance Sections cited in French Army Orders:
No. 567, Februarv, 1919, Order of the Army.
No. 580, November, 191S, Order of the Division.
No. 583, October, 191S, Order of the Army.
No. 623, Januarv, 1919, Order of the Division.
No. 629, October, 1918, Order of the Armv.
No. 633, Julv, 1918. Order of the Armv.
No. 641, August, 1918, Order of the Division.
No. 649, Julv, 1918. Order of the Division.
Section .591 awarded Croix de Guerre December 22, 1918, and January 12, 1919.
Surgeon General's Office, Enlisted Personnel, July 29, 1919.
5. Dental Corps.
At the close of the last report there was a total of 5,837 dental
officers commissioned, and at the signing of the armistice there were
0,284 in the corps, a very small increase, due to the fact that examina-
tions for commission in the Dental Eeserve Corps had been closed
September 18. 1917, and only those who pos-sessed special qualifica-
tions and others who received specific authority were gi^anted a com-
mission during the period which this report covers.
On September 30. 1918. authority was obtained to increase the
flental personnel from one dental officer per thousand total strength
to two dental officers per thou.sand troops in training in the United
States, and three dental officers to each thousand beds in military
hospitals. There Avere not enough dental officers commissioned to
take care of this increase, and examinations were reopened on October
3. 1918. Those dentists who were in actual military service were
given the first opportunity for examination, and 1,500 of those men
had been examined and were in the process of being passed upon by
the Final Review Board when an order discontinuing the issuance
of commissions was received from the Secretarj' of War on Novem-
PERSONNEL. 1121
ber 9. Approximately 500 examinations had been passed upon by the
Final Review Board, and recommendations for commission and as-
signment to duty had been made to The Adjutant General before
the armistice. Of these, only about 10 actually received commissions
and were ordered to duty.
The order of the Secretary of War which discontinued further
commissions in the Army was modified later to permit the commis-
sioning of those men whose examinations were initiated prior to
November 11, 1918. and on this authority approximately 1,500 ex-
aminations were carried through to final decision, and recommenda-
tion for commission, inactive status, was subsequently made to The
Adjutant General. Thus 1.509 officers were commissioned in the new
Reserve Corps. At the close of this report there were 920 officers
who had been on active duty and who upon discharge requested
recommissioning in the new Reserve Corps and have accepted com-
missions. Those officers who were in the Reserve Corps but who
were never on active duty were automatically placed in the new
Reserve Corps, and the new Reserve Corps now totals 2,999 officers,
of whom 25 are majors, 101 are captains, and 2.873 are lieutenants.
There were on active duty 4,510 dental officers when the armistice
was signed. Of these approximately 2.000 were with the American
Expeditionary Forces. Of the 1.510. 9 were colonels, IT lieutenant
colonels. 91 majors. 292 captains, and 1.101 first lieutenants. Al-
though the corps was entitled to 1,068 majors, based on the number
of officers on active duty, only 96 had reached the grade of major
because of the rules of promotion which required that dental officers
enter the service as first lieutenants and were promoted only after
recommendation through military channels. Only 292 reached the
rank of captain because it was required that a dental officer should
have at least three years" private practice or one full year's military
service before he was eligible for promotion to that gi-ade.
A large percentage of dental officers called to active duty during
the period which this report covers were assigned to the dental
officers' training camp. Fort Oglethorpe, Ga., for basic training.
The school was closed December 15. 1918. and practically all officers
were discharged and returned to civil life.
Discharges Avere granted as rapidly as possible, but for a time
applications for discharge were disapproved because of the great
demand for dental officers in general hospitals.
On Xovember 1 examinations were held for candidates who de-
sired to enter the Regular Army, and 32 dentists qualified but have
not received appointment pending reorganization of the Regular
Army.
Nine officers of the Dental Corps. Regular Army, have tendered
their resignations and the resignations have been accepted since the
signing of the armistice. Six other officers of the Regular Corps
have forwarded their resignations, but same have been disapproved
for the present because the reasons presented were not considered
as urgent, and it was hoped that legislation reorganizing the Regu-
lar Army Avould cause these men to consider service in the Dental
Corps more favorably.
At the close of this report there were approximately 2,339 dental
officers on duty.
1122 report of the surgeon general of the army.
6. Army Nurse Corps.
a. general discussion.
During the fiscal year ending June 30, 1919, the Army Nurse Corps
reached its zenith. On the day the armistice was signed, Novem-
ber 11, 1918, there were in the service, or under orders to proceed
to their first station, 3,52-4 reguhir nurses and 1T.95G reserve nurses,
making a total of 21,480; 11,235 of this number were distributed to
174 stations in this country, the Philippines, Hawaii, and Porto
Rico ; the remainder, 10,245, were serving overseas, en route, or await-
ing transportation at ports of embarkation. The distribution, on
November 15, 1918, before the demobilization consequent upon the
signing of the armistice was begun, in this country and overseas
was as follows :
Number of nurses :
2, 431 serving in 37 general hospitals.
6, 610 serving in 38 camp and base hospitals.
568 serving in 41 post hospitals, arsenals, and recruit depots.
7.56 serving in 5 embarkation hospitals.
192 serving in 3 debarkation ho.spitals.
490 serving in 36 aviation stations.
96 serving in 9 miscellaneous stations such as the Surgeon General's
Office and attending surgeon's office, Washington, D. C. ; and
nurses's mobilization station, Hotel Albert, New York, N. Y., etc.
32 serving in 3 stations, Philippine Department.
16 serving in 1 station, Hawaiian Department.
44 serving in 1 station, Porto Rico.
742 serving with British forces.
14 serving with French forces.
8, 044 serving with American Expeditionary Forces.
1, 445 awaiting transportation, en route to mobilization stations, or under
orders to mobilize.
(This distribution does not include nurses on final leave or under
orders to proceed to their homes for discharge or relief from
active service.)
21,480
Since November 15, 1918, demobilization has reduced the corps
to approximately half the above total.
Early in the fiscal year a shortage of graduate nurses in the coun-
try became apparent, and both the Army Nurse Corps division of
the Surgeon General's Office and the Red Cross nursing service in-
augurated drives to obtain the needed number. Nurses were also
appointed in the regidar corps for the period of the emergency only.
Nurses responded to the call for their services in large number, but
it was a difficult problem to supply the daily demand.
When the influenza epidemic assumed serious proportions in the
fall of 1918 nurses awaiting transportation at the port of embarka-
tion were rushed to near-by hospitals for temporary duty pending
sailing orders. In consequence of the epidemic and the great need
for nurses in this country authority was sent to all commanding offi-
cers of the cantonment and general hospitals to employ civilian gradu-
ate nurses locally during the emergency, to be allowed $75 a month
pay, one ration a day, lodging, l^iundry, transportation, and $4 a
day in lieu of traveling expenses to join their first station and re-
PERSONNEL. 1123
turning home from last station. The sick report of nurses during
the epidemic was A'ery high, and 127 died from influenza or pneu-
monia resulting from it. As the epidemic subsided somewhat it was
possible to again withdraw nurses from the cantonments and gen-
eral hospitals in this country to form the personnel of base hospitals
for overseas duty. The latter part of October the mobilization of
nurses was resumed, and those nurses who had been temporarily
assigned to duty in the cantonments during the period of the epi-
demic were returned to the mobilization station. The personnel of
base hospitals, replacement, and special units were sent overseas as
rapidly as transportatior facilities could be secured.
Early in August. 191», all the base hospitals organized hj the
American Red Cross nursing service, Xos. 1 to 50, had been sent
to Europe. Base Hospitals Xo. 51 upward to Xo. 79, and the special
hospitals, Xo. 102 for duty in Italy, Xo. 114 for orthopedic cases, Xo.
115 for head surger}', Xo. 116 for fracture cases, and Xo. 117 for
psychiatric cases were organized in the Army Xurse Corps division
of the Surgeon General's Office. The personnel was selected from
among those nurses who had proved themselves professionally and
physically fit for duty in the cantonments in this country. There
were 1,415 nurses at the port of em])arkation awaiting sailing orders
en Voute to the mobilization station or under orders to mobilize when
the armistice was signed. Of the number awaiting sailing orders
650 were sent overseas upon th^ request of the chief surgeon American
Expeditionary Forces.
Since the signing of the armistice, Xovember 11. 1918, many hos-
pitals have closed, and the corps has been gradually reduced in size
as the need for tlie services of nurses has lessened until on June 30,
1919, there were in the corps approximately 2,084 regular nui^es and
7,532 reserve nurses. making a total of 9,616, including 3,448 over-
seas. This number does not include those under orders for discharge,
en route to their homes for discharge or relief from active service,
or on final leave, which would approximate 3,300 in number. There
have been 48 nurses transferred from the Eeserve to the Regular
Corps since Xovember 11, 1918.
In order to avoid delay at ports of debarkation blanket authority
was given to the surgeons ports of embarkation, Hoboken. X. J., and
Xewport Xews, Va., to send all nurses arriving from overseas who
request it to their homes for separation from the service. The de-
mobilization of nurses in this country could not be effected as rapidly
as those returning from overseas because of the number of wounded
soldiers returning to hospit'^ls in this country for treatment.
The Army appropriation bill for the fiscal'year 1919, passed July
9, 1918, carried with it provisions for the reorganization of tlie Army
Xurse Corps. This bill increased the number of executive officers of
the corps, authorizing six assistant superintendents. Four were as-
signed to duty in the Office of the Surgeon General to assist the
superintendent of the Army Xurse Corps. The positions of director
and assistant directors for each Armv or separate military organiza-
tion outside the limits of the United States were created. The pay
of all members of the corps was increased from $50 to $60 while serv-
ing in this country, and from $60 to $70 while serving overseas.
Provision was made for a sick leave for nurses of 30 dnjs in each
142367— 19— VOL 2 10
1124 REPORT OF THE SURGEON GENERAL OF THE ARMY.
calendar year, following disability incurred in line of duty. The pay
of chief nurse was inadvertently reduced from $30 in addition to
pay of nurse to but $10 in addition, but the former rate of $30 over
the base pay was restored by act of Congress dated February 28. 1919,
to be retroactive effective as on and of July 9, 1918.
A total of 260 nurses died from all causes while serving as mem-
bers of the Army Nurse Corps during the war — 164 in the United
States and 102 overseas.
A number of nurses have been decorated by foreign Governments.
The Medaille d'Honneur was conferred on 37 members of the Army
Xurse Corps by the French Government ; the silver cross of St. Anne
was conferred upon 8 nurses by the Kussian Government : the British
Royal Red Cross was conferred upon 34 nurses by the British Gov-
ernment : and the order of the Croix Reine Marie was conferred on
3 nurses by the King of Roumania.
The services of the nurses during tlie past war have been charac-
terized by marked unselfishness and devotion to duty.
B. ar:my school or xursing.
As stated in the report of the Surgeon General for the year 1918.
the establishment of tlie Army School of Nursing was approved by
the Secretary of War on May 25. 1918, as the method of providing
for the rapid expansion of skilled nursing service which the war
situation demanded.
a', statisticai, summary of the fiscal year.
On November 11, the date of the signing of the armistice, the
statistics relating to the school show 10.689 applications for admis-
sion filed. 5,267 accepted, 3,185 declined, 2.219 under consideration,
1.000 on duty in 25 military hospitals, wliile in the hands of the com-
manding officers were the names of 567 ready for assignment imme-
diately upon the withdrawal for overseas duty of a suffi dent number
of graduate nurses to provide the necessary acconmiodations.
For a brief period following the signing of the armistice the ac-
ceptance and assignment of students continued, bringing the accepted
applications up to 5,869, and the students assigned to 1,578 in 32 mili-
tary hospitals on December 21, 1918.
Evidence of a rapidly decreasing service led, early in 1919, to a
division of the student body into two groups, those desiring to render
temporary service only and those desiring to coni])lete the course
leading to the diploma of the Armv school. The statistical report at
the end of the fiscal year presents the total number remaining to com-
plete the course as 741 — 573 on duty in 15 military hospitals, and
168 absent in the affiliating schools; with 1,131 withdrawn. The
large number of withdrawals relates mainly to the high percentage of
applicants previousl - engaged in other occupational or professional
fields, a study of 4,( 9 accepted candidates showing that 3,820 were
so engaged, of whom 1.805 Avere teachers. Approximately 1,100 of
the students assigned to the military hospitals successfully completed
the preliminary course.
PERSONNEL. 1125
B.' PROGRAM OF EXPANSION.
Civil-school students. — As a means of further increasing the nurs-
ing personnel through a student body, and to steady the situation
in the civil hospitals by giving their students a place in the great
war program, an opportunity was opened in August to .the schools
of the 50 base hospitals first sent overseas to send such a number of
their senior students as could be spared, through affiliation with
the Army School of Xursing, for immediate service overseas.
A course in the military hospitals of four months was also arranged
for the senior and intermediate students of other civil schools,
through which, if adjusting satisfactorily, they would be prepared
for ovei-seas service immediately upon graduation, or could be sent
earlier if necessary; it being desired that the students in the Army
School of Xursing should have been in the service, if possible, a
year before being sent overseas. Information and regulations re-
lating to the course had been issued, and a number of civil schools
had signified their desire to send students when hostilities ceased.
Uosintal assistants. — In order to conserve all available material,
it was also decided to enroll as hospital assistants women disqualified
for overseas service by marriage or overage, and therefore not eligi-
ble for enrollment as students in the Army School of Xursing or in
the civil schools. It -was believed that this group, of whom approxi-
mately 1,000 have applied, would well supplement the graduate
nurses in the convalescent hospitals in this country, leaving the acute
service for the student body. To avoid complications and confusion
relating to eligibilitv and placement and to insure an increasing
competency of service through instruction and supervision, this
gix)up was entered as a division of the Armv School of Xursing.
Development of the school units. — The study of the military hos-
pitals had led to the conclusion that the best method of developing
the school was bv placing groups of from 25 to 30 students in the
various base hospitals, under qualified directors and instructors. The
large number of training-school executives who had been sent over-
seas and the shortage of such personnel in the civil hospitals greatly
complicated the problem. The temporary release, therefore, was
requested and was accorded by the boards of trustees of the Presby-
terian Hospital, Philadelphia: the Xewton Hospital, Massachusetts;
the Albanv Hospital, Xew York: the Johns Hopkins Hospital, Mary-
land: MacDonald College. Canada: and the State Medical Board of
Ohio of executives of their staffs of established ability and experience
in the nursing field, and. in the majority of cases, instructors with
pedagogical as well as professional preparation were obtained.
A most notable contribution was the privilege of the four months'
preliminarv course at the Teachers' College, Columbia University,
for the training-school unit at United States Army General Hospital
Xo. 1, made possible hv the authorities of the college through the
omission of all tuition fees for these students.
Cooperation of civil schools of nv7^sing. — Thr igh the exceedingly
generous response of the civil hospitals to the request for affiliations
School are amply covered. Those which the students have already
for experience with Avomen and children, the needs of the Army
entered are :
1126 REPORT OF THE SURGEON GENERAL OF THE ARMY.
New York: Boston: The Boston Floating Hos-
Bellevue Hospital. pital.
St. Luke's Hospital. Minneapolis : The University Hos-
The Post Graduate Hospital. pitals.
Baltimore: Other affiliations are with —
The Johns Hopkins Hospital. New York:
The Hospital for Women of Mary- The Brooklyn Hospital.
land. Nursery and Child's Hospital.
Philadelphia : The New York Ho.'^pital.
The Philadelphia General Hos- The Lying-in Hospital.
pital. Philadelphia :
The Presbyterian Hospital. The West Philadelphia Hospital
The Children's Hospital. for Women.
St. Louis : The Barnes Hospital. The Visiting Nurse Society.
Washington : Cincinnati : The Cincinnati General
The Columbia Hospital for Hospital.
Women. San Francisco : The Children's Hos-
The Children's Hospital. pital.
Camp Good Will (conducted by Washington, D. C. : The Providence
the Associated Cliarities for Hospital.
children. Newton, Mass. : The Newton Hospital.
Chicago : Boston : Boston Lying-in Hospital.
The Chicago Lying-in Hospital. Chicago :
The Children's Memorial Hos- The Illinois Training School,
pital. Cook County Hospital,
liockford, 111.: The Rockford Hos-
pital.
As all of the stiulents entered the school between July, 1918, and
Janiiai\v, 1910. and many were allowed credits of from three to nine
months, an earlier affiliation for the services in the civil schools than
is usual was necessary.
The ease with which they have fallen into their place in the civil
hospitals, and for a more demanding service, after less than a year's
experience in the military institutions — the reports being exceed-
ingly satisfactory — evidences the place they would have taken had
they been sent, as it was expected they would be at this time, for
.service overseas.
While it is true that a nursing personnel of 1,800 was an almost
insignificant figure in comparison with the large numbers of grad-
uate nurses, nevertheless there is abundant evidence that the students
rendered a definite service. Approximately 500 were called by tele-
grams clearly indicating the discomforts and danger involved at the
outbreak of the influenza epidemic, with a fully 90 per cent response.
Twenty-two succumbed to the disease.
C' CONTRIRUTIOX OF THE SCHOOL.
It is obvious that 1,800 student nurses made no appreciable con-
tribution, from the standpoint of numbers, to the nursing service in
the war. The value of the experiment lies in that it demonstrated
without doubt the great asset a well-established school under the
Medical Department would be in the rapid expansion of nursing
service required by a similar emergency.
The statistics relating to the applicants are important in estimat-
ing the value of the school as a supplement to the graduate-nurse
staff from the standpoint of numerical strength. It will be recalled
that the enrollment of the approximately 2'2.000 graduate nurses had
extended over 17 months. The 10,689 candidates who applied for
PERSONNEL. 1127
admission to the school in the period of five months, therefore,
equaled one-half of the enrollment of graduate nurses, and the 5,869
accepted candidates one-fourth. The supply of young women meet-
ing the educational requirement of four years of secondary work
was by no means exhausted and, had the war continued, there is little
question that the requirement of 5,000 students on duty January 1.
1919, and 15,000 by July 1, or an even greater number, could have
been met.
Upon the establishment of the school as a permanent institution
the preliminar}^ course for all the students will be given at Walter
Reed and Letterman, or possibh' onl}'' at Walter Eeed. Had it been
possible through one or two well-equipped posts to give a three
months' intensive course, manj^ of the difficulties and all of the break-
downs that occurred would have been averted.
Attention need hardly be called to the exceedingly desirable re-
serve corps the graduates of such a school would form and from
which could be selected the executives so greatly needed and in such
increased numbers in war times. Not all the graduates would re-
main in the service. It is probably that not even all the graduates
demonstrating executive ability could be assigned to military posts
in times of peace, but all would be conversant with military methods,
while a postgraduate course in administrative work is quite possible
of development. An executive experience that included both the
civilian and military hospitals would be of peculiar value in times
of war.
' C. DIETITIAN SERVICE.
The dietitian service, although a comparatively new branch of the
Medical Department, has grown considerably in size and importance
since the beginning of the war, at which time there were no dieti-
tians attached to Army hospitals. At the close of the fiscal year,
June 30, 1918, there were 161 dietitians in the service. At the time
of the signing of the armistice, Xovember.ll, 1918, there were 356
dietitians. Of this number 81 served overseas; the remaining 272
were distributed among 97 base, general, and post hospitals of the
United States. Since the signing of the armistice the numbers have
been gradually decreased, 194 having been discharged or are under
orders to proceed to their homes for discharge from the service.
There are still 28 overseas or en route to this country. There are 143
still in this country and Hawaii, distributed among 52 hospitals.
Nine new appointments have been made to fill vacancies.
Early in November, 1918, a supervising dietitian was appointed
and assigned to duty in the Surgeon General's Office. "
The increasing demand on the part of hospitals for additional die-
titians and complimentary verbal reports from commanding officers
are evidences of the popularity of this branch of the service. Some
of the larger hospitals have had as many as 10 dietitians. During
the epidemic of influenza, the dietitians proved themselves of ines-
timable value in organizing the forces for the feeding of the sick
and well. Three dietitians lost their lives during the epidemic and
several others were seriously ill from it. It seems unfortunate that
these professional women who worked side by side with nurses, doc-
1128 REPORT OF THE SURGEON GENERAL OF THE ARMY.
tors, and enlisted men should not have had the privileges of the war-
risk insurance.
The value of food and nutrition, for both sick and well, has come
to be recognized as such an important factor in Army life that it is
believed that the dietitian has come to be a permanent factor in all
well-regulated Army hospitals as well as civilian hospitals.
7. Instruction of Medical Officers at Training Camps. 1917
AND 1918.
A. GENERAL REMARKS.
The training camp for medical officers was established b}^ order in
Ma}', 1917, and the camp at Fort Riley, Kans., commanded by the
undersigned, was opened June 1, 1917.
It was the intention of the Surgeon General's Office at that time to
send medical officers coming into the service to such a camp for their
basic military training, with the idea that these men would be in
great part sent to divisions for duty with troops in the field. Follow-
ing that idea a course of instruction was outlined providing as thor-
ough instruction as possible in the three months, the time allotted.
This course was called the basic course and a letter of instruction em-
bodying an outline of this course was sent to the commanders of
camps.
The course as outlined was divided into three periods of one month
each.
The first period was intended to give, in addition to physical in-
struction, an outline of Army procedure covered by regulations ; also
a more thorough understanding of the life of the enlisted men. To
obtain this instruction in as thorough a manner as possible the officers
were divided into training companies, with company officers and non-
commissioned officers appointee! from their own ranks. At first, when
the number of regular officers on duty permitted this, a regular officer
was placed in charge of each company as a permanent company com-
mander. These companies were lodged in barracks and their daily
routine was very similar to that of the enlisted force. The experience
of two years in the war has thoroughly justified this method, and
much less trouble has been found to exist where officers who have re-
ceived this training of detachments of enlisted men. Furthermore, a
strict military discipline, combined with certain work of a dis-
ciplinary character, such as drills, etc., is very important in teaching
the officer to understand that he is a part of a machine and no longer
an individual who can do as he wishes and not directed.
The extreme physical exertion which an officer is called upon to
put forth in time of actual campaign requires that he should be as
physically perfect as it is possible to make him. Therefore a great
deal of attention was paid to careful physical instruction. The letter
of instructions prescribed 15 minutes' physical drill daily. This was
increased at Fort Riley to one-half daih', and as horses were not
available for equitation at first, the companies were given short prac-
tice marches of from 3 to 5 miles 5 days a week. This was in addition
to regular Infantry and sanitary drill, for which two hours daily
was alloAved. This physical instruction was found to be excellent and
improvement was very marked. Most of the officers were not only sat-
TRAINING CAMPS. 1129
isfied with work but later on, when the tmie of instruction was cur-
tailed and the practice march was discontinued to a certain degree,
there were numerous protests from the officers. One important error
was made in the beginning in that all officers were required to take
this ph3'sical instruction. This plan was changed later and arbitrary
decision made that officers 40 years old and over would not be re-
quired to take this work, but would be sent to the gymnasium for spe-
cial exercises under an officer trained in handling such work. Looking
backward I would go further than this in case of any future emer-
gency and provide officers understanding the proper training needed
to strengthen undeveloped and weak individuals. The whole number
of officers, regardless of age, on their physical examination should be
divided into classes and the undeveloped weakling be not allowed
to take heavy work until he has reached a certain degree of develop-
ment under special instruction. It can not be too strongly empha-
sized that especially qualified and instructetl officers should have
charge of this physical instruction. The average man knows so little
about it that he is dangerous.
The didactic instruction in this, first, was entirely militar}', con-
sisting of Army regulations manual, Medical Department paper
work, etc., as was particularly directed in the letter of instructions.
Lectures were not encouraged and all instructions of this character
were as far as possible carried out under tutorial lines. The classes
were small and each instructor taught his section by recitations, care-
ful explanations of detail, and every effort was made to pro^'ide even
the most backward in the classes with the groundwork sufficient upon
which to build his future experience. At Camp Greenleaf lectures
on these subjects, followed by a quiz conducted by quiz masters in
the comi^anies, was the method pursued. This was not satisfactory
for the following reasons: First, most men can not lecture on such
subjects and retain the attention of the class, particularly such large
classes, consisting of at times over a thousand men, which were pres-
ent at lectures at this camp. Second, the quiz was conducted by men
slightly more familiar with the subject than the students themselves,
and they were unable to explain a great deal of the work, and also
did not know just what the most essential points were that the lec-
turer wished to emphasize. In other words, it degenerated into ^
parrotlike recitation on the subject. It is my strong belief that
regulations of all kinds should not be taught in the same way that
spelling is taught in the average school. It is very necessary that
new officers should understand primarily the reasons for these regu-
lations and where regulations covering certain subjects can most
easily be found and studied. No one can memorize them and no one
should be expected to do so. The hours allotted in this first month
were changed for certain subjects, as too much time had been allotted
for some things and too little for others. A general reassignment
of these hours was gradually effected.
During the second month the phj^sical instruction and drill was
kept up steadily. This particular phase, though not altogether
pleasing at fii-st to the average student, gives very prompt results,
and where this was carried out carefully and tlidroughly it can not
be denied that the officer was improved remarkably in his general
attitude toward the military service.
1130 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Equitation was taken up only to a limited degree, priniarilj'^ be-
cause the number of animals available were not sufficient to give
them thorough instruction. Apart fi'om the desire to be able, as
officers in the Army, to ride and the physical training that it gives,
it i>5 questionable whether the time proWded was necessary. In
other words, with the modern methods of warfare an officer is sel-
dom called upon to be mounted and such training is not altogether
necessary.
Map reading and elementary sketching was taught to such an ex-
tent that a student was able not only to read his maps, but also to
find his way over unknown territory when provided with a map of
this territory. In field work I am of the opinion that knowledge
to that degree is necessary to all medical officei's. ^Many times the
sanitary units are left to their own devices and a knowledge of tb*^
terrain is absolutely necessary-. The teaching should be amplified
to such a degree that the officer will be instructed so that he can con-
duct his unit properly. In some camps this was not done and the
students had very little knowledge of a map when they were com-
pelled to use it.
In the second month training was more or less on specialized lines,
the student officer being detailed to different sanitary units for spe-
cial instruction in the handling of these units. This instruction is
extremely valuable, and the more of it that is provided the better
qualified the officer is to serve with such units under actual field con-
ditions. Another important factor presents itself in this regard.
Frequently after being detailed to such units an officer is found not to
be suited for the type of work, though he may be pai'ticulary well
qualified professionally. Such an officer could be eliminated from
the field service and be turned over to the professional schools for
special instruction on those lines. It should be noted that details
to the sanitary units in the three months' course can not be suffi-
ciently long to give thorough instruction in the handling of such
units, but is only intended to provide a sufficient knowledge to make
the men useful instead of ornamental.
A great deal of paper work was outlined for this second month,
and advisedly so. Though we constantly hear talk of too much
paper work, still a certain amount is absolutely necessary. These
officers at the training camp should have the elements of the work
ground into them by actual experience. These papers should not be
taught by demonstration alone but sufficient numbers of blank forms
should be provided so that every student officer can prepare a thor-
oughly complete set of medical department papers before he finishes
liis course.
Considerable instruction was ^iven on the subject of the medical
department in campaign, and instructors for such a department
should be carefully selected. It is found by actual experience that
the tendency is always to magnify one particular part of the work
to the neglect of others. This gives the student a one-sided view, and
it must be emphasized that instruction along this line must be so
thoroughly prepared that every part of the medical department is
given its full value and its work outlined to such an extent that the
student wdll have a clear picture of the entire scheme. One of the
l)est means of teaching this subject is l:>y the use of problems pre-
pared to show certain methods of procedure. These problems should
TRAINING CAMPS. 1131
be worked out by the student officer himself without assistance and
sufficient time be spent in a conference on each problem to show
flearly most of the principles encountered in this work.
Military hygiene and sanitation is another important subject
taught at this time. Again it is desired to emphasize strongly the
point that actual practical instruction should be used to the elimi-
nation as much as possible of lectures. Students should be com-
pelled to make sanitary inspections to such an extent that they
thoroughly appreciate the problem and understand the difficulties
before them. In field work so many improvised sanitary appliances
are used that a sanitary laboratory, so called, should be alwaj'S es-
tablished. In this laboratory, which is simply a plot of ground
set aside for the purpose, all sanitary appliances should be dem-
onstrated under actual working conditions. This will show the
student not only the good points of the approved appliances and
how to work them but also the defects of those that are not considered
practical.
The third month of training continued the physical instruction as
outlined in the first two months. The drill Avas changed in character,
and during this month officers were not drilled in companies but
were detailed as instructors for new companies and also in drilling
squads of enlisted men. This method is extremely good. It not only
tends to give a better knowledge of the drill, whicli is a rather sec-
ondary consideration, but also gives the officer much more confi-
dence in himself and gives him the habit of command.
The instruction in regulations comprised mostly the more ad-
vanced work of court-martial duty, the rules of land warfare, Geneva
and Hague convention. Court-martial procedure, though somewhat
foreign to the duties of the medical officer, still is very necessary, as
he will frequently sit upon courts for trials of cases.
Instructions in the handling of rations and mess management were
given, but considering pa.st experience it is thought that the time
allotted was entirely too small, and much more care and thought
should be given to this very important work. The feeding of sick
and wounded as well as soldiers is of extreme importance, and a
medical officer having supervision of this according to regulations
should have a thorough knowledge of this work. It is suggested
that this course be increased materially and officers be required to
act like mess sergeants for companies or hospitals. This would give
practical experience which is badly needed.
Certain instruction in military surgery, war psychoses, and other
purely professional subjects was given. If this three months' course
was the only one contenq^lated it is suggested that most of the in-
struction under such heads be confined to practical first-aid work,
and if a supplementary professional course is to be given this
should be left out entireh\
At Fort Riley careful instruction in trench warfare was given in
a thoroughly well-built system of trenches. This instruction can not
be given without properly built trenches and should not be attempted
except under absolutely practical conditions.
Some instructions in the organization and management of hospi-
tals of different characters and the sanitary service of the line of
comnnmications was given. This is necessary, but very little can be
taught on this subject except by practical demonstration. Details
1132 REPORT OF THE SURGEON GENERAL OF THE ARMY.
of the organization, etc., of the Red Cross were taught and con-
sidering the development of this war a considerable more thorough
course should be given and instead of one hour two or three should
be allotted so that all the details of this organization can be thor-
oughly well understood by the student officer.
A great deal of the time this month was taken up by ttxctical rides,
practical field maneuvers, and practice marches. This, in my opin-
ion, is essential, and every officer who is to serve at any place in the
zone of operations with the Army in the field should be thoroughly
familiar with all the operations of such an Army, not by theoretical
instruction but by practical field work under conditions as closely
simulating warfare as can be obtained. It has frequently been stated
that officers in the Medical Department do not need to know much
about such work, but observation overseas has shown that those
officers who are familiar with this work have functioned better and
have handled their sanitary units much more efficiently by reason of
this knowledge.
As it has been stated, this course of three months was primarily
instituted to give officers who are to serve with the troops in the field
the groundwork of military instruction. This is necessary, but one
must remember that all medical officers will not do field service, but
a large portion will be needed for the service of the rear. In time of
war the needs of the Medical Department are always so urgent that
it is practically impossible to give the men who do not go to give
the troops duty the full three months military instruction, though
they would not be injured but rather helped by being able to take this
full instruction. It is recommended that in such contingency they
be required to take at least two months of this instruction, to be fol-
lowed up. if necessary, by special professional instruction at profes-
sional schools. In peace times when preparing for war it is strongly
reconunended that full three months be given to each student officer
regardless of his special qualifications.
On reporting for training each officer should be examined carefully
as to his professional qualifications. This examination should not
be a written one, but oral, and held by officers thoroughly familiar
with such work. If the prospective student claims special knowl-
edge of any branch of medicine, he should be examined also by
a specialist in that line. By this means officers can be classified
after the three months' military training has been given and those
showing special qualifications can be given careful instruction in
special professional schools. During the three months' course clas-
sification of the officer can be continued and weekly reports by all
instructors should be made, giving their estimate of the officer's
general ability as well as his class standing. By these reports an
officer can be reclassified and if he is found unfit for military
service he can be placed before a board for final consideration. If
he has been found unfit for field duty and still is professionalh^
qualified he can be placed on the list for further professional in-
struction along special lines. An effort should be made continuously
during this three months" course to classify the men so that those
who are best qualified for field duty will receive such assignments
and those Avho would do better in professional work alone can be
placed in that category. In peace times it is recommended that
all receive this military instruction. Still the record of the officer
TRAINING CAMPS. 1133
can be so carefully made that when needed for special work an
officer properly qualified can be selected. The officer to be placed
in char^re of Ihis work should be one with a well-lialanced mind
and able to give proper value to all reports received in reference
to the men, and also to be such a judge of men that he can verify
his conclusions arrived at from instructors' reports by personal in-
terviews with the officers in question.
At the outbreak of the war it was not considered necessary to
give professional instruction to officers brought into the service for
emergency. This decision was very soon revoked and schemes
for further professional training of these officers were put into
effect. In the first place, it was found that men claiming to be
specialists in different branches of medicine had only very slight
knowledge of the specialty and required further training to make
them of value to the service. Furthermore the demand for special-
ists, especially along surgical lines, was much greater as the war
progressed and the visible supply diminished that young men hav-
ing the proper educational foundation Avere selected to be given
rapid courses in certain special subjects. This work as carried out
in the early months of the war at different medical schools in the
country was not satisfactory and the instruction received would not
qualify the officer to practice the specialty to only a slight degi^ee.
This was due to several reasons. In the first place, they were be-
ing trained by civilian physicians out of touch with Army needs
and these same physicians were looking after their own practice
and frequently teaching other classes in the same institution. Sec-
ond, on account of the basic defects in the methods of postgraduate
instruction is built upon the theory that the student is passive and
not active in the course which is given. In the third place instruc-
tion was almost entirely from a civil standpoint, and cases used
for demonstration were frequently types that would not be met
with in military service. It was recognized by the summer of
1917 that this instruction along special lines could l)e given at the
training camps themselves. When this method was approved by
the different sections in the Surgeon General's Office the training
camp at Fort Benjamin Harrison had been abandoned leaving only
Fort Riley and Camp Greenleaf as the places where this work was
to be carried out.
The work was started by the establishment of a school of roent-
genology, an orthopedic school, and a school for internal medicine.
These began in a small way, and an effort was made to select officers
as students who were particularly fitted for the different lines of
Avork, in addition to those who Avere reserAed by the several sections
in the Surgeon General's Office. From these small beginnings was
finally developed, at Camp Greenleaf, a postgraduate school which
Avas Avithout doubt the most complete one ever contemplated in this
country.
These professional schools consisted of the foUoAving: Military
surgery, internal medicine, anatomy, roentgenology, laboratory tech-
nique, neuro surgery, otolaryngolog>\ ophthalmology, applied
hygiene and sanitation, epidemiology.
These schools Avere Avell organized and Avere all headed by men
who Avere well-knoAvn specialists in these lines and who had been
1134 REPORT OF THE SURGEON GENERAL OE THE ARMY.
professors at some of the most prominent medical schools in the coun-
try. These schools were carefully inspected by the undersigned and
^Yere kept under careful superAision at all times, and, in addition,
each director was requested, at the time Camp Greenleaf was closed,
to give a detailed report of the operations of his school, with criti-
cisms and recommendations. The following remarks in reference to
these schools are the result of a close study of these reports, com-
bined with personal knowledge of the schools themselves.
B. SCHOOL or ANATOMY.
This school will be considered first, as its instruction was the basis
of a great deal of the instruction which was carried out in a number
of other schools established at Camp Greenleaf. When this was
organized there was no suitable place for a school at Camp Green-
leaf itself, so the laboratory of the medical department, University
of Chattanooga, was secured for this work and the school was then
organized. Arrangements were made for the purchase of material
through the secretary of Yanderbilt University. Instructors ap-
pointed were men who had considerable work as practitioners. The
organization contemplated a course of study whereby a student would
be able to get a thorough view of anatomy and applied surgical
anatomy.
It Avas first considered that it would only apply to the school of
surger}^, but as other special schools were established almost all
included a special course in anatomy covering their particular line
of Avork.
The basis of the instruction was an anatomical syllabus, which
was covered by lectures, followed by demonstration on dissected
material of the region considered. The classes were not put in as
a whole, with a demonstration by an instructor to the complete
number, but were divided into small sections of 10 men each, with,
as far as possible, an instructor to each section, so that not only could
the instructors demonstrate the material but the individual officer
could, by very close observation and actual Avork upon the cadaver,
get a thorough idea of the original anatomy upon Avliich he was
working.
The course as outlined covered from 10 days to 2 weeks, and,
though it was as thorough as possible under the circumstances, it
is recommended that if this course is conducted in peace times
at least a month be given to it as a basis for all instructions along
surgical lines.
Though most schools at the present time give a good course in
anatomy, still a physician who has completed such a course three or
four years previously has forgotten a great deal of his original
anatomy unless he has been very careful to keep it up, which few
men doing hospital work have the opportunity to do. Such a
course gives a groundAvork upon Avhich to build more thorough in-
struction in surgery and surgical technique.
It is strongly recommended that a well-balanced course of this
character handled on very much the same lines as the school at
Greenleaf be organized for basic professional instruction in all surgi-
cal specialties carried out through the professional schools to be or-
ganized in the Armv.
TRAINING CAMPS. 1135
C. SCHOOL OF SURGERY.
This school was not started until the summer of 1918, but it was
developed to the fullest extent during the latter months of the war.
The intention of establishing this school was to give, not so much
a complete surgical course as a course of anatomy and surgical tech-
nique with sufficient pathology to cause the officer to understand the
surgical conditions he would meet in warfare.
Each class spent about six weeks in the school and started off
their course by instruction in the school of anatomy. Five days was
allotted to this course, and a remarkable amount of good practical
instruction was obtained. After that the student officer received lec-
tures and special demonstrations at the school of surgery itself. If
the men qualified, ward instruction and instructions in the operating
room itself were given.
This school in contradistinction to those organized for other spe-
cialties was wholly intended to qualify as muTij men as possible for
surgical assistants. If the course should be given again in war
time or if, as contemplated, the school should be continued under the
peace administration it is recommended that more time be given to
the details of surgical diagnosis and technique and to general surgi-
cal pathology, cutting out as much as possible lectures of a didactic
nature.
This course should consist of two months of almost altogether
practical instruction, and in peace times men completing this course
could be detailed as assistants in the different hospitals controlled
bv the Army, and their instruction could be continued at those places.
D. SCHOOL OF ORTHOPEDIC STJRGERY.
This course consisted of two weeks in anatomy of the bones, joints,
and muscles, and two weeks of instruction in the manufacture of
standard Army splints and actual clinical demonstrations on ortho-
pedic cases from the wards of General Hospital Xo. 14 and out-
patient departments.
In this clinical work the class was handled in such a way that the
student officer came in personal contact with these cases instead of
having them demonstrated before the classes in an amphitheater.
Instruction in interpretation of plates in the X-ray department
was also given. The classes were taken at times for special demon-
stration to the surgical school and the pathological department.
The director of this school gave as his opinion that more anatomi-
cal instruction should be given in all of these special schools, par-
ticularly as the average medical officer showed considerable igno-
rance of even the elements of anatomy. This course, instead of
being four weeks as ordered, shoidd be increased to six weeks, the
last two weeks used for clinical work and instruction in ward man-
agement solely.
In peace times it might be thought be^t to combine the school of
surgery and the school of orthopatic surgery in one school of surgery
with a division of orthopaedic surgery in wliich instruction could be
given for men especially qualified for orthopaedic work. It is
thought that the ilemands of a large number of irthopaedic surgeons
is not great enough to establish a special autonomy for that branch
of surgery.
1136 REPORT OF THE SURGEON GENERAL OF THE ARMY.
E. SCHOOL OF ROENTGENOLOGY.
This school was orc:anizecl primarily to <rive a thorough knowledge
of the meclianics of roentgenoloay ^iid a primary knowledge of the
interj^retation of X-ray plates, and not to make finished roentgenolo-
gists. It appeared very earl}^ in the war that efforts to make officers
expert in this line would take too much time and would not be to the
best interests of the service. The major part of the work that was
done in the oversea units was of a very simple character, such as loca-
tion of foreign bodies, determination of fractures, etc., and the work
of a more complicated nature was to be done at centers where a
trained roentgenologist was on duty. Operating from these prem-
ises. The school was established with the most complete equipment
for instruction in the mechanics and electrical installation of this
section of the profession. A building was taken and equipped com-
pletely with machines of all types which were being used and classes
in small sections were carefully instructed from the most primary
principals up to a point which it was considered that these officers
would be suitable for work in France as outlined above. This method
of instruction was proved to be excellent and beyond doubt the
school as constituted was the best school of its kind in the world
and the results were frequently such that its graduates were better
qualified to handle the work thaii men who had been making X-ray
examinations for some years past.
The only change that I would suggest, in war time, would be to
give a little more instruction in anatomy of the bones and joints. If
this course is to be conducted in peace time it should be increased ma-
terially. The course as originally outlined to be a foundation upon
which to construct a more thorough instructio]i in interjDretation and
therapeutic uses of Roentgen ray.
F. SCHOOL OF UEOLOGT.
This school was established under the same auspices as the pro-
ceeding one, and on account of the normal constitution of an army,
instruction along this line was very necessary. It was found on ex-
amining officers entering the service that very few had a thorough
knowledge of urology though a great many claimed to be practicing
that specialty. It Avas found that a standardization of methods and
a proper instruction in those methods was extremely necessary.
This school provided a course of two months instruction which
gave the officer not only careful instruction in the treatment of
venereal diseases but also very thorough instruction in the finer
points of urology. The results were extremely gratifying and justify
the statement that such a school is of extreme importance in the
preparation of officers for Army service. In j^eace time or war time
this school should have its full two months' instruction as outlined.
Officers specially qualified to be instructed should be detailed to such
a course of military surgery.
G. SCHOOL OF OPHTHALjMOLOGY.
This school was established for the same reason as stated above, and
Avas extremely valuable in training men to be real specialists in this
TRAINING CAMPS. 1137
line, not that they were thoronghh' experienced, bnt still the instruc-
tion was such that they were able, after completion of the coarse, to
make the proper examinations and complete the diagnosis with a
great deal of confidence.
The course consisted of four weeks, most of wdiich time was spent
in teaching the methods of making examinations and instilling into
the student officer the need for system and thoroughness with this
most delicate work. The time allowed was sufficient for war-time
training, but in peace this should be lengthened to eight weeks at the
least and more clinical material used for the complete instruction
in diagnosis and treatment.
H. SCHOOL OF LARYNGOLOGY.
This school was established at the same time as the school of
ophthalmology. It consisted of a six weeks' course which was con-
ducted primarily to give sufficient knowledge of this work to permit
graduates from the school to carry on the routine work of this de-
partment without trouble.
One part of this course should be emphasized. This is the primary
anatomical instruction which was found to be required in practically
all cases. This conclusion was the same as with practically all of the
professional schools established. Medical officers did not know a
sufficient amount of anatomy to really understand the work of the
different branches unless a special course was given them.
The type of instruction carried out in this school was the same
as in other schools and included a few set lectures outlining general
schemes of work with the remainder of the time taken up by class
conference and practical clinical instruction.
One point which is brought up by the director of this school is one
wdiich has been strongly emphasized in all of our dealings with the
general medical profession. He decided that officers who are not
qualified for this work by previaus general medical education of the
first class or do not desire such type of work should not be ordered
to take the course, as the time is practically thrown away.
Finally it is recommended that this course of six weeks is suf-
ficient for war-time service, but a course of two months or even longer
is absolutely necessary if the school is to be instituted under our peace
administration.
I. SCHOOL OF PLASTIC AND ORAL SURGERY.
This school was established, unfortunately, in October, 1918, and
naturally could not be developed in the short time allowed by the
armistice to the degree of excellence as shown by the other schools
of earlier establishment, but I consider this work of great impor-
tance and would recommend that it be always one of the schools es-
tablished either for peace or war. The two months' course, as out-
lined at Camp Greenleaf, should be extended if the course is to be
of value in the instruction of officers to be real plastic and oral
surgeons. The actual time to be given can not be determined with-
out further study.
.1. SCHOOL OF N EURO-SURGERY.
This school, unfortunately, was not established until November
11, 1918, and it ran for such a short time that it is impossible to
1138 REPORT OF THE SURGEON GENERAL OF THE ARMY.
determine just exactly what changes should be made in the scheme
as outlined at that time. The system of instruction carried out was
as is stated in the following words by the director of that school:
"Anatomy and physiology were so correlated that the student was
not forced to ingest dry academic fact, but Avas given the living
conception of neurological mechanism.
The instruction was given wnth the desire of training men to such
an extent that they could act as assistants in operations on the brain
, cord and nerves. In any other scheme of professional instruction
it is strongly reconmi ended that this course be considered as part
of the curriculum and a course of at least two months should be
given to all students specially assigned to such work.
K. SCHOOL OF MEDICINE.
This school was primarily established to instruct officers who had
become members of the cardio-vascular or tubercular examining boards
and for some time was continued solely for that purpose. The
results under the guidance of some of the most expert teachers of the
subjects in the country were remarkably good. It was an actual fact
that officers who had not made a specialty of such a line were able
to master the subject sufficiently to make them very successful in
their work in something less than four wrecks' instruction.
As the school was expanded to take in internal medicine, per se,
this chest work was made the basis of most of the instruction re-
ceived. It was considered that as most illnesses of the soldier which
could be classed under internal medicine were in the upper half of
the body this section should receive the most attention, but careful
instruction was given particularly in physical examinations, han-
dling of ward work and the proper treatment of cases encountered.
From the nature of the cases considered this was a more or less
specialized instruction covering certain important diseases, and not
the entire field of internal medicine. In any future instruction in
this line it is recommended that this be pursued. If thorough in-
struction is given in cardio-vascular diseases, tuberculosis, kidney
diseases, and several other of the major pathological conditions the
student officer would be able himself to master these minor or less
frequently encountered illnesses without outsiders' assistance.
It is further recommended that this course be at least two months
in length, and that it be, as was strongly recommended by the director
of the school, a thorough and practical course with student officer
actively taking charge of cases in the hospital, and also given a
thorough course in proper physical examination. In conclusion it
should be noted that this systematic physical examination was so
little known by the average practitioner who entered the service that
the instruction had to be inaugurated from the most primary
principles.
L. SCHOOL or LABORATORY TECHNIQUE.
This school, unfortunately, was not properly established from the
beginning. The officer detailed in charge of it was not suitable and
consequently this school did not deA'elop as the other professional
schools did. This officer was relieved from the command of the
TRAINING CAMPS, 1139
school in the early part of October, 1918, and under a new director,
Maj. McFarland, the school proo:ressed wonderfully and bid fair,
if the war had continued, to take equal rank with the other schools
established.
Effort here was not to teach pathology and bacteriology entirely,
but a sufficient amount of technique to permit the graduates from the
school to act as laboratory assistants and make them a foundation
upon which to build a real wide knowledge of this work. The scheme
upon which this school was started is perfectly feasible for war time,
but during peace time instruction was the work at the laboratory
in Washington as carried out heretofore, would be much more suit-
able and would give better results. It is therefore recommended
that this action be taken.
M. SCHOOL or HYGIENE AND SANITATION.
This was one of the most important schools established, and un-
fortunately, though it was the oldest, the original scheme upon which
instruction was carried out was such that real practical instruction
was not given. A superficial knowledge of the theory of hygiene and
sanitation was imparted, but the graduates of the school were not
able to perform the duties of sanitary inspector, etc. This was
changed in the summer of 1918 by release of the then director, Lieut.
Col. Abbott, and the detail of Lieut. Col. Williamson as director of
the school.
The school was divided into several parts: First, a few formal lec-
tures and a course of reading of standard works on the subject:
second, the most important work of practical field instruction in
which the officers were to make sanitary inspections, etc., under care-
ful supervision; third, the practical study, including the drawing of
plans, of all important field sanitary appliances; finallv, a section
of the camp was assigned to surgery of this area.
The course covered one month, and at the end of that time it was
anticipated that an officer successfully completing the course woidd
be suitable for detail as sanitary inspector. This was not always the
case, because even after close observation and careful selection officers
temperamentally unsuited for this type of work were included in the
course and had to be eliminated.
With this work it is strongly reconunended that no officer be
allowed to take this course unless he has the full military course, and
if possible in time of war a longer period be allowed to this school of
at least six weeks or two months. It should be understood that the
detail of the sanitary inspector is one of such great importance that
no one should be given this unless he is thoroughly qualified. In
time of peace this course should be at least two months, and an
officer completing the course should be assigned to a detail for this
type for several months under close observation, and at the end of
that time it can then be decided whether he is suitable or not and
be given his final assignment.
N. SCHOOL OF EPIDEMIOLOGY.
The need for such a school was evident in the early days of the war.
Absolute lack of knowledge of communicable diseases displayed by
142367— 19— VOL 2 11
1140 REPORT OF THE SURGEOI? GENERAL OF THE ARMY.
officers was deplorable, and some scheme had to be evolved imme-
diately to provide epidemioloofical instruction for selected men.
The course as originated at Fort Riley was arranged with a mini-
mum auiount of lecture and class Avork with a maximum amount of
practical field instruction. This school at this camp was extremely
successful, and the student officers during part of the time took over
the handling of epidemiological work at Camp Funston, and were
very successful in immediately stopping a severe epidemic of
cerebrospinal meningitis. The practical demonstration of the value
of this work Avas shown by the fact that, though the camp at Fort
Rilev reached a maximum" of 8,500 men, there were never communi-
cable diseases which reached the stage of an epidemic.
Later in the fall of 1918 a similar school was established at Camp
Greenleaf, and the work done there was of high character, particu-
larly as the influenza epidemic handled by this school of epidemiology
was much milder and had fewer cases than any other camp of its
size.
The importance of this work can not be overestimated, and a school
of this character, probably in conjunction with the school of hygiene
and sanitation, should be an important adjunct in training during the
war and especially arranged for during peace times. It is recom-
mended that in the rearrangement of the professional schools that a
school of epidemiology be combined with the school of hygiene and
sanitation, and these student officers be given as thorough a course in
epidemiology as in any other branch covered in that school. The rec-
ommendation for this school was given under the heading of the
school of hygiene and sanitation.
VI. THE HOSPITAL DIVISION.
Tlie procurement of hospital space for the sick of the troops in
the United States and for the casualties returned from the American
Expeditionary Forces and the subsequent administration of this
hospital space is a subject which may be dealt with but briefly in
this report. To present the subject in a manner complete enough
to maintain continuity and thus enhance its interest would be un-
suitable for this report. There is in process of preparation, how-
ever, a more complete discussion of the subject, especially of the
procurement section with the necessary pictures and drawings to
illustrate. It is hoped to get the material for this work together
before the commissioned and civilian office force is reduced to a
prohibitive point.
The function of this division may be stated briefly to be the pro-
curement of all hospital space in the United States and the adminis-
tration of those hospitals operated directlv under the War Depart-
ment. The report of the work of this division will, for the con-
venience of this report, be divided into the following heads corre-
sponding to the functional subdivisions or so-called sections of this
division :
(a) Procurement section.
(h) Administration section.
(c) Census section.
(d) Statistical section.
HOSPITAL DIVISIOX. 1141
The above sections cover all the activities of this division. Tht-
short name given to them aims to state the keynote function of the
section, but in fact many other important activities allied or sub-
sidiary' were encompassed by the sections. For example: (a) The
procurement section included the necessary liaison with all agencies
instrumental in producing hospital space and liaison with the con-
templated users; it calculated the requirements and expedited con-
struction. It determined and stated the necessity for and obtained
lease of property, and the head of this section was the leasing officer
for the Surgeon General. Before the statistical section was estab-
lished, this section collected and collated data upon which to base
requirements. It prepared preliminary plans for hospitals and
working with the constructing agency of the War Department sup-
plied through to plan completion the Medical Department's require-
ments. It initiated cancellation and abandonment proceedings,
which in the latter months of this year bid fair to become almost
as long and complicated a matter as the acquisition of hospital
facilities.
(h) The administrative section, in addition to its signified func-
tion of handling the administration of the many hospitals directly
under the Surgeon General's Office, acted as the executive section of
the hospital divisions' offices. It procured hospital trains, hospital
cars, and unit cars, handled them for the office and maintained
liaison with The Adjutant General's Office and the ports of em-
barkation relative to hospital-train service. It undertook the pro-
curement and distribution of Sanitary Corps personnel for adminis-
trative work in the hospitals.
(c) The census section in addition to tabulating a daily tele-
graphic census of the number of sick in all hospitals operated by
the Surgeon General's Office manipulated the distribution of sick
from the ports of embarkation. It handled the subsequent move-
ment of sick, with the exception of individual cases, from one inte-
rior hospital to another and published a weekly table of hospital
space thus operated.
(d) The statistical section, in addition to preparing useful tables,
etc., kept contact with hospital personnel and conducted the intra
and extra office correspondence required by inspection reports by
sanitary inspectors.
More complete statements concerning the duties of these sections,
as well as the work done by them in this fiscal year, will follow
under the proper heading. What has been related above will give a
general idea of the management and distribution of the work.
1. Procurement Sectigis'.
a. securing of appropriations.
After careful study has been made of the forecasted requirements
for the fiscal year, including all necessary improvements and addi-
tions to the existing hospitals and the accumulated requests for new
construction at various posts and the purchase of land or lease of
properties, all are listed and reduced to beds and divided into ap-
proximately the portion to be leased, constructed outright or remod-
eled. The whole is presented to the construction division for esti-
1142 REPORT OF THK SURGEON GENERAL OF THE ARMY.
iiiatc wlu'iT a cost \nn- bed riili' is caivfully applied aiul the ago:rc'<2:ate
sum plus a margin of safety is set foith. ami the w hoh' is consolidated
with other bureaus' estimates and is placed before Congress through
the proper channels. This constitutes the basis for the " construc-
tion and repair of hospitals" ai)i)ropriation.
I'.. ri{i:rAi{.\i ION of s( iikdiles.
Schedules of buildings are prepared and forwarded to the con-
struction division with every request for new construction. These
schedules are based upon the re<iuirements for the particular hospital
or improvement desired, and incorporate all buildings or parts of
buildings to give the ne:essary complete service.
c. KxrEi)rriN(; rRo.iKCTs;
When projects weie approved and >ent to the construction division,
an expediting officer from this office followed them through the va-
rious stages of the construction process. Before a project was re-
leased from that office it had to receive the approval and signatures
of six officers, including the chief of division, after which it was sent
to the director of finance, by Avhoni clearance papers were, if money
was available, issued. During a portion of the year, and when ma-
terials and labor were most scarce, each project of over $25,000 at
this stage was also passed through the War Industries Board and the
Purchase, Storage and Traffic Division, General Staflf. It was then
returned to the construction division and sent to the General Staff,
for final authorization of the Secretary of War. It was the dutj^ of
this expediting officer to see that it went promptly to these various
divisions. After a project was authorized and work started, the
above-named officer conferred with the supervising constructing
quartermaster at frequent intervals, in order to supply full infor-
mation of our requirements and promote prompt execution of the
work.
D. PREPARATION OF PLANS.
The procurement section maintains a small drafting room where
all original sketches for hospital work are prepared. After the
sketches have been approved by the hospital division, and other di-
visions concerned, they are turned over to the drafting room in the
construction division, where the finished drawings are prepared.
The construction division maintains a drafting organization to take
care of the work from this office. While that organization maintains
complete control, the work is executed entirely under the advice of
the architectural officers in the procurement section of this office.
Before these plans are issued they are inspected and signed by the
liaison officer from the procurement section, and such signature is
the approval of the Surgeon General's Office. In many instances the
actual draw^ings of leased projects were prepared in the field, the con-
struction division assigning the necessary draftsmen and an officer
from the procurement section directing tlie design. This method of
handling the work was found verv desirable and highlv satisfactorv.
HOSPITAL DIVISION. 1143
E. PROCUREMENT OF HOSPITAL SPACE BY LEASES.
In order to procure the required hospital facilities it was necessary
to lease existing buildings and make such alterations as were re-
quired. This method resulted in a saving of money, quicker occu-
pancy, and at the same time avoided constructing new hospitals where
there was already a heavy demand, as well as shortage of all build-
ing materials and labor.
Tlie usual process of separate requests for lease and funds was
pursued with moderate success until about September 1. 1918, when,
after careful computation of actual and predicted casualties based
on larger troop shipments to the American P^xpeditionary Forces it
was determined that the building program was going to fall behind
unless more rapid means of leasing property and authorizing funds
for alterations were secured. It was deemed necessary to provide
for 38.500 beds during .the next 3 or 4 months in order to catch up
with the theoretical building program and that a total of 117,000
beds, in addition to those noAV provided, would be required in the
next 22 months, being approximately an increase of 5,500 beds per
month. Tliese accommodations were to be ])rovided for in new
general hospitals. To obtain these accommodations it would be neces-
sary to send out two commissions who would select the sites for the
proposed general hospitals.
On September IG the Surgeon General wrote a letter to the director
of operations presenting the above general scheme and with it again
pi'esented the general plan of hosj^italization in the United States,
and suggested that: (1) The recommendation of a board for leasing
the premises be approved at as early a date as possible. (2) The
tentative estimate of the representative of the construction division
as to the cost of converting the building into a hospital be accepted
and the necessary funds allotted when the lease is approved by the
War Department. Such a plan would save weeks of delav in secur-
ing accurate estimates as to cost of conversion of buildings. (3)
Immediately upon receipt of the information by wire that such a
l)uilding had been selected and agreement entered into with the
owners, the necessary architects be at once sent by the department to
make detailed plans for the conversion of the building into a hospi-
tal : the architects so sent be representatives of the Surgeon General's
Office and the construction division. As it requires approximately
three or four months to convert a building such as the Greenhut
Building into a hospital, with a need of 38.500 beds within a very
short time, quick action upon any recommendations received and
approved by the War Department is essential. To obtain by lease
or purchase existing buildings and facilities and to make modifica-
tions therein so as to accommodate practically 38,500 beds, the con-
struction division estimated that it would require an expenditure of
$15,400,000, chargeable to the appropriation " construction and re-
pair of hospitals." The funds were available.
It was believed that the boards constituted above should be given
such authority as would enable the department to obtain the number
of beds desired at the earliest practicable date, and it was so recom-
mended by the Surgeon General's Office. The plan of hospitalization
as previously decided upon provided that the patients shoidd be
1144 IIKPOUT OF THE SURGEON GENERAI> OF THE ARMY.
placed in hospitals at or near centers of population or on Govern-
ment-owned lands and as near their homes as practicable.
On September 21 the Assistant Secretary of AVar approved the
above scheme Avith the followinir main stipulations: That total cost
for lease and alteration should not cost the Government over $250
per bed per year; tliat the beds procured under this authority when
added to those already authorized in any hospital district shall not
exceed more than 1.") per cent of the ratio of the total authorization
which the population of that district bears to the total population
of the United States; that each project should be submitted to the
regional adviser War Industries Board for his clearance; that the
boards promptly telegraph action to the director of operations and
the Surgeon General's Office; and, finally, that the action of each
board nuist be unanimous. Under the above conditions the boards,
each composed of three members, one from the Surgeon General's
Office, one from the Construction Division, War Department, and one
from the real estate section. General Staif, could close leases, obligate
funds, and enter into contracts for construction. Where any of the
above conditions could not be carried out the project was to be
handled in the manner usual up to that time.
These two boards were supplied with all available data, references,
prospective projects, and with properties listed in the procurement
section. Surgeon General's Office, and in the real estate section. Pur-
chase, Storage and Traffic Division, General Staif. They proceeded
in a group to the various sites, and, acting and conferring as a body,
the medical officer representing the Surgeon General's Office decided
upon the suitability and adaptability for hospital purposes, the real
estate man investigated real estate values and prepared the lease,
and the construction division representative advised on structural
matters and prepared the estimate of funds to be obligated. The
lease was closed and the use of the funds authorized. It now re-
mained for the i)rocurement section. Surgeon General's Office, in
liaison with the hospital section. Construction Division, to send its
remodeling *' teams " to the site, work up the plans, and convert the
property iuto a hospital. These couunissions, one operating in the
East and South find one in the West and North, either visited or
corresponded with every city of consequence in all of the draft dis-
tricts of the country, with the result that every available building
useful for hospital purposes was thoroughly investigated. In the
selection of these sites the first consideration was that the patients
should be as near their homes as possible. A great numy projects
were voluntarily submitted to the Surgeon General for his consid-
eration and each one was carefully investigated as to its suitability
and adaptability. Many of these, of course, were eliminated for one
reason or another. First, they were not of sufficient size to warrant
establishing a hospital in that particular location ; second, they were
too great a fire risk ; and, third, they were not accessible to transpor-
tation. Others demanded exorbitant prices.
Many types of buildings were selected for these hospital accom-
modations ; among them were hotels, factories, department stores, ex-
hibition halls, civilian hospitals, infirmaries, and almshouses.
When notification from the boards was received in this office that
a project had been accepted and closed, a hospital architect from the
HOSPITAL DIVISION. 1145
hospital division and a constructing quartermaster from the con-
struction division proceeded to the site. The architect then designed
the necessary alteration in the building, providing for all the re-
quirements of the Surgeon General, and the constructing quarter-
master furnished the draftsman who prepared plans under the di-
rection of the architect. The constructing quartermaster planned
his work so as to be able to award contracts upon the completion of
the plans and specifications, so that there would be no delay in pro-
ceeding with the actual converting of the building for hospital use.
The time required for this work consumed from two to four months,
depending upon the amount of work that was necessary. However,
before the work was completed, notice of completion was given the
chief of the hospital division, and the hospital personnel was as-
sembled and immediately started work in procuring supplies, so that
there would be no delay in the reception of patients when the build-
ing was finally completed. This method of procedure saved con-
siderable time and expense, as the architect from the hospital division
decided all points pertaining to the hospital requirements and ap-
proved these plans at the hospital, making it unnecessar}^ that they
be forwarded to the Surgeon General's Office for approval. The
constructing quartermaster approved all construction work at the
site, with the exception of special particulars, such as plumbing, heat-
ing, electric, fire protection, etc. In these cases a special representa-
tive was sent from Washington to assist the constructing quarter-
master in laying out this work. This also saved considerable time, as
these plans did not have to be returned to Washington for the ap-
proval of the Chief of the Construction Division.
In October, 1918, the Surgeon General had five different hospital
architects with their necessary assistants working on different proj-
ects and was prepared to send out another. Each crew was supplied
with a sufficient number of draftsmen, who belonged either to the
hospital division. Surgeon General's Office, or the hospital section of
the construction division.
The following is a list of the buildings that were taken over by
this department and operated as hospitals:
1146
REPORT OF THE SURGEON (JENERAL OK THE AT^M Y
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1
HOSPITAL Dmsiox. 1147
F. RENEWALS.
Before the end of the fiscal year 1918 the hospital division de-
termined which hospitals should be continued and would be required
during the fiscal year of 1919. Form I-B, real estate service, was
then filled in and forwarded to the commanding- officer of each of
the hospitals required, who was requested to complete the form and
to verify all names, dates, etc. These forms were then returned to
the hospital division. Surgeon General's Office, where they were ap-
proved always by the same officer who had been designated as leas-
ing officer for the Surgeon General's Office and forwarded to the
Purchase, Storage and Traffic Division of the General Staff, where
new leases were prepared.
G. CAXCELLATIOXS.
After securing approval from the Chief of Staff of our recom-
mendation to discontinue a general hospital. Form III, disposal of
surplus real estate, was forwarded to the commanding officer for
completion of certain data obtainable only locally, after which it
was forwarded to the director of operations for necessary action.
The construction division surveys property about to be abandoned
and reports to Purchase, Storage and Traffic Division, General Staff,
cost of alterations made by Government, salvage value of same to
owner, estimated time required to restore property, cost of restora-
tion, etc. This office has already stated when it will have patients
and personnel off the premises. The real estate section now pro-
ceeds with negotiations for cancellation. Hospitals, under the port
surgeons, after approval for abandonment have been handled in sev-
eral ways, and as yet a routine process h.as not been developed.
In most cases it was found more advantageous for the Govern-
ment to pay an aggregate sum to the lessor to compensate for dam-
ages rather than remove salvage and restore property for the lessor
at Government expense. In negotiations for cancellation this office
played a less important role than either the construction division
or the real estate section, whereas in the acquisition of property the
considerations of this office were the more important.
H. PURCHASE OF LAND.
The procurement section made a careful survey of additional
property requirements at Walter Reed General Hospital. Takoma
Park, Washington. D. C. This additional propert}- is made neces-
sary b)' the proposed location of the Army medical center at this
place. The purchase has been approved by the War Department and
was authorized by Congress, and the actual purchase will be ac-
complished during the coming year.
The property at General Hospital. Denver, Colo., is not actually
owned by the Government, but to all intents it owns the same. The
property is practically a donation — technically a 99-year lease with
$1 a year rental. Its purchase for $1 was requested by this office, but
the Judge Advocate (General ruled that this could not be done. The
people of the city of Denver raised the money by popular subscrip-
1148 REPORT OF THE SirRGEON OEISIERAL OF THE ARMY.
tion for the piircliiise of the land and have turned the leases over
to the Government on the above terms.
The property upon which General Hospital No. 10, at Oteen, N. C,
is located was ])urchased from the appropriation construction and
repair of hospitals and is owned by the Government, with the excep-
tion of two outlyino: tracts for which the owners asked exorbitant
prices. Methods are now being })nrsued whereby these tracts will be
acquire<l, either 1)V purchase or condemnation proceedings.
I. TRANSFER OF GOVKRN:srENT PROPERTY.
In order to obtain additional hospital space in an economical man-
ner many Army posts and Government institutions were transferred
to the Medical Department for hospital purposes. In the case of
military j^osts this office requested authority for their transfer from
the Chief of Staff, and if favorable action was taken orders were
issued by The Adjutant General's Office effecting the actual transfer.
The following sites were obtained in a different manner : In the case
of the Southern Branch of the National Home for Disabled Volun-
teer Soldiers, at Hampton, Va., this office requested authority from the
Chief of Staff and, after favorable action, the matter was submitted
for consfressional action, and finally on November 7, 1918. a bill was
passed by Congress transferrinof this institution to the Medical De-
partment. In the case of the Carlisle Indian School, after favorable
action by the Chief of Staff, the Interior Department transferred the
property to the War Department and the latter turned it over to the
Medical Department.
The following is a list of Government property transferred to the
Medical Department for hospital purposes :
Government proitriii/ transferred to the Medient Department for neneral
hospital purposes.
Fort McHenry. Md.. General Hospital No. 2 (fiscal year 1918).
Fort Porter, N. Y., General H >s!nfl No. 4 (fiscal year 191.S).
Fort Ontario, N. Y., General Ho.spital No. 5 (fiscal year 1918).
Fort McPherson. Ga., General Hospital No. 6 (fiscal year 1918).
Fort Odethoi-jje. Ga.. General Hosnitiil No. 1-1 (fiscal year 1918K
Whipple Barracks. Ariz.. General Hospital No. 20 (fiscal year 1918).
Fort Benjamin Harrison, Ind., General Hospital No. 25 (fiscal year 1918).
Fort Des ^Moines, Iowa., General Hospital No. 26 (fiscal year 1918).
Fort Dou.slas, Utah, General Hospital No. 27,
Fort Sheridan, 111., General Hospital No. 28.
Fort Snelling, Minn., General Hospital No. 29.
Plattshnrs Barracks. N. V., General Hospital No. .'50 (fiscal year 1918).
Fort Lopan H. Tloots, Ark.. Genin-al Hospital No. Xi (fiscal year 1918).
Madison Barracks. N. Y., General Hospital No. 37.
The Southern Branch of National Home for Disahled Volunteer Soldiers,
Hampton, Va., General Hospital No. 43.
The Carlisle Indian School, Carlisle, Pa., General Hospital No. 31.
.J. NEW CONSTRUCTION.
\'. U.\SE HOSPITALS.
Much new construction has been accomplished during the year,
consisting of new base hospitals at Camps Mills, Bragg, and Knox
and alterations and additions to various base hospitals by reason of
increased strength in camps or unbalanced hospital facilities. The
HOSPITAL DIVISION. 1149
ratio foi- computing the size of the hospitals was arrived at by
averaging the percentage of sick at the base hospitals for the previous
year, and 4 per cent of the strength of the command was determined
as the proper ratio, with the exception of replacement camps, where
the frequent turnover of troops necessitated greater hospital facili-
ties. Outgoing organizations always leave a large number of sick to
be cared for by the hospital, and each new draft contingent brings
its large percentage of noneffectives. Therefore replacement camps
are computed at 4i per cent of the strength of the command. The
following is a list of new construction authorized at the base hos-
pitals for the fiscal j^ear 1919 :
Neil' const nict ion iind alterationH.
Approximate
amount
Station : expended.
Camp Beauregard, Miss $10,675.00
Camp Cu.ster, Mich 11,050.00
Camp Devens, Mass 6,000.00
Camp Dix, N. J 7,100.00
Camp Dodge, Iowa 25,905.00
Camp Fremont, Calif 5, 970. 00
Can.'p Funston, Kans 1,150.00
Camp Gordon, Ga 1,100.00
Camp Grant, 111 19, 500. 00
Camp Green. N. C 18, 896. 58
Camp Jackson, S. C 19,182.00
Camp Kearney, Calif 24,294.61
Camp Lee, Va 13, 775. 00
Camp Meade, Md 43, 840. 00
Camp MacArthiir, Tex 18, 000. 00
Camp Sherman, Ohio 17,500.00
Camp Taylor, Ky 21, 250. 00
Camp Sevier, S. C 12. 850. 00
Camp Pike, Ark 10. 815. 00
Camp Travis, Tex 5, 900. 00
Camp Upton. Long Island, N. Y 5,900.00
Camp Wheeler, Ga 13,650.00
Department base hospital. Fort Bliss, Tex 18,603.00
Base hospital. Camp Eustis, Va 465,750.00
Base hospital, Camp Humphreys, Va 343,500.00
Base hospital. Camp .Toseph E. .Johnston 2, 666. 83
Base hospital. Fort Sam Houston, Tex 481,570.00
b'. general hospitals.
New construction as follows for general hospitals Avas completed
in various parts of the country in this fiscal year. The largest single
hospital in this class was General Hospital Xo. 28, Fort Sheridan, 111.,
where 2,600 beds were provided, in new buildings, and 2,180 in con-
verted post and post hospital buildings. General Hospital No. 21,
Denver, Colo., comes next, with 2,500 beds, in new two-story tile and
stucco buildings. Third in consequence is the General Hospital at
Oteen, N. C, where 1,500 beds were provided in new one-story frame
buildings. The two latter hospitals are for the treatment of tubercu-
losis patients.
Among the prominent buildings where conversion was completed
this year are : The hotel at Long Beach, Long Island, 500 beds ; the
Robert Bingham Hospital and the west department of Boston City
Hospital, Boston, 800 beds; the West Baden Hotel, West Baden
1150 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Springs, Iiid., 1,200 beds; the Allegheny County Infirmary at Park-
view, Pa., 1,000 beds; and the Biltmo're Inn, Biltmore, N. C, 450
beds.
The following is a list of new construction authorized for general
hospital, fiscal year 1919:
Xcic const ructiuu (uid (lUcrations.
Approximate
amount
expended.
Station — jieneral hospital :
"Walter Keed, Takoma Park. D. C .$673,188
Letterman, San Francisco, Calif 130,096
Fort Bavard, N. .Mex 41.5,850
No. 1, Williams Bridge, N. Y 12,820
No. 2, Fort McHenry, Md 17.5,638
No. 3. Colonia, N. J 70. 375
No. 4, Fort Porter, N. Y 10,980
No. 5, Fort Ontario, N. Y 229,582
No. 6, Fort IMcPherson, Ga 99,636
No. 7, Roland Park, Md 18-5,066
No. 8, Otisville. N. Y 323,163
No. 9. Lakewood. N. .T 2,167
No. 10, Boston, Mass i 4,886
No. 11, Cape May, N. J 46, 1.50
No. 14, Oglethorpe, Ga 408,753
No. 16. New Haven, Conn 28.650
No. 17, Markleton, Pa 40,000
No. 18. Wavnesville, N. C .57,500
No. 19, Oteen, N. C 763,860
No. 20, Whipple Barracks, Ariz 1,819,282
No. 21. Denver Colo 1,522,385
No. 22, Philadelphia, Pa 6-5,656
No. 23, Hot Spring.s, N. C 10.3. 200
No. 24, Parkview, Pa 163,271
No. 25, Benjamin Harrison, Ind 31,979
No. 26, Des Moines, Iowa 19,305
No. 27, Fort Douglas. Utah 4-39.6.52
No. 28, Fort Sheridan. Ill 2,9.50.4.50
No. 29, Fort Snelling, Minn 191,062
No. 30, Plattshurg Barracks, N. Y 274,160
No. 31, Carlisle, Pa 192.600
No. 32, Chicago, 111 108,156
No. 34. East Norfolk, Mass 120,000
No. 3-5. West Baden, Ind 12.3.714
No. 36, Detroit, ]\Iich 32, 750-
No. 37, Madison Barracks, N. Y 12.5. -508
No. 38, Eastview, N. Y 109,483
No. 39, Long Beach, N. Y 25,000
No. 40, St. Louis, Mo 129,500
No. 41, Fox Hills, N. Y ._ .344, -500
No. 43, Hampton, Va 262,490
Total 12, 8.32, 463
C'. DEBARKATION CAMP.
New construction for debarkation hospitals was accomplished at
both the ports of New Tork and Newport News. Most prominent
among these was the Greenhut Building, at Sixth Avenue and Eight-
eenth Street, New York City, with 3,100 beds, and the Grand Cen-
tral Palace, Parkway and Forty-fifth Street, New York City, with
2,000 beds, together with the National Soldiers' Home, at Hampton,
Va., with approximately 1,800 beds.
HOSPITAL DIVISION. 1151
The folloAviiio- is a list of new construction authorized for debarka-
tion hospitals, during fiscal year of 1919 :
Xeir co)i~st ruction diid dUcnitioiis.
Approximate
i , amount
I Debarkation hospitals : expended.
No. 3, Greeuhut Building, New York City $371. 40(»
No. 5, Grand Central I'alat-e. New York Cit.v 215.000
No. 52, Kiciuuund College, Kiclimoud, Va 50,000
No. 51, National Home for Disabled Volunteer Soldiers, Hanip
ton, Va (')
d'. embarkation hospitals.
The following is a list of hospitals for embarkation purposes in
which new construction was authorized during the fiscal year 1919 :
\(ir (■f))lsfiiirtioii <ntil (ilt( itltuDis.
Approximate
amount
Embarkation liospital.s: expended.
Base hospital. Camp Stuart. Va $717,703
Base hospital. Cami) Merritt, N. J 6.740
Base hospital, Canij) Mills, N. Y' 2,775.770
K'. MISC'KLLAXEOI'S COXSTKIT'TION.
Miscellaneous new construction was accomplished in the various
small camps and post hospitals, the total of whicli amounts approxi-
mately to $1,875,000.
■ Repairs (maintenance) and rental for the vear approximated
$13,000,000.
The total amount appropriated for construction and repair of hos-
pitals for the fiscal year of 1919 was $95,681,940, of which, up to
March, approximately $30,000,000 was expended. This left more
than $60,000,000 to do the necessary work for the remaining three
months of the year. One of the most urgent projects to be under-
taken was the correction of the hospital conditions at Base Hospital
No. ^, Fort Bliss. However, the appropriation Construction and re-
pair of hospitals, with certain others, were for purposes of disburse-
ment grouped under one head — General appropriations. Quartermas-
ter Corps — and in the spring of 1919 a deficit was declared to exist
in certain of the appropriations grouped with ours under that head.
The overobligations wei'e sufficient to require all money still un-
touched under the general appropriations. Quartermaster Corps, and
consequently it was held by the Director of P'inance that no funds
were available under construction and repair of hospitals. This
action served to prevent the accomplishment of some very necessary
work, the most notable project being that at Fort Bliss.
Exhihitimh'^. — Three exhibitions have been prepared by this office,
as follows:
The frst was an exhibit for the American Medical Association's
convention at Atlantic City, June, 1919. It consisted of four plaster
models :
{a) General Hospital No. 21, at Denver.
(6) Base hospital at Camp Dix.
(g) Camp hospital at Camp Bragg.
{d) A typical pavilion single ward.
■ See General Hospital No. 43.
1152 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Photograplis were gathered showing typical hospitals, interior a&
well as exterior views.
Drawings were prepared showing the block plans of typical hos-
pitals :
[a) Original 1,000-bed, one-story pavilion unit, typical of 44
hospitals.
(6) Camp Mills, 2,000-bed capacity, two-story head hospital
type, typical of three hospitals.
(<?) Camp Bragg, 450-bed capacity, one-story pavilion type,
tvpical of three hospitals.
Plans of Avards, mess halls, kitchens, surgical buildings, labora-
tories, mortuaries, etc.. demonstrating the evolution and improve-
ments on same were prepared and shown in an instructive manner.
A map of the United States was exhibited, showing the location
of all Army hospitals with air lines from the two ports of debarka-
tion to the various hospitals receiving overseas patients. This de-
picted schematically the numbers of sick transported and the man-
ner in which it was done.
The original sketches for the Army medical center were shown.
The second was an exhibit known as the States circuit exhibit,
operated by the Department of Agriculture, to be shown at various
State fairs and expositions. It consisted of carefully selected and
prepared photograplis, showing the most important problems in
hospital construction and administration.
The third was a duplicate of the first or American Medical Asso-
ciation's exhibit and it is to ])e sent to the Canadian Government,
which in turn will send to this office a similar exhibit covering their
hosj)itals.
History. — A brief treatise is being prepared covering the work
of the procurement section of the hospital division. It is believed
that such a treatise will be of interest and value. All of the matter
will of course be available and some may be useful in the compila-
tion of the medical histor}' of this war.
Drawings have been prepared showing the important designs of
various buildings turned out by this office, photographs of the work
have been collected and in some instances taken by the Signal Corps
especially for this work.
The subject is being prepared in three parts: Part 1, historical,
or a statement of what was done in the office; part 2, critical, or a
discussion of what was done in the office and how it worked out in
the field; and part 3, a manual of all suggestions of this office for
base hospitals 50 to 300, 300 to 1,000, 1,000 to 2,000, 2,000 to
5,000 bed capacity that the architects and doctors who have been
working on the problem were able to recommend.
2. AniUNISTRATION SECTION.
A. FUNCTION.
To coordinate and unify and promulgate the methods of adminis-
tration to be followed at the various hospitals. With this end in
view the administration section of the hospital division was started
in the past fiscal year under the direct supervision of the chief of the
hospital division. This section has continued to the present time,
HOSPITAL DIVISION. 1153
and has had charge of all routine records, reports, and correspond-
ence pertaining to the administration of all hospitals other than
those under control of department commanders.
Tables of organization were planned and prepared. These tables
show the commissioned, enlisted, and Army Nurse Corps personnel,
and were sent to the commanding officers of all hospitals. Monthly
reports of the commissioned personnel are furnished this office by
the various commanding officers. These reports indicate the duties
performed by the various officers and whether or not their services
are satisfactory to the commanding officer. These reports are kept
on file in the hospital division.
A system of circular letters containing information for the guid-
ance of commanding officers was inaugurated, and this system still
continues. By means of these circular letters desirable features ob-
taining at one of the hospitals are brought to the attention of the
commanding officers of other hospitals. Similarly, undesirable or
unsatisfactory methods of administration have been eliminated and
a more uniform system of administration has been made possible.
B. PERSONXEL.
While the maintenance of the personnel at the various hospitals
was largely in the hands of the personnel division of the Surgeon
General's Office, it was necessary that a more or less close supervision
be maintained over this feature by the hospital division, and this duty
fell to the administrative section. This applies particularly to the
commanding officers of the hospitals and their administrative and
executive assistants.
The table of organization which was adopted, -mimeographed, and
distributed authorized the following commissioned personnel for a
1,000-bed hospital :
1 colonel or lieutennnt colonel, Medical Corps.
4 majors, Medical Corps.
1 captain or lieutenant. Quartermaster Corps.
2 captains or lieutenants, Sanitary Corps.
12 captains. Medical Corps.
13 lieutenants, Medical Corps.
2 captains or lieutenants, Dental Corps.
This table also provided for a personnel of 400 enlisted men and
100 members of the Army Nurse Corps.
The commanding officer w\as selected by the chief of the hospital
division from among those officers of the Medical Corps, Regular
Service, who were available, and from those officers of the Medical
Reserve Corps whose prior experience, either civil or military, had
qualified them for the duties of this position. The officers assigned
to administrative work were very largely officers of the Sanitary
Corps and were assigned by this section. The officers of the profes-
sional staffs were selected and assigned by the various professional
divisions of the Surgeon General's Office upon the request of the
hospital division. Enlisted men and nurses were provided by the
personnel division of this office.
In addition to the more or less permanent staffs of the hospitals,
the plan previously adopted of having a supplementary staff under
training at the larger hospitals was continued. These supplementary
1154 IlEPOET OF THE SUROKOX GKNEHAL OF THE ARMY.
stntfs were for the purpose of providing the personnel of units being
organized for overseas service, and as the organization of overseas
units was discontinued with the signing of the armistice tliese sup-
plementary staifs were discontinued at about that time, since which
date the training of acKlitional officers in administrative duties has
ceased. The i^lan has been generally successful, and we were able to
provide suitable administrative stall's for all units going overseas.
f. RAILWAY TKAXSPOKTAnOX.
Shortly after the outbreak of hostdities it was recognized that it
would be ne<?essary for the Medical Department to provide some
means of evacuating the returning sick from the ports to interior
hospitals, and plans were therefore made for the equipment of a
sufficient number of hospital trains. The following statement and
table is a summarv of this work. It will be noted that some of the
report under this heading does not pertain to this fisr-al year, but it is
included because it has never been previously presented and because
of its bearing on the general question.
Hospital trains in possessioji of the Medical Department prior to
the war. — At the outbreak of hostilities the Medical Department had
one hospital train, consisting of 10 cars, as follows: One kitchen
and personnel car, three 16-section patient cars, one operating car,
one storage and baggage car, three bed cars, one officers' car.
These cars are all of Avood construction. The kitchen car and the
officers' car have steel underframes. This train has a capacity of
225 patients, with accommodations for personnel of 31. This train
had been remodeled from old Pullman cars in August, 1916, by the
Pullman Co. for service on the Mexican border. This lease was on
a per diem basis and with the understanding that the train could be
purchased by the Government if it was so desired. After about six
months the train was purchased by the Quartermaster's Department,
and has since been Government property.
Cars purchased prior to this -fiscal year. — In October, 1917, it be-
came evident that it would be necessary to obtain more cars for the
evacuation of sick and wounded arriving at the ports, and request
was made by the Surgeon General for an appropriation sufficient to
construct three additional trains of six cars each. It Avas proposed
to take three bed cars from train No. 1, reducing this train to a
seven-car train, and applying one each of these cars to each of the
new trains, thus making four trains of seven cars each. On Febru-
ary 13, 1918, authorit}' was obtained for the purchase of these 18
additional cars, and in June, 1918, the cars had been purchased, re-
modeled, and were in service. This made a total of 4 trains of
seven cars each, with a capacity of 141 patients and 31 personnel for
each train.
Pending the arrival of overseas cases at the ports, these trains were
distributed as follows:
Train Xo. 1, at port of embarkation, Hoboken, N. J.
Train No. 2 was sent to the medical officers' training camp, Fort
Oglethorpe, Ga., for instruction purposes, and in October, 1918, was
sent to the port of embarkation, Hoboken. N. J.
HOSPITAL DIVISION. 1155
Train No. 3 was used for instruction purposes at the medical offi-
cers' training camp. Fort Riley, Kans., for a short time, and was
then taken to the port of embarkation, Newport News, Va.
Train No. 4 was sent to the port of embarkation, Hoboken, N. J.
It was estimated that in October, 1918, the three hospital trains
at Hoboken, with a patient-carrying capacity of 423, could make a
minimum of three round trips per month each from the port to points
into the interior at an average distance of 1,000 miles. This would
give a carrying capacity of 1,269 patients per month, and by adding
three Pullman cars to each train this number could be increased to
approximately 2,079 per month.
Additions made during this fiscal year. — It was apparent that this
number would not meet the situation which would arise when pa-
tients begin returning in large numbers. The greatest need was for
cars with kitchen facilities, and after a careful study of the situation
a request was made in October, 1918, for authority to purchase 20
cars and to have them remodeled into unit cars. This authority was
granted on October 25, 1918, and the matter was immediately taken
up with the Pullman Co. It w^as then found that, owing to the in-
creased cost of material and labor, the original estimate of $25,000
each for these cars no longer obtained, and that the cars would now
cost, including remodeling, approximately $27,000 each. Further-
more, the Pullman Co. could not promise deliveries for three or four
months. After correspondence, however, it was found that 20 steel
miderframe Pullman parlor cars were available and could be over-
hauled and remodeled in a very short time. The order was given
the Pullman Co. to proceed on this basis December 9, 1918, and the
cars were all completed and in service on January 21, 1919.
These 20 cars, including the original cost and the cost of remodel-
ing, which included removal of the interior fittings and the installa-
tion of Glennan adjustable bunks, large kitchens, refrigerators, axle
devices, and lighting systems, cost $326,000. Ten of these cars were
sent to the port of embarkation at Hoboken, and 10 were sent to the
port of embarkation at Newport News.
In using these cars, the plan adopted was to attach six or seven
standard Pullmans or tourists to one of these unit cars, thus form-
ing a hospital train of seven or eight cars. The patients for the en-
tire train w^ere subsisted from the kitchen in the unit car, and were
cared for by the medical personnel of that car. This plan was found
to be very satisfactory, in that we were enabled to furnish hot meals
for 250 patients from each unit car. There was room for sufficient
personnel to care for all of their needs and it was unnecessary to
pay return mileage on the Pullman cars used as they were simply
dropped at their destination and the unit car alone returned to the
port. This was a considerable saving over the use of the hospital
train, as return mileage had to be paid for the entire train.
Leased cars. — While waiting for the delivery of the unit cars
above mentioned, it was necessary that some cars be obtained for im-
mediate use to handle the incoming patients. Authority was there-
fore obtained to lease from tlie Railroad Administration 20 cars at
$15 per day each. In the latter part of November, 1918, two kitchen-
tourist cars, two hotel cars with kitchens, and six private cars with
kitchens were leased and were sent to the port of embarkation at
142367— 19— VOL 2 12
1156 REPORT OF THE SURGEOK GENERAL OF THE ARMY.
Hoboken. At the same time seven kitchen-tourist cars, one hotel car
with kitchen, and two private cars with kitchens were leased and
were sent to the port of embarkation at Xewport News. The cars
were used as were the unit cars. The private cars had a feeding
capacity of 50 patients each, while the hotel and kitchen cars had a
feeding capacity of 250 patients eacli.
It was intended that these cars would be used only until delivery
was made of the unit cars being remodeled, but the influx of patients
was so great that it was found necessary to retain them in service for
a considerably longer period. During tlie montli of June, 1919, how-
ever, these cars were all returned to the Railroad Administration,
and at the present time no leased cars are in service.
D. RESUME.
The attached chart gives a general idea of the Medical Department
railway transportation. (See Table A.)
HOSPITAL DIVISION,
1157
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1158
REPORT OF THK SURGEON GENERAL OF THE ARMY.
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HOSPITAL DIVISION. 115ft
E. DEMOBnJZATIOX OF BASE HOSPITALS.
Some time after the signing of the armistice and with the begin-
ning of the demobilization period it became necessary to reduce in
capacity the various base hospitals. The hospitals, in addition to
caring for camp sick, had been caring for many overseas cases who
resided in the vicinity of the camps. This practice was begun as soon
as the armistice was signed, as it was no longer necessary that men in
training be kept apart from the wounded returned from the American
Expeditionary Forces.
During the past two months the sending of overseas patients to the
base hospitals at the camps has been stopped. This was done to en-
able hospitals then to reduce to camp necessities. Also, there was no
longer any necessity to conserve space in general hospitals. (It
should be pointed out here parenthetically, as it was a construction
section activity, that inunediately after the armistice about -20 new
general hospital projects in process of conversion were either stopped
or gi'eath' curtailed; this action being taken after careful computa-
tion of probable bed space to become available and required.) Later,
in June, the overseas sick that were at the base hospitals in camps and
who would require long treatment were transferred to general hos-
pitals. On June 30 the hospitals at the camps were caring for prac-
tically only the sick of their commands. As these commands have
been very materially reduced in size, a corresponding reduction has
been made in the capacity of the hospitals. Recommendation has
been made that these base hospitals be designated camp hospitals and
placed under the direct supervision of the camp surgeons. It is ex-
pected that during the month of July, 1919, these hospitals will be
reduced to an average capacity of approximately l.'iO lieds each.
F. DEMOBILIZATION OF GENERAL HOSPITALS.
There has been a gradual reduction in the number of general hos-
pitals; most of tho.ie which were located in leased property have been
discontinued; and on May 24, 1919. in order to secure uniformity of
thought and action reference demobilization and care of chronic sick,
it was agreed that the following general hospitals would be consid
(?red the most permanent :
Army and Xavy General Hospital, Hot Springs, Ark.
Letterman General Hospital, San Francisco, Calif.
Walter Eeed General Hospital, Takoma Park, D. C. •
General Hospital No. 6. McPherson, Ga.
General Hospital Xo. 19, Oteen, X. C.
General Hospital Xo. 21, Denver, Colo.
General Hospital Xo, 26, Des Moines, Iowa.
General Hospital Xo. 31, Carlisle, Pa!
Department Base Hospital, Fort Sam Houston, Tex.
^ It was agreed that the general hospitals which would be con-
sidered next most permanent and which would operate for a sufficient
time after July 1. 1919, to rare for any chronic cases were —
General Hospital. Fort Bayard, X. Mex.
General Hospital Xo. 2, Fort McHenry, Md.
General Hospital Xo. 3, Colonia, X. J.
General Hospital Xo. 8. Otisville. X. Y.
1160 REPORT OF THE SURGE05? GENERAL OF THE ARMY.
General Hospital No. 20, Whipple Barracks, Ariz.
General Hospital No. 28, Fort Sheridan, 111.
General Hospital No. 30, Plattsburg, N. Y.
General Hospital No. 41, Fox Hills, 'Staten Island, N. Y.
General Hospital No. 42, Spartanburg. S. C.
General Hospital No. 43, Hampton. Va.
Base hospital. Fort Riley, Kans.
Geographical distribution of the patients, which had be©n con-
sistently followed up until this time was now to be disregarded if
no beds were available at the proper geographical hospital when the
case was cleared from the port, and as a rule such case would not
be later transferred to a hospital near its home unless it be a chronic
case of long prospective duration. With the above restrictions
geographical distribution would be attempted.
Since the above general postulation reference duration of general
hospitals and space required in them much has transpired to alter
its validity. In spite of the large number of chronic sick sent to
general hospitals from the base hospitals the total average daily
population of sick for all general hospitals has decreased. This
decrease was, of course, fostered somewhat by the much reduced
flow of sick from the American Expeditionary Forces. Previously
the return had been from 10,000 to 25,000 per month, and with a
reduction to 10.000 or less per month the situation was easily met
by these hospitals.
In the abandonment of these general hospitals many considerations
presented themselves, and it was not always a simple matter to deter-
mine the proper sequence and date of their abandonment. Adequate
care, economy of personnel, location in relation to population, and
cost of maintenance were the most important considerations. They
will probably remain the most important and in the same order.
So that, looking ahead into 1920, we should be concentrating our sick
in a few well-appointed hospitals, particularly in northern and eastern
United States, and near New York City, Chicago. Baltimore, Wash-
ington, and San Francisco. The two last-named places have perma-
nent general hospitals and are included in part because of that.
The following military hospitals have been taken over intact by
the Public Health Service under the act of Congress approved March
3, 1919:
Bed capacity.
Base Hospital, ("auiij Beaureguard, La 2.144
Base Hospital, Camp Cody, N. Mex 1.289
Base Hospital, Camp Fremont, Calif 1, 156
Base Hospital. Camp Hancock, Ga 1,604
Base Hospital, Camp .Joseph E. Johnston, Fla 816
Base Hospital, Camp Logan, Tex 1, 156
Base Hospital. Camp Sevier, S. C 1,396
General Hospital No. 13, Dansville, N. Y 288
General Hospital No. 15, Corpus Christi, Tex 262
General Hospital No. 34, Ea-t Norfolk, Mass 350
The Norwegian Deaconesses' Home and Hospital, Brooklyn, N. Y 250
General Hospital No. 10. Boston, Mass 750
General Hospital No. 32, Chicago, 111 5.30
General Hospital No. 40. St. Louis. Mo 531
Total 12.522
14236T— 10. (To face page 1161.)
HOSPITAL DIVISION. 1161
The Public Health Bureau has also indicated a desire to take over
the following-listed hospitals upon their discontinuance :
General Hospital No. 16, New Haven. Ci ' a\_ -^ 500
General Hospital No. 24, Parkview ' ••'heii^'ittsburgli, Pa 700
General Ho i)ital No. 36, Detroit. M ''fJit>atieI-- ^^^
T..t:il ^ ■'; ^^— _- 2,119
3. Census , "^'^.j^.
, 'ftp/
The census section of the hospitai 'sion was organized for the
purpose of centralizing the distribui ) hospitals of the sick and
wounded of the Army, the accomp' ^nt of which required the
compilation of considerable data ob ^fi'^^^i various reports and
records. The activities of this secti^ t^ been :
(a) Distribution of over-sea sick n^ounded from the ports of
embarkation to interior hospitals. t^
(b) Transfer of groups of patien^i, f '^n hospital to hospital.
(c) Preparation of a weekly bedTiTep ct o^^ nil hospitals, undei'
direct control of the War Departmer*^. '1i
(d) Compilation of daily telegrap^iic h^C >orts from all hos-
pitals under direct control of the \, ar 0|pp nent, showing beds
occupied and empty. "^ '■'■
(e) Maintaining accurate record of patients arriving from over-
seas, and of patients en route to the various hospitals.
A. DISTRIBUTION OF OVER-SEA SICK AND WOUNDED.
Patieuts upon arrival at debarkation ports from over-seas, were
sent to one of the hospitals under control of that port, and there
classified under the following headings, viz, amputations, arthritis,
blind, epileptics, genito-urinary, head, maxillo-facial, medical, men-
tal, mental defectives, neurosis, orthopedic, peripheral nerve in-
juries, surgical, tuberculosis, and venereal. They were then listed
at the port of embarkation for transfer to hospitals located nearest
their homes, first taking into consideration the nature of the disease
or injury, and secondly the facilities at that hospital for the care
of that particular case. This could not be carried out in all in-
stances, but was done as far as it was possible. This classification
was telephoned to this office ])y the surgeon of the port. The list
was checked against the daily record of available beds, changes made
when necessary, and the result reported to the surgeon of the port
by telephone, with authority for transfer, the commanding generals
at ports of embarkation having been authorized by the War De-
partment to transfer cases to any hospital in the United States, upon
recommendation from this office.
During the fiscal year ending June 30, 1919, this section authorized
the transfer of 97,271 over-sea cases from Hoboken, N. J., and 37,564
cases from Newport News, Va.
Copy of distribution list in effect June 30, 1919, is shown by
" Exhibit A."
Exhibit B shows the distribution of patients from ports of em-
barkation to the various hospitals.
Exhibit C shows distribution of patients from ports of embarka-
tion bv classification of diseases.
1162
REPORT OF THE SURGEON GENERAL OF THE ARMY.
B. TRANSFER OF PATIENTS FROM HOSPITAL TO HOSPITAL.
During: the fiscal year endini; June 30, 1919, this section has recom-
mended the transfer of 33,934 patients from hospital to hospital in
the United States. This large i\umber of transfers has been due to
many reasons, among the nK)st important of which are:
(a) Transfer of all cases re<iuiring one or more months' treatment
from base to general hospitals. This action was necessary in order
that personnel might be reduced.
(h) Transfers from one general hospital to another. This has
been found necessary in order to reduce the number of general hos-
pitals in operation to a minimum.
In making these transfers, the same general policy has been fol-
lowed, i. e., to send patients as near their homes as hospital facilities
would permit.
Fig. 138.
c. wp:ekly bed report.
A weekly bed report of all hospitals directly under the Surgeon
General's ()ffice was issued each Monday and furnished at first to
those most intimately concerned, but the demand for it grew until
it reached a circulation of 300 copies per week.
The table of bed capacity issued on July 3, 1918, the beginning
of the fiscal year, showed 22 general hos])itals, T embaikation hospi-
tals, G department base hospitals, and 31 base hospitals at the various
camps and cantonments, with a total bed capacity of 79,077 and 48,014
i:)atients in hospitals on that date.
On June 30, 1919, the date of this report, there were remaining 30
general hosi)itals, 17 base hospitals, and 8 embarkation and debarka-
tion ho'^pitals, with a total bed capacity of 63.961 and 40,796 patients
in hospital. Approximately 30,000 of these patients had been re-
turned from overseas.
The hiirhost number of available beds was shown on i-eport dated
October 12, 1918. At this time there were 173,505 beds, of which
131,213 were occupied by patients. This was during the period of
the influenza outbreak, and many of the hospitals had been tem-
porarily increased by the use of barracks and other buildings.
HOSPITAL, DIVISION.
1163
On November 11, 1918, the date of the armistice, the following
hospitals were in operation: Forty general hospitals, 35 base hos-
pitals at the various camps and cantonments, 14 embarkation and
debarkation hospitals, and 3 department base hospitals, with a total
bed capacity of 120,916 and 76,961 patients in hospital.
D. OCCUPIED AND VACANT BEDS.
In order to make an intelligent distribution of patients recom-
mended for transfer, and to follow out the established policy of
transferring patients as near their homes as possible, a daily tele-
graphic report of occupied and vacant beds was required from all
hospitals under control of the AVar Department.
E. ARRIVAL. OF PATIENTS FROM OVERSEAS AND THEIR TRANSFER TO
VARIOUS HOSPITALS.
During the period covered by this report 111,917 patients were
received through the port of embarkation, Hoboken, N. J., and
39,898 through Newport News, Va., making a total of 151,815 patients
received from overseas.
All hospitals receiving patients by transfer were instructed to
report by wire their arrival, showing number received and from what
hospital transferred. This report, together with the daily record
of available beds, enabled this office to keep an accurate check of
the patients en route to the various hospitals, so that no hospital
would receive more patients than it was prepared to care for, Chart
138 shows arrivals of patients from OA'erseas by months.
CLASSIFICATIONS
NO C Aits
■/o 1 2 2.4 5 10 15 20 25 30 35 ||
MEDICAL
50i59
37 35
1^
^^^^
^^^^
^^^^
^^
SWPGlCAL
!S
^^^_
^^^_
^^^_
_
OOTMODtO"lC
I203Z
8.97
:s
^^
TCBEQCULOSIS
5777
426
1
■
HEAD
4667
3.48
1
ii
MENTAL
3979
2.95
1
^^^^— ^— ^— ^— — — ^
AMDUTATIONS
27se
207
EXHIBIT "C'
DISTCllBUTiCN OF
oven SEA. DATIENT5
FQOM POQT5 OF
EMBARKATION
BY
CLA5SIFICA.TION
OF DISEASES.
NEUPOSES
2Ai3
1.82
PEQIPhEDAL
NEBvE injurie:s
l&AI
1.44
1
EPILEPTICS
559
.41
lvlENT/>.L
DEFECTIVES
<U6
.^i
1
VENEREAL
i&<I
.27
'
MAXILLO-FACIAL
J07
23
TO T/VL
l3A6i5
lOOOO
J
Ik;, i;:;).
1164 REPOKT OF THE SURGEON GEXKllAL OF THE ARMY.
Exhibit A.
Wak Depaktment,
Office of the Surgeon Generai,.
WasJiin(/ton, May 31, 1919.
[Note. — Patients will be transferred to the hospitals shown on rijiht, iicfcirdinK
to disease or injury shown on left.]
Revised list of hospitals designated for over-sea cases.
Amputations All amputations arriving at port of em-
The commanding officers of Gen- i)arkation, Hoboken, N. J., will be sent
eral Hospital No. 3, Colonia, N. J., t(» General Hospital No. 3, Colonia,
and Walter Reed General Hospital, N. J.
Takoma Park, D. C, will recom- All amputations arriving at port of em-
mend for transfer amputation bargation, Newport News, Ya., will be
cases to amputation centers near- sent to Walter Reed General Hospital,
est their homes. Takoma Park, D. C.
Walter Reed General Hospital, Takoma
Park, D. C.
Letterman General Hospital, San fran-
cisco, Calif.
General Hospital No. 3, Colonia, N. J.
General Hospital No. 6, Fort McPherson,
Ga.
General Hospital No. 2G, Fort Des
Moines, Iowa.
Arthritis, chronic (nontraumatic) Letterman General Hospital, San Fran-
cisco, Calif.
Walter Reed General Hospital, Takoma
Park, D. C.
General Hospital No. 6, Fort McPherson,
Ga.
General Hospital No. 26, Fort Des
Moines, Iowa.
General Hospital No. 28, Fort Sheridan,
III.
Blindness (partial or total) General Hospital No. 2, Fort McHenry,
Md.
Epileptics and mental defectives Walter Reed General Hospital, Takoma
Park, D. C.
Letterman General Hospital, San Fran-
cisco, Calif.
General Hospital No. 6, Fort McPherson,
Ga.
General Hospital No. 28. Fort Sheridan.
III.
Base Hospital, Fort Sam Houston, Tex.
Eye, ear, nose, and throat (wounds and Walter Reed General Hospital, Takoma
injuries or diseases requiring surgi- Park, D. C.
cal treatment of importance). . Letterman General Hospital, San Fran-
cisco, Calif.
General Hospital No. 2, Fort McHenry,
Md.
Insane Walter Reed General Hospital, Takoma
Park, D. C.
Letterman General Hospital, San Fran-
cisco, Calif.
General Hospital No. 6, Fort McPherson.
Ga.
General Hospital No. 28, Fort Sheridan,
III.
General Hospital No. 43, Hampton, Ya.
Base Hospital, Fort Sam Houston, Tex.
Maxillo-facial (injuries of the face Walter Reed General Hospital, Takoma
and jaw). Park, D. C.
General Hospital No. 2, Fort McHenry,
Md.
Post Hospital, Jefferson Barracks, Mo.
HOSPITAL DIVISION. 1165
Medical cases, general (includiug Walter Reed General Hospital, Takoma
cardio-vascular, diabetes, and gassed Park, D. C.
cases). Letterman General Hospital, San Fran-
cisco, Calif.
General Hospital, No. 2, Fort McHenry,
Md.
General Hospital No. 5, Fort Ontario,
N. Y.
General Hospital No. 6. Fort McPher-
son, Ga.
General Hospital No. 12, Biltmore, N. C.
General Hospital No. 22, Philadelphia,
Pa.
General Hospital No. 24, Parkview, Pa.
General Hospital No. 25, Fort Benjamin
Harrison, Ind.
General Hospital No. 26, Fort De.s
Moines, Iowa.
General Hospital No. 27, Fort Douglas,
Utah.
General Hospital, No. 28, Fort Sheridan.
111.
General Hospital No. 29, Fort Snelling,
Minn.
General Hospital No. 30, Plattsburg Bar-
racks, N. Y.
General Hospital No. 31, Carlisle, Pa.
General Hospital No. 36, Detroit, Mich.
General Hospital No. 88, East View,
N. Y.
General Hospital No. 41, Fox Hills,
Staten Island. N. Y.
Base ho.spital, Fort Sam Houston, Tex.
Base ho.spital. Fort Riley, Ivans.
Nervous svsteni (organic disease) Walter Reed General Hospital. Takoraa
Park, D. C.
Letterman General Hospital, San Fran-
cisco, Calif.
General Hospital No. 2, Fort McHenry,
Md.
General Hospital No. 6, Fort McPher-
son, Ga.
General Hospital No. 28, Fort Slieridan,
111.
Base hospital. Fort Sam Houston, Tex.
Neuroses (functional) General Hospital No. 4, Fort Porter,
N. Y.
Orthopedic cases Walter Reed General Hospital. Takoma
1. Deformities of extremities due Park, D. C.
to or associated with contrac- Letterman General Hospital, San Fran-
tures of muscles, ligaments. Cisco, Calif.
and tendons. General Hospital No. 2, Fort ^McHenry,
2. Derangements and disabilities Md.
of joints, including articular General Hospital No. 3, Colonia. N. .1.
fractures. • General Hospital No. 6, Fort McPher-
3. Deformities and disabilities of son, Ga.
the feet. General Hospital No. 26, Fort Des
4. Cases requiring tendon trans- Moines, Iowa.
plantation. General Hospital No. 28, Fort Sheridan,
111.
General Hospital No. 41, Fox Hills,
N. Y.
Base hospital. Fort Riley, Kans.
Base hospital, Fort Sam Houston, Tex.
1 166 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Peripheral nerve injuries and paraly- Walter Keed General Hospital, Takoma
ses (including healed or unhealed Park, D. C.
wounds; with or without fracture). Letternian (General Hospital, San Fran-
cisco, Calif.
General Hospital No. 2, Fort McHenry,
Md.
General Hospital No. 6, Fort McPher-
son, Ga.
General Hospital No. 26, Fort Des
Moines, Iowa.
General Hospital No. 28, Fort Sheridan,
111.
General Hospital No. 41, Fox Hills,
Staten Island, N. Y.
Base hospital, Fort Sam Houston, Tex.
Speech defects and hearing General Hospital No. 41, Fox Hills,
Staten Island, N. Y.
Surgical cases, general Walter Reed General Hospital, Takoma
1. Unhealed wounds of soft parts Park, D. C.
in general. Letterman General Hospital, San Fran-
2. All fractures of upper exti'emi- cisco, Cnlif.
ties, except articular frac- General Hospital No. 2, Fort McHenry,
tures, where the joint lesion Md.
is the major condition. This General Hosi)ital No. 3, Colonia (Rah-
will include unhealed or way), N. J.
healed wounds, nonunion, de- General Hospital No. 6, Fort McPherson,
layed union, or malunion. Ga.
(For fractures of lower ex- General Hospital No. 24, Parkview, Pa.
tremities see below.) General Hospital No. 25, Fort Benjamin
3. All osteomyelitis and all bone Harrison, Ind.
sinuses. General Hospital No. 26, Fort Des
4. Thoracic, abdominal, and gen- Moines, Iowa.
ito-urinary injuries. General Hospital No. 27, Fort Douglas,
5. Injuries and tumors of bldod Utah.
vessels. General Hospital No. 28, Fort Sheridan,
6. Amputations, fingers and toes. 111.
General Hospital No. 29, Fort Snelling,
Minn.
General Hospital No. 30, Plattsliurj;
Barracks, N. Y^.
General Hospital No. 31, Carlisle, Pa.
General Hospital No. 36, Detroit, Mich.
General Hospital No. 38, East View,
N. Y.
General Hospital No. 41, Fox Hills,
Staten Island, N. Y.
Base Hospital, Fort Sam Houston, Tex.
Base Hospital, Fort Riley. Kans.
Surgical cases, fractures of the lower Walter Reed General Hospital, Takoma
extremities, except articular frac- Park, D. C.
tures, where the joint lesion is the Letterman General Hospital, San Fran-
major condition. This will include cisco, Calif.
unhealed or healed wounds, non- General Hospital No. 2, Fort McHenry,
union, delayed union, or malunion. Md.
General Hospital No. 3, Colonia, N. J.
General Hospital No. 6, Fort McPherson,
Ga.
Genei-al Hospital No. 26, Fort Des
Moines. Iowa.
General Hospital No. 28, Fort Sheridan,
111.
fJeneral Hospital No. 31, Carlisle, Pa.
General Hospital No. 41, Fox Hills,
Staten Island, N. Y.
Base Hospital, Fort Sam Houston, Tex.
HOSPITAL DIVISION. 1167
Tuberculosis, pulmonary General Hospital, Fort Bayard, N. Mex.
General Hospital No. 8, Otisville, N. Y.
General Hospital No. 16, New Haven,
Conn.
General Hospital No. 19, Oteen (Bilt-
more), N. C.
General Hospital No. 20, Whipple Bar-
racks, Ariz.
General Hospital No. 21, Denver, Colo.
General Hospital No. 42, Spartanburg,
S. C.
Venerea! diseases, and its sequel:p. Any hosintal caring for medical cases,
where venereal diseases are major
disability.
Wounds or injuries of the skull or Walter lleed General Hospital, Takoma
brain (including traumatic epi- Park, D. C.
lepsy). Letterman General Hospital, San Fran-
Wounds or injuries of the spinal cord. cisco, Cnlif.
(Jeneral Hosjtital No. 2, Fort McHenry,
Aid.
General Hospitiil No. 6. Fort McPherson,
(in.
(Jf'ueral Hospital No. 26, Fort Des
Moines. Iowa.
General Hospital No. 28, Fort Sheridan,
111.
r.'se H()S])ital, Fort Sam Houston, Tex.
Patients who will be Itenc 'ted Ity Army nn(l Navy (ieneral Hospital, Hot
waters of Hot Springs, Ark. Spiings, Ark.
4. Statistical Sfxtiox.
A. Kl'N( TIO.N.
Tlie function of this section of tlie hospital division was the col-
lection and recording of scientific and historical data in relation to
the work of the division, and of workinof up this data into practical
working: statistics.
B. CAPACITY or hospitals.
All information in relation to the daily capacity of the Army
hospitals was made a matter of record in this section, so that at
any time the total number of patients and the total nmnber of vacant
beds in any hosjiital could be ascertained. This was important data,
especially during the rapid return of injured from the American
Expeditionary Forces and durinaf the influenza epidemic in the
camps in this country. This was especially valuable in connection
with those hospitals that had specialized professional staffs and
special equij^ment for the handling of certain small groups of in-
juries and diseases.
C. TI'HNOVER OF' PATIENTS.
The I'ate of si)eed with wiiic h jiatients passed through their period
of treatment in the various hospitals was worked out in this section
from data collected from all hosi)itals. If the rate was found unduly
short in certain hospitals and apparently too long in other hospitals,
the matter was nuide the subject of investigation, the causes deter-
mined, and if errors in administration were found, corrective meas-
ures were instituted.
1168 REPORT OF THE SURGEON GENERAL OF THE ARMY.
nOSPITAL DIVISION,
1169
I). NUMBER OF PATIENTS.
At the end of each week this section determined the total number
of patients in each of the Army hospitals: the total number of
patients and total number of beds in all hospitals under the War De-
partment. This information was then entered on a larsfe graphic chart
covering all hospitals. Later the section worked out a series of
individual charts showing this information, together with the bed
situation, for each hospital. Properly filed, this information will
be of gi'eat historical interest. A sample figure showing the situa-
tion at base hospital. Camp Dodge, Iowa, is printed on page 1168.
E. REPORTS.
At the end of each week this section collected from several divisions
of the office certain figures pertaining to the activities of all the
various hospitals. A table showing the names and status of the
more important hospitals directly under the administration of the
War Department at the close of the fiscal year 1918 is herewith
submitted as a sample of this report.
Table B. — Names and status of the more important hospitals directly under
the administration of the War Department at the close of the fiscal year
1918.
GENERAL HOSPITALS.
Army and Navy General Hospital,
Hot Springs, Ark
General Hospital, Fort Bayard, N.Mex.
General Hospital, San Francisco, Calif.
Walter Reed General Hospital, Tako-
ma Park, D. C
General Hospital No 2, Fort McHenry,
Md
General Hospital No. 3, Colonia N. J. . .
General Hospital No 4, Fort Porter,
N. Y
General Hospital No. 5, Fort Ontario,
N. Y
General Hospital Nc. 6, Fort McPher-
son, Ga
General Hospital No. 7, Roland Park,
Md
General Hospital No. 8, Otisville, N. Y.
General Hospital No. 11, Cape Mav,
N.J "...
General Hospital No. 12. Biltmore, N. C.
General Hospital No. 16, New Haven,
Conn
General Hospital No. 19, Oteen, N. C.
General Hospital No. 20, Whipple Bar-
racks, .\iiz
General Hospital No. 21, Denver, Colo..
General Hospital No. 24 Park\ iew, Pa.
General Hospital No. 25, Fort Benja-
min Harrison, Ind
General Hospital No. 26, Fort Des
Moines, Iowa
General Hospital No. 27, Fort Douglas,
Utah
General Hospital No. 2f, Fort Sheri-
dan, 111
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1
i
P.
1 -s^
i 11
6 P
11'
'So
.o
o
g
o
1^
S £"
ti
cl —
g
03
■c)
!ii
3
o
(O
Xl
<D
e3
.2
a
o
fH
<
El
Q
P5
>
H
S
'A
H
287
194
8
202
23
179
55
266
5
13
88
1,218
784
29
813
65
748
124
1,C00
26
69
421
1,995
1,242
159
1,401
195
1,220
132
1,716
86
637
3,177
2,049
71
2,120
122
1,998
146
1,900
126
181
907
3,313
2,225
546
2,771
367
2.404
313
2,800
68
187
718
2,33]| 1,2J9
125
1, 374
43
1,331
219
1,550
44
120
596
538| 375
9
384
149
135
118
250
16
36
246
1,503] 564
397
961
171
790
202
1,023
24
76
738
3,25l! 2,064
406
2,470
399
2,071
705
2,865
57
170
881
62; 6
1.305! 862
2
85
8
947
""72
8
875
3
34
40
153
1,000
69, 351
1,035 551
18
569
96
473
246
710
34
53 328
560 247
29
276
26
250
125
451
23
54 224
819 474
11
485
45
440
59
500
29
62 277
J, 672 1,079
22
1,101
69
1,032
266
1,300
46
111 528
515 241
43
284
19
265
133
400
24
43 193
2,101 1,345
141
1,486
119
1,367
245
1,609
53
132 541
1,122 666
42
708
79
629
87
700
40
60 351
1, 367 720
77
797
151
646
397
1,027
38
70 400
1,403 821
. 174
995
129
866
186
1,060
48
1051 492
1
649 441
53
497
34
<60
43
499
18
41
180
4,443
3,232
573
3,795
450
3,345
1,058
4,300
119
264
1,020
1170
RKPORT OF THK SURGEON GENERAL OF THE ARMY.
Table B. — Xamcji and .>>■/«/»/*• of the hkiic iiiiportnnt hosiiitalN directly under
the administration of the War Department at the close of the fiseal year
191S — Continued.
GENERAL HOSPITALS— Continued.
General Hospital No. 29. Fort Snelling,
Minn
General Hospital No. 30, Plattsburg
Barracks, N. Y
General Hospital No. 31 , Carlisle. Pa. .
General Hospital No. 36, Detroit, Mich,
General Hospital No. 3S, Eastivew,
N. Y
General Hospital No. 41, Fox Hill,
Staten Island, N. Y
General Hospital No. 42, Spartanburg,
S.C
General Hospital No. 43, Hampton, Va.
Total
BASE HOSPITALS.
Camp Bowie, Tex
Camp Devens, Mass
Camp Dix, N. .T
Camp Dodge, Iowa
Camp Gordon, Ga
Camp Grant, 111
Camp Jackson, S.C
Camp Lee, Va
Camp Lewis, Wash
Camp Meade, Md
Camp Tike, Ark
Camp Riley, Kans., Funston. (Camp).
Camp Shelby, Miss
Camp Sherrnan, Ohio
Camp Taylor, Ky
Camp Upton, Long Island, N. Y
Total
1,231
961
1,299
1,022
1.917
1,176
bt<o
.9 m
546
551
643
498
1,124
621
176
274
18
95
157
317
^ o
^^ V
•S.9
1,087
820
569
738
655
1,441
2.1281 1,287
70 691
428 1,715
213
129
63
139
113
228
05 O
S
691
506
599
542
1,213
107 584
555 1,140
362
121
278
308
253
293
431
45, 953 27, 612 4, 555 32, 167 4, 370 27, 797 7, 958
2,702
4,958
10.081
4,014
3,252
7,780
9,264
7,307
3,121
6,844
4,072
2,019
2,879
5,912
7,673
8,648
90,526
162
445
1,013
488
95
444
344
548
388
591
412
208
103
718
609
764
63
225
47
492
198
1,271
146
634
27
122
94
538
83
427
118
666
89
477
145
736
104
516
37
245
58
161
211
929
100
709
301
1,065
9,153 2,821
49
155
403
331
46
140
133
275
117
217
142
72
42
267
158
274
176
337
808
303
76
398
294
391
360
519
374
173
119
652
551
791
6,332
1,275
870
800
909
789
1,468
1,000
1,164
35,201
610
896
392
586
404
800
673
645
359
729
334
478
381
881
456
87
750
1, 200
1,200
900
500
1, 200
1,000
1,000
750
1,200
750
1,200
500
1,480
1,000
800
"O H
634
358
374
493
363
56 8
469
653
1,143 2,622 13, %9
8,71115,430
47 124
31 1 64
19 20
,..l 50
30 41
29, 78
31, 57
31| 56
31 1 28
53 108
15: 16
33 61
44 65
52; 60
491 902
231
342
520
302
206
545
441
388
345
378
381
'"'234
548
481
786
6,128
In order that this division could keep informed as to the status
of the administrative and special commissioned personnel at the
various hospitals this section worked up at the end of each week
a table showinix the number of medical officers on duty in all the
various hospitals, divided into the several services.
In this report tlie total number of })atients in each hospital was
also reported, and bv it the ratio of medical officers to the number
of patients could be rapidly determined and kept constant. This re-
port was used principally by the administrative section of the divi-
sion and b}'^ the chief of the personnel division. As a sample a report
coverinjr general lios])ita]s is appended.
HOSPITAL DIVISION. 1171
Table C. — Numerical list of medical officers on duty week ending June 1^, 1919.
General hospitals.
Army and Navy General Hospital, Hot Springs, Ark.
Fort Bavard, N. Mex.
,San Francisco, Calif .
General Hospita
General Hospita
Walter Reed General Hospital, Takoma Park, D. C.
General Hospita' "
General Hospita
General Hospita
General Hospiia
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hosnita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita
General Hospita!
No. 2, Fort McHenry, Md 4
No. 3, Colonia, N. J (Rahway «) 3
No. 4 Fort Porter, N. Y 3
No. 5, Fort Ontario, N. Y 2
No 6, Fort McPherson, Ga 2
No. 7, Roland Park, Md 1
No. S, Otisville,N. Y 1
No. 9, Lakewocd, N. J.«
No. 10, Boston, Mass 3
No 11, Cape Mav, N.J 2
No. 12, Biltmore. N. C 3
No. 14, Fort Oglethorpe, Ga •. 2
No. 16, New Haven, Conn 3
No. 19, Oteen, N. C. (Biltmore') 2
No. 21, Wliipple Barracks, Ariz 5
No. 21, Denver, Colo 3
No. 22, Philadelphia, Pa 1
No. 24, Parkview, Pa
No. 25, Port Benjamin Harrison, Ind 2
No. 26, Fort Des Moines, Iowa 6
No. 27, Fort Douglas, Utah 3
No. 2H, Fort Sheridan, 111 1
No. 20, Fort Snelling, Minn 4
No 30, Plattsburg Barracks, N. Y J 5
No. 31, Carlisle, Pa I 4
No. 32, Chicago, 111 2
No. 34, East Norfolk, Mass | 2
-^ . --. - 2
2
5
7
2
6
No. 36, Detroit, Mich.
No. 38, Eastview, N. Y
No. *), St. Louis, Mo
No 41, Fo X Hills, Staten Island, N. Y.
No. 42, Spartanburg, S. C ,
No. 43, Hampton, Va
^ a
5
1 1 26
1 52
25 141
2 72
37
35
26
39
29
1 I 45
....I 24
4 I 55
...I 19
2 ; 39
1 36
1 I 45
.... 18
19 122
2 41
237
873
1,501
1,762
2,227
1,261
293
619
1,985
38
550
315
508
1,118
2 40
1,361
266
612
838
837
453
3,302
919
255
568
171
686
637
i'6i2
731
1,166
1 Station.
' Not reported.
To this section came all reports of inspections made of hospitals
by the Surgeon General's inspectors, by the chief inspecting nurse,
and by the officers making the nutritional surveys. Notices of de-
ficiencies and discrepancies were extracted to the responsible officers,
and memoranda of corrective action were returned by them to this
section. When it had been determined that all items of the reports
alleging errors had been noted, this section then reported in de-
tail on such action to the chief of the division of sanitation, under
whose direction all inspections were made.
5. Division of Physical Reconstruction.
A. ORGANIZATION.
This division was organized as the division of special hospitals and
physical reconstruction in August, 1917. Early in the year, begin-
ning July 1, 1918, the title was changed to the division of physical
reconstruction.
The provision made by the Government on June 27, 1918. for the
training and reeducation of compensable, disabled soldiers after dis-
142367— 19— VOL 2 13
1172 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
charge indicated also that the Surgeon General would have full au-
thority to apply all modern methods of medical and surgical treat-
ment to the soldiers disabled by sickness and injury before their dis-
charge from the Anny. This authority was expressed in the follow-
ing language :
Physical reconstruction is defined as complete medical and surgical treat-
ment, carried to the point where maximum functional restoration, mental, and
physical, has been secured. In securing tliis resiilt the use of work, mental,
and manual, will often be required during the convalescent period.
Hereafter no member of tlie military service disabled in line of duty, even
though not expected to return to duty, will be discharged from service until
he has attained complete recovery or as complete recovery as it is to be ex-
pected he will attain when the nature of his disability is considered. When
the degree of recovery described in this paragraph has been attained, members
of the military service who remain unfit for further duty should be discharged
in the manner provided in the Army Regulations.
(201.6, A. G. O.)
By order of the Secretary of War :
Peyton C. March,
General, Chief of Staff.
Official :
H. P. McCain,
The Adjutant General.
On July 31 the completed plan for physical reconstruction of dis-
abled soldiers in general military hospitals was announced officially
by the War Department and published in the Official Bulletin of
August 1, 1918.
This plan embraced the equipment of the general and base hospitals
which functioned in physical reconstruction with curative Avork-
shops and educational buildings properly equipped to carry on cura-
tive work, physio-therapy buildings, including gymnasia properly
equipped to utilize every physical means of cure.
The plan embraced the authority to commission in the Sanitary
Corps of the Medical Department the necessary personnel of edu-
cational officers to administer the work in the Office of the Surgeon
General and in each of the designated hospitals. In the department
of physio-therapy the personnel of administratiA^e officers would be
obtained from qualified officers of the Medical Reserve Corps.
In both the educational and the physiotherapeutic departments
an enlisted personnel was assigned.
The War Department authorized the employment of civilian
women in general hospitals to be designated reconstruction aids.
These aids are of two classes — {a) to function in occupational
therapy, and (&) in physiotherapy.
On July 31, 1918, the Surgeon General designated the general
hospitals which should function in physical reconstruction. The list
included :
Walter Reed General Hospital, Takoma Park, D. C.
General Hospital No. 2, Fort McHenry, Md.
General Hospital No. 3, Colonia, N. J.
General Hospital No. 4, Fort Porter, N. Y.
General Hospital No. 6, Fort McPherson, Ga.
General Hospital No. 7, Roland Park, Baltimore (for the blind).
General Hospital No. 8, Otisville, N. Y.
General Hospital No. 9, Lakewood, N. J.
General Hospital No. 11, Cape May, N. J.
General Hospital No. 16, New Haven, Conn.
KECONSTRUCTION. 1173
General Hospital No. 17, Markleton, Pa.
Letterman General Hospital, San Francisco, Calif.
T'^nited States Armv Hospital, Fort Des Moines. Iowa.
Plattsbiirs: Barracks Hospital, Plattsbiirg Barracks, N. Y.
General Hospital, Fort Bayard, N. Mex.
In the plan for physical reconstruction the Secretary of War
directed that the disabled soldiers would be considered in three
classes :
(a) Those who could be restored to full military duty;
(h) Those who could be fitted for special or limited military
service ;
(c) Those whose disabilities disqualified them for any further
military service.
In the treatment of class B, the Secretary of War directed that the
Surgeon General should cooperate with the committee on education
and special training of the War Department to fit these men for
special service in the Army, and is phrased in a letter of the Secretary
of War to the Secretary of Commerce, dated Augu^ 23, 1918, as
follows :
Physical reconstruction, as defined by the Surgeon General, is " complete
medical and surgical treatment carried to the point of maximum functional
restoration both mental and physical." Whenever play, work, or study can be
used advantageously as a therapeutic agent, they will be so employed in the
general military hospitals. In the work of fitting men for limited military
service, strictly vocational training will be given whenever in the judgment of
the medical officer of a hospital such training will be either beneficial or not
detrimental to the patient. When such a patient is ready for discharge from
the hospital and his special training for limited service is not yet complete, he
will be turned over to the AVar Department committee on education and special
training for further development. In the case of patients who will ultimately
be discharged from military service, arrangements have already been made in
AValter Reed General Hospital whereby the Federal Board for Vocational
Training may have access to these men as soon as it is known that they are to
be discharged. The educational officers have been directed to cooperate with the
representatives of the Federal Board to the fullest possible extent in order that
the men concerned may have all the advantages assured them by the Federal
Government.
In regard to class C, the Secretary of War indicated concurrence
with the request made by the Secretary of Commerce that the func-
tion of the Federal Board be defined in the training of disabled
soldiers in the following phraseology :
The War Department agrees in principle with the proposal of the Federal
Board that the course of training for disabled men who are to be discharged
from military service should be continuous throughout the period of con-
valescence in the hospital and thereafter under the jurisdiction of the Federal
Board. He is ready through the division of physical reconstruction to formu-
late a plan for close cooperation.
This cooperation between the Medical Department of the Army
in the physical reconstruction of disabled soldiers and the Federal
Board for Vocational Education in the work for which the Gov-
ernment had made the board responsible, was perfected early in
the year, beginning July 31, since which date the cordial relations
then established have continued to this date.
The plan of the Surgeon General, approved by the War Depart-
ment, for the physical reconstruction of disabled soldiers, which
included authority to commission educational officers in the Sani-
1174 REPORT OF THE SURGEON GENERAL OF THE ARMY.
tarv Corps, and the establishment of facilities for the work in
eacli of the desisniated hospitals, was given approval in the follow-
ing phraseology^ :
A. G. O. 1st Ind. July 31, 1918 (S. G. O. 356) : . v, .x, c
The general policv of physical reconstruction as proposed by the Surgeon
GeneraPs Office for "tlie puiTOse, primarily, of effecting the maximum restora-
tion of disabled soldiers using manual and mental work as a curative agent
and incidentally of training and educating them for further useful work
in the Military Establishment, is approved Avith the understanding that such
Incidental training will not involve the Government in large expenditures
and elaborate installations of shops and apparatus, and provided that all
existing facilities, both military and civilian, for training and educating
the soldier toward the end in view shall be used to the fullest possible
extent.
Early in the year the Surgeon General approved the ph\n formu-
lated by the hospital division, cooperating with this division, for
types of workshop?^, educational buildings, physio-therapy building
and maximum and minimum specifications for equipment for shops,
schools, and physio-therapy apparatus.
The work of physical reconstruction begun in the designated gen-
eral hospitals early in the year 1918 was rapidly extended to the
hospitals enumerated in the list designated on July 31, 1918.
In this connection, it should be recalled that on May 27. 1918,
the War Department agreed to afford physical reconstruction to
disabled soldiers and sailors in the military hospitals. The fol-
lowing letter in relation thereto is self-explanatory:
May 27, 1918.
Hon. .losEPHX's Danifxs,
Secretary of the Nary, WasJdngton, D. C.
My Dear IMr. Secretary : Replying to your letter of April 1.5 on the subject
of physical reconstruction (M. & S., 120246). Authority has been given for
the admission of naval patients to military hospitals for physical reconstruc-
tion on request of the Surgeon General of the Navy or other proper official
of that department.
Tours, very truly,
Benkdict Croweli,,
The Assistant Secretary of War.
It was recognized that the program of physical reconstruction of
disabled soldiers would require a policy of extended publicity to
make the work successful. This program of publicity embraced the
following :
(a) To educate the public to the need of physical reconstruction for disabled
men before their return to civil life.
(b) To educate the family of the soldier of the need of continued treatment
until he is well, that they may be satisfied to have him remain in the hospital.
(c) To educate the soldier himself by placing in his hands, at the earliest
possible moment after his disability has been incurred, the necessary literature
which will inform him of his status as a soldier, and the privileges which
are his as a disabled man, from the INIedical Department of the Army, the Federal
Board for Vocational Education, and the Bureau of War Risk insurance; to
place in his hands such literature as will inform him of facts concerning
various trades from which he may choose a vocation, together with all the
information in regard to the need of men in the various industries of the
country. As a part of the publicity program the Surgeon General authorized
the publication of the magazine Carry On, cooperating with the American
Red Cross Institute for tbe Crippled. Cooperating with the instruction labora-
tory of this office, moving-picture films of an eduactional character were made
and exhibited in many of the hospitals and in moving-picture houses of the
RECONSTRUCTION. 1175
country. Censored newspaper articles were issued to the syndicated press of
the country. Mucli information was distributed to the families of the disabled
soldiers through the home service of the American Red Cross chapters.
Special provision was made for the training and education of the
blind or nearly blind soldiers, sailors, and marines at General Hos-
pital No. 7, Roland Park, Baltimore, during the year beginning July
I, 1917, This hospital was completed, a corps of teachers, including
civilian employees of the Army, augmented by volunteers from civil
life, was obtained, and active work begim on May 30, 1918. During
the six months beginning July 1, 1918, the number of patients in
General Hospital No. 7 rapidly increased and the teaching of Braille
and typewriting to these men was efficiently carried on.
After the signing of the armistice the blind or nearly blind
patients insisted upon discharge from the Army so that they could
take advantage of the benefit afforded them by their insurance and
monthly pensions. On May 10, 1919, final arrangements were com-
pleted, with the approval of the War Department, for the transfer
of the school for the blind to the American Red Cross. Under this
plan the War Department maintains the reservation with one build-
ing for the hospital with the assignment of a commanding officer and
a medical detachment of approximately 15 men to safeguard the
propert}^ of the Government. By May 24, 1919, all of the blind or
nearl}- blind soldiers at General Hospital Xo. 7 were discharged and
passed to the jurisdiction of the Bureau of War Risk Insurance and
the Federal Board for Vocational Education. The Federal board
cooperates with the American Red Cross in the conduct of the
school for the blind at Roland Park.
Special arrangements were made for the care of the soldiers dis-
abled by deafness and by speech defects at General Hospital No.
II, Cape May, N. J. The deaf soldiers are taught lip reading and
incidentally trained in suitable occupations. The soldiers disabled
by speech defects are trained in speech articulation and are voca-
tionally trained.
On December 10, 1918, a memorandum was forwarded b}' the Sur-
geon General to the Chief of Staff requesting authority to amplify
the number of centers to function in physical reconstruction to meet
the need of rehabilitation of the very large number of disabled men
returning from overseas after the signing of the armistice. This
memorandum was approved on December 19, 1918. This authority
embraced the policy and program of physical reconstruction for-
merly authorized : amplication of the centers of physical reconstruc-
tion, including the alteration of existing available buildings in the
designated centers ; the purchase of new or the transfer of the neces-
sary equipment already owned by the Government for workshops,
school buildings, farm, motor mechanics, physical education, and
the like; allotment of funds for the purchase of expendable mate-
rials to be utilized by the soldiers in the curative workshop schedule;
the transfer of disabled soldiers who required physical reconstruc-
tion from hospitals where no facilities for the work existed to recon-
struction hospitals; the transfer of enlisted and commissioned per-
sonnel qualified as educators and instructors from other corps with
the provision that such transfers will be requested separately and
completed only with the consent of the officer to be transferred ; and
the rehabilitation of convalescent soldiers from the American Ex-
1176 REPORT OF THE SURGEON GENERAL OF THE ARMY.
peditionary Forces in the convalescent centers of 19 of the training
camps. To meet the added work indicated the following additional
centers were designated to function in physical reconstruction:
General Hospital Xo. 12, Biltmore, X. C.
General Hospital Xo. 31, Carlisle, Pa.
General Hospital Xo. 36, Detroit, Mich.
General Hospital Xo. 38, East View, X. Y.
General Hospital Xo. 41, Fox Hills, Staten Island, N. Y.
General Hospital Xo. 42, Spartanburg, S. C.
Base hospitals at Camps Gordon, Ga., Jackson, S. C, Lee, Va.,
Meade, Md.. Sherman, Ohio, Taylor, Ky., Fun.ston (Fort Riley),
Kans., Custer, Mich., Grant, 111.,*^ Travis, Tex., Pike, Ark., Dodge,
Iowa, Lewis, Wash., Dix, X. J., Devens, Mass., Upton, Long
Island, and Kearney, Calif., and on May 1, 1919, General Hospital
X'^o. 43, Hampton, Va.
In the administration of the physical reconstruction of disabled
soldiers, sailors, and Marines, the following sections of the division
were organized: Section on education, section on physiotherapy,
section on convalescent centers, section on publicity.
B. SECTIOiSr ON EDUCATION.
The educational service of each hospital included a chief educa-
tional officer commissioned in the Sanitary Corps or Medical Corps,
or a qualified officer transferred from other Army organizations.
As assistants in the administration of the curative workshop schedule,
or as instructors, additional personnel was obtained from qualified
teachers from civil life commissioned in the Sanitary Corps or
transferred from other corps of the Army ; by the enlistment of men
with defects disqualifj'ing for general military service, but who were
fit for special or limited service and by the retention of soldiers dis-
abled in the war who were qualified as technical instructors and will-
ing to remain in the service to train their fellow disabled soldiers.
Reconstruction aides in occupational therapy, chiefly women, were
brought into the service to instruct and train patients in the arts
and handicrafts, in commercial and academic courses applied as cura-
tive work in the treatment of the patients.
The educational personnel from October, 1918, to June 20, 1919,
with the number of hospitals functioning in physical reconstruction
for the time mentioned is indicated in the following table:
Octo-
ber.
Novem-
ber.
Decem-
ber.
Janu-
ary.
Febru-
ary.
March.
April.
May.
June
1-20.
Number of hospitals
16
17
25
27
41
44
45
40
40
Commissioned olTiccrs
Enlisted men
37
335
124
43
314
157
102
695
337
125
681
449
210
809
806
270
888
1,163
264
808
1,290
252 !
750
1,383 i
200
600
Reconstruction aides
1,100
Total on staff
496
514
1,134
1,255
1,825
2,321
2,362
2,385
11,900
1 Hospitals closing in June will make a material reduction in personnel.
Note.— Eighty-sev-ea ailitianal reconstruction aides in occupational therapy served in the hospitals
of the American Expeditionary Forces.
EECOKSTRUCTIOK.
1177
The number of patients enrolled in the educational service who
took manual and mental curative work from month to month and the
number of hospitals operating in the special month are indicated in
the following table:
Octo-
ber.
Novem-
ber.
Decem-
ber.
Janu-
ary.
Febru-
ary.
March.
April.
May.
Number of hospitals reporting
Number of patients enrolled in eduea-
tinnal worV
16
829
17
4,387
2.5
5,292
27
8,167
41
16,296
44
24,969
45
28,500
140
30.096
1 Reports have not been received from two hospitals which functioned in the work in May.
Many aliens have been Americanized in the hospitals. The fol-
lowing table shows the rise of enrollments in the Americanization
courses from August, 1918, to April, 1919, inclusive. Full reports
for Mav have not been made at this date.
Au-
gust.
Sep-
tem-
ber.
Octo-
ber.
No-
vem-
ber.
De-
cem-
ber.
Janu-
ary.
Febru-
ary.
March.
Apr'l
and
May.
English
Reading
Spelling
Penmanship.
Geography. .
History
Arithmetic . .
Total.
84
179
158
200
872
72
204
140
239
52
261
107
315
263
28.5
58
222
155
256
12
20
245
122
421
248
608
12
20
570
.535
371
347
707
557
510
1,194
^81
1,134
1,338
739
702
1,638
52
30
1,765
918
1,026
%8
2,001
4,375
5,632
1,490
656
769
1,861
83
70
1,838
6,767
The study of 12,067 patients in 15,978 enrollments in regard to
length of schooling in hospital showed a variation from a period
of 5 days or less to over 200 clays, the median 19.5 days' duration.
This study was made April 30 and included a larger proportion of
short-time students than will be found in later months. The average
period of schooling in hospitals thus exceed 20 days for each man
formally reported to the Surgeon General's Office.
Recreational activities, including play, were conducted in each
hospital under tlie jurisdiction of the chief educational officer. These
activities have been most successful because of the hearty coopera-
tion in this work by the American Red Cross, Young Men's Christian
Association, Knights of Columbus, Jewish Welfare Board, and other
civilian agencies. These recreational activities included amusements
in the wards in the form of music, theatrical plays, and the like. Ro-
mance literature has been furnished in each hospital by the American
Library Association. Outdoor games with setting-up exercises, mili-
tary drill, and play have been of great value in the hospitals and in
the convalescent centers. In the centers the recreational activities
were administered by the administration officers of the center, cooper-
ating with the War Department commission on training camp
activities.
C. SECTION ox PHYSIOTHERAPY.
The measures included under physiotherapy (electro, hydro,
thermo, and mechanical therap}', massage, and gymnastics) have been
efficiently carried out in each hospital under the direction of a chief
1178 REPORT OF THE SURGEON" GENERAL OF THE ARMY.
of service, a qualified physiotherapist commissioned in the Medical
Corps, with a personnel of other commissioned officers, noncommis-
sioned officers, and enlisted men. Reconstruction aids in physio-
therapy have efficiently carried on massage, passive motion of dis-
abled parts, electro and thermo therapy and local hydrotherapy.
Physical gymnastics and mechanical therapy have been efficiently ap-
plied in the gymnasia and out of doors. Particular attention has
been given to the training of the men suffering from amputations in
teaching them, when necessar3\ how to dress, feed, and care for them-
selves in an independent manner, and also how to use the artificial
appliances attached to the legs or arms.
The personnel in the department of physiotherapy of each hospi-
tal, the number of patients treated, and the total number of treatments
given from October 1, 1918, to May 31, 1919, is indicated in the fol-
lowing table:
Octo-
ber.
Novem-
ber.
Decem-
ber.
Janu-
ary.
Febru-
ary.
March.
April.
May.
Hospitals with facilities for physio-
9
12
25
125
11
14
29
378
13
19
36
504
27
32
40
530
32
37
60
674
40
39
75
718
49
44
60
748
45
46
54
Reconstruction aids
700
Of the total number of physiotherapy aids indicated in the table,
80 served in the hospitals of the American Expeditionary Forces.
Note.— Total patients treated to May 31, 1919, 48,988; total treat-
ments given to May 31, 1919, 1,307,457.
D. SECTION ON CONVALESCENT CENTERS.
Following the signing of the armistice, convalescent disabled
soldiers of the American Expeditionary Forces were returned to the
United States as convalescent detachments on a duty status. These
soldiers were sent to convalescent centers nearest their homes in 19
designated training camps. This division was given advisory and
administrative authority in the program of rehabilitation of the
soldiers in convalescent centers. To properly administer the program
of the application of active and passive exercise curative work and
play, 14 medical officers were assigned to duty in the field as con-
sultants by the authority granted to this division by the Surgeon
General. From the time of the establishment of the convalescent
centers on or about January 25, 1919, to their abolition on April 28,
1919, 47,858 convalescent soldiers received final hardening by educa-
tional training and physical exercise under the supervisory adminis-
tration of this division.
E. SECTION ON PUBLICITY.
In addition to the compilation of the various governmental docu-
ments which describe the provisions made for the benefit of disabled
soldiers, sailors, and marines before and after their discharge and
circulation for the information of the disabled soldiers and their
friends, the division has disseminated other literature of a cheer-up
EECOXSTRUCTION. 1179
character through the home-service division of the American Red
Cross chapters, and has in this way reached the families of the
soldiers and the general public. Ten numbers of the magazine
Carry On have been issued. Cooperating with the American Red
Cross Institute for the Crippled, and without cost to the War De-
partment, approximately 125,000 copies of each issue of Carry On
have been published and distributed.
On June 1, 1919, the division was instructed to concentrate the
work of physical reconstruction in 20 hospital centers. The hospitals
selected to function in physical reconstruction are :
Walter Reed General Hospital, Takoma Park, D. C.
Army and Navy General Hospital, Hot Springs, Ark.
General Hospital, Fort Ba^'ard, N. Mex.
General Hospital, Fort Letterman, San Francisco, Calif.
General Hospital No. 2, Fort McHenry, Baltimore, Md.
General Hospital No. 3, Colonia, N. J.
General Hospital No. 6, Fort McPherson, Ga.
General Hospital No. 8, Otisville, N. Y.
General Hospital No. 19, Oteen, N. C.
General Hospital No. 20, "^A^iipple Barracks, Ariz.
General Hospital No, 21, Denver, Colo.
General Hospital No. 26, Fort Des Moines, Iowa.
General Hospital No. 28, Fort Sheridan, 111.
General Hospital No, 30, Plattsburg Barracks, N. Y.
General Hospital No. 31, Carlisle, Pa.
General Hospital No, 41, Fox Hills, Staten Island, N. Y.
General Hospital No. 42, Spartanburg, S. C.
General Hospital No. 43, Hampton, Va.
Departmental Base Hospital, Fort Riley, Kans.
Departmental Base Hospital, Fort Sam Houston, Tex.
In confirmation with this order, reconstruction was discontinued in
all of the base hospitals of the training camps with the exception of
base hospital. Fort Riley. Arrangements were also made for an early
discontinuation of the work at General Hospital No. 11, Cape May,
N. J. ; General Hospital No. 12, Biltmore, N. C. ; General Hospital
No. 16, New Haven, Conn. ; General Hospital No. 24, Parkview, Pa. ;
General Hospital No. 29, Fort Snelling, Minn. ; and General Hospital
No. 36, Detroit, Mich.
It has also been determined to still further concentrate the work of
physical reconstruction into eight more or less permanent centers.
The hospitals selected for this more permanent tvpe of work are :
Walter Reed General Hospital, Takoma Park.' D. C.
General Hospital, Fort Letterman, San Francisco, Calif.
General Hospital No. 6, Fort McPherson, Ga.
General Hospital No. 19, Oteen, N. C.
General Hospital No. 21, Denver, Colo.
General Hospital No. 26, Fort Des Moines, Iowa.
General Hospital No. 31, Carlisle, Pa.
General Hospital No. 43, Hampton, Va.
The concensus of opinion of the officers made responsible for the
application of physical reconstruction in the treatment of disabled
soldiers, which is strengthened by the judgment due to experience of
the medical staffs of the hospitals which function in physical recon-
1180 REPORT OF THE SURGEON GENERAL. OF THE ARMY.
struction, is that the rational application of standardized measures
included under physiotherapy and of curative work has been of the
greatest value in the more certain and rapid physical and functional
restoration of disabled men. It has been applicable alike to the dis-
abilities due to illness and to injury.
The application of curative work, recreation, and play has been
an important factor in maintaining a better discipline and stimula-
tion of morale of the patients and of the w^hole personnel of the
hospitals.
On June 20, 1919, the division of physical reconstruction was dis-
continued. The functions of this division were merged with those of
the hospital division as a section of the hospital division of the Office
of the Surgeon General.
6. 0^'ERSEAS Mobile Hospitals.
1. Since July 1, 1918, the following medical units have been sent
abroad. These units were organized, equipped, and trained at the
base and general hospitals shown, except in cases where Camp Green-
leaf is also noted. These units were organized at medical officers'
training camp. Camp Greenleaf, Ga., and then sent to base and
general hospitals for further training :
Base hospitals:
No. 51. Camp Wlieeler, Ga.
No. 52. Camp Gordon, Ga.
No. 53. Camp Hancock, Ga.
No. 54. Camp Greene, N. C.
No. 55. Fort Oglethorpe, Ga.
No. 56. Camp Wadsworth, S. C.
No. 57. Fort Oglethorpe, Ga.
No. 58. Camp Grant, 111.
No. 59. Camp Shelby, Miss.
No. 60. Camp Jackson, S. C.
No. 61. Camp Lee, Va.
No. 62. Camp Upton, L. I.
No. 63. Camp McClellan, Ala.
No. 64. Camp Sevier, S. C.
No. 65. Fort McPherson, Ga.
No. 69. Camp Meade, Md.
No. 70. Fort Ontario, N. Y.
No. 71. Camp Beaviregard, La.
(Greenleaf).
No. 72. Camp Gordon, Ga. (Green-
leaf).
No. 76. Camp Devens, Mass.
No. 77. Camp Sherman, Ohio.
No. 78. Fort McHenry, Md.
No. 79. Fort Des Moines, Iowa.
No. 80. Camp Wheeler. Ga.
No. 81. Camp Travis, Tex.
No. 82. Camp Funston, Kans.
No. 83. Camp Pike, Ark.
No. 84. Camp Bowie, Tex.
No. 85. Camp Doniphan, Okla.
No. 86. Camp Logan, Tex.
No. 87. Camp MacArthur, Tex.
No. 88. Camp Dodge, Iowa.
No. 89. Camp Sheridan, 111.
No. 90. Fort Riley, Kans.
No. 91. Camp Gordon, Ga. (Green-
leaf).
No.
No.
No.
No. 102.
No. 103.
Base hospitals — Continued.
No. 92. Camp Greene, N. C. (Green-
leaf).
No. 93. Camp Lewis, Wash.
No. 94. Camp Cody, N. Mex.
No. 95. Camp Fremont, Calif.
96. Camp Kearney, Calif.
97. Camp Baker, Tex.
98. Cam p Hancock, Ga.
(Greenleaf).
No. 99. Camp Custer, Mich.
(Greenleaf).
No. 100. Camp Custer, Mich.
(Greenleaf).
Camp Beauregard, La.
Fort Sheridan, 111.
(Greenleaf.)
No. 104. C a m p Dodge, Iowa
(Greenleaf.)
No. 105. Fort Benjamin Harrison,
Ind. ( Greenleaf. )
No. 106. Camp .Tackson, S. C.
(Greenleaf).
No. 107. Fort Snelling, Minn.
(Greenleaf).
No. 108. Fort Snelling, Minn.
(Greenleaf).
No. 109. Fort Benjamin Harrison,
Ind. (Greenleaf.)
No. 110. Camp Sevier, S. C. (Green-
leaf).
No. 111. Camp Beauregard,
(Greenleaf).
No. 112. Camp Sherman,
(Greenleaf).
No. 113. Camp Sherman,
(Greenleaf).
No. 115. Cape May, N. J.
La.
Ohio
Ohio
OVERSEAS MOBILE HOSPITALS.
1181
Base hospitals — Continued.
No. 118. Camp Taylor, Ky.
(Greenleaf ).
No. 119. Camp Taylor, Ky.
(Greenleaf).
No. 120. Camp Beauregard La.
(Greenleaf).
No. 121. Camp Beauregard, La.
(Greenleaf).
No. 122. Camp Greene, N. C.
(Greenleaf.)
No. 123. Camp Greene, N. C.
(Greenleaf).
No. 131. Jefferson Barracks, Mo.
No. 136. Camp Wheeler, Ga.
(Greenleaf).
Evacuation hospitals :
No. 9. Fort Riley, Kans.
No. 10. Fort Riley, Kans.
No. 11. Foi-t Riley, Kans.
No. 12. Fort Riley, Kans.
. No. 13. Camp Gordon, Ga.
No. 14. Camp Jackson, S. C.
No. 15. Camp Lee, Va.
No. 16. Camp Meade, Md.
No. 17. Fort Sam Houston, Tex.
No. 18. Camp Taylor, Ky.
No. 19. Camp Dix, N. J.
No. 20. Camp Grant, 111.
No. 21. Camp Custer, Mich.
No. 22. Camp Sevier, S. C.
No. 23. Fort INIePherson, Ga.
No. 24. Camp Devens. Mass.
No. 25. Camp Dodge, Iowa (Green-
leaf).
No. 26. Camp .Tfickson, S. C.
(Greenleaf).
No 27. Camp Pike, Ark. (Green-
leaf).
No. 28. Camp Sherman, Ohio
(Greenleaf).
No. 29. Camp Beauregard, La.
(Greenleaf).
No. 30. Camp Greene, N. C.
(Greenleaf).
No. 31. Camp H a n c o c k, Ga.
(Greenleaf).
No. 32. Camp McClellan, Ala.
(Greenleaf).
No. 33. Camp Shelby. Miss.
(Greenleaf).
No. 34. Camp Sheridan, Ala.
(Greenleaf).
No. So. Camp Wadsworth. S. C.
(Greenleaf).
No. 36. Camp Wheeler, Ga.
(Greenleaf).
No. 37. Camp Grant. 111. (Green-
leaf).
No. 38. Camp Meade, Md. (Green-
leaf).
No. 40. Camp Greenleaf, Ga.
No. 49. Camp Greenleaf, Ga.
Evacuation ambulance companies :
No. 5. Camp Crane, Pa.
No. 6. Camp Crane, Pa.
No. 7. Camp Crane, Pa.
Evacuation ambulance companies-
Continued.
No. S. Camp Crane, Pa.
No. 9. Camp Crane, Pa.
No. 10. Camp Greenleaf, Ga.
No. 11. Camp Greenleaf, Ga.
No. 12. Camp Greenleaf, Ga.
No. 13. Camp Greenleaf, Ga.
No. 14. Camp Greenleaf, Ga.
No. 15. Camp Greenleaf, Ga.
No. 16. Camp Greenleaf, Ga.
No. 17. Camp Greenleaf, Ga.
No. 18. Camp Greenleaf, Ga.
No. 19. Camp Greenleaf, Ga.
No. 20. Camp Greenleaf, Ga.
No. 21. Fort Riley, Kans.
No. 22. Fort Riley, Kans.
No. 23. Fort Riley, Kans.
No. 24. Fort Riley, Kans.
No. 25. Fort Riley, Kans.
No. 26. Fort Riley, Kans.
No. 27. Fort Riley, Kans.
No. 28. Fort Riley, Kans.
No. 29. Fort Riley, Kans.
No. 30. Fort Riley, Kans.
No, 31. Fort Riley, Kans.
No. 32. Fort Riley, Kans.
No. 33. Fort Riley, Kans.
No. 34. Fort Riley, Kans.
No. 35. Fort Riley, Kans.
No. 36. Fort Riley, Kans.
No. 37. Fort Riley, Kans.
No. 38. Fort Riley, Kans.
No. 39. Fort Riley, Kans.
No. 40. Fort Riley, Kans.
No. 41. Fort Riley, Kans.
No. 50. Camp Crane, Pa.
No. 51. Camp Crane, Pa.
No. 52. Camp Crane, Pa.
No. 53. Camp Crane, Pa.
No. 54. Camp Crane, Pa.
No. 55. Camp Crane, Pa.
No. 56. Camp Crane, Pa.
No. 57. Camp Crane, Pa.
No. 58. Camp Crane, Pa.
No. 59. Camp Crane, Pa.
No. 60. Camp Crane, Pa.
No. 61. Camp Crane, Pa.
No. 62. Camp Crane, Pa.
No. 63. Camp Crane, Pa.
No. 64. Camp Crane, Pa.
No. 65. Camp Crane, Pa.
No. 66. Camp Crane, Pa.
No. 67. Camp Crane, Pa.
No. 68. Camp Crane, Pa.
No. 69. Camp Crane, Pa.
No. 70. Camp Crane, Pa.
No. 71. Camp Crane, Pa.
No. 72. Camp Greenleaf, Ga.
No. 73. Camp Greenleaf, Ga.
No. 74. Camp Greenleaf, Ga.
No. 75. Camp Greenleaf, Ga.
No. 76. Camp Greenleaf. Ga.
No. 77. Camp Greenleaf. Ga,
No. 78. Camp Greenleaf. Ga.
No. 79. Camp Greenleaf, Ga.
No. 80. Camp Greenleaf, Ga.
No. 81. Camp Greenleaf, Ga.
1182
REPORT OF THE SURGEON GENERAL, OF THE ARMY.
Convalescent camps :
No. 3. Camp Greenleaf, Ga.
No. 4. Camp Groenleaf, Ga.
No. 5. Fort Kiley, Kans.
No. 6. Camp Greenleaf, Ga.
No. 7. Camp Greenleaf, Ga.
No. 8. Camp Greenleaf, Ga.
No. 9. Camp Greenleaf, Ga.
No. 10. Camp Gi-eenleaf, Ga.
No. 11. Camp Greenleaf, Ga.
No. 12. Camp Greenleaf, Ga.
Convalescent depot :
No. 1. Section B, Camp Greenleaf,
Ga.
Medical supply depots:
No. 5. Newport News, Va.
No. 6. Newport News, Va.
No. 7. Presidio, San Francisco,
Calif.
No. 8. Newport News, Va.
Stationary laboratories :
No. 3. Fort Leavenworth, Kans.
No. 4. Army Medical School.
No. 5. New Haven, Conn.
Mobile laboratories :
No. 46. New Haven, Conn.
No. 47. New Haven, Conn.
No. 48. New Haven, Conn.
No. 49. New Haven, Conn.
No. 50. New Haven, Conn.
No. 100. Camp Crane, Pa.
No. 101. Camp Crane, Pa.
No. 102. Camp Crane, Pa.
No. 103. Camp Crane, Pa.
No. 104. Camp Crane, Pa.
No. 105. Camp Crane, Pa.
Mobile surgical units :
No. 100. Camp Crane, Pa.
No. 101. Camp Crane, Pa.
No. 102. Camp Crane, Pa.
No. 103. Camp Crane, Pa.
Hospital trains :
No. 35. Fort Riley, Kans.
No. 36. Camp Greenleaf, Ga.
No. 37. Fort Rilev, Kans.
No. 38. Fort Rilev, Kans.
No. 39. Fort Riley, Kans.
No. 40. Camp Greenleaf, Ga.
No. 41. Camp Greenleaf, Ga.
No. 42. Camp Greenleaf, Ga.
No. 43. Camp Greenleaf, Ga.
No. 44. Fort Riley, Kans.
No. 45. Fort Riley, Kans.
No. 46. Camp Greenleaf, Ga.
No. 47. Camp Greanleaf, Ga.
No. 48. Camp Greenleaf, Ga.
No. 49. Camp Greenleaf, Ga.
No. 50. Camp Greenleaf, Ga.
No. 51. Camp Greenleaf, Ga.
No. 52. Camp Greenleaf, Ga.
No. 53. Camp Greenleaf, Ga.
No. 54. Camp Greenleaf, Ga.
Army sanitary train No. 1:
Section B. Fort Riley, Kans.
Section C. Camp Naker, Tex.
Section D. Camp Greenleaf, Ga.
Section E. Fort Riley, Kans.
Special units:
Mobile Operating Unit No. 1,
Camp Crane, Pa.
Central Optical Unit No. 1, Camp
Crane, Pa.
Medical Department, Replacement
Unit No. 1, Camp Crane, Pa.
Neuro Surgical Unit No. 1, Ho-
boken. N. J.
Aviation Medical Unit No. 1,
Mineola, N. Y.
Medical Research Board No. 1,
Mineola, N. Y.
Aviation Opthalmo-Otological Unit
No. 1, Mineola, N. Y.
Anaesthetic Unit No. 1. General
-Hospital No. 1, New York City.
Museum Unit No. 1, Army Medi-
cal Museum.
Otolaryngoloical Unit No. 1, Ho-
boken, N. J.
Roentgenological Unit No. 1, Camp
Crane, Pa.
Neuro-Psychiatric Units Nos. 1
and 2, Plattsburg, N. Y.
Opthalmological Unit No. 1, Ho-
boken, N. J.
Surgical Groups Nos. 1, 2. 4, 5, 6,
7, 8, 10, Camp Crane, Pa.
Medical Classifying Unit No. 1,
Hoboken, N. J.
Rodentological Unit No. 1, Ho-
boken, N. ,J.
Medical Department Repair Shop
Unit No. 1, Hoboken, N. J.
Sanitary squads :
Nos. 73 and 74. Camp Wheeler. Ga.
Nos. 75 and 76. Camp Cody, N. Mex
Nos. 77 and 78. Camp Shelby, Miss.
Nos. 79 and SO. Camp Tavlor, Kv.
Nos. 81 and 82. Camp Grant, 111."
Nos. 115 and 116. Camp Crane. Pa.
Nos. 117 and 118. Camp Crane, Pa.
Nos. 119 and 120. Camp Crane, Pa.
Ambulance sections :
No. 507. Camp Crane, Pa.
No. 508. Camp Crane, Pa.
No. 514. Camp Crane, Pa.
No. 518. Camp Crane, Pa.
No. 522. Camp Crane, Pa.
No. 528. Camp Crane. Pa.
No. 531. Camp Crane, Pa.
No. 537. Camp Crane, Pa.
No. 540. Camp Crane, Pa.
No. .541. Camp Crane, Pa.
No. .543. Camp Crane, Pa.
No. 547. Camp Crane, Pa.
No. .548. Camp Crane, Pa.
No. .5.50. Camp Crane, Pa.
No. 556. Camp Crane, Pa.
No. .564. Camp Crane, Pa.
No. 572. Camp Crane, Pa.
No. 582. Camp Crane, Pa.
No. 589. Camp Crane, Pa,
No. 595. Camp Crane, Pa.
No. 605. Camp Crane, Pa.
No. 610. Camp Crane, Pa.
OVERSEAS MOBILE HOSPITALS.
1183
Ambulance sections — Continued.
No. 612. Caiup Crane, Pa.
No. 613. Camp Crane, Pa.
No. 614. Camp Crane, Pa.
No. 615. Camp Crane, Pa.
No. 616. Camp Crane, Pa.
Division sanitar
Sanitary Divi-
traln. sion.
y trains :
Amb
1st
2d
3d
4th
5tli
6th
7th
101st
102d
103d
104th
105th
106th
107th
108th
109th
110th
111th
112th
113th
114th
1st
2d
3d
4th
5th
6th
7th
26th
27th
28th
29th
30th
31st
32d
33d
34th
35th
36th
37th
3Sth
39th
2,
1,'
5,
19,
17,
20,
DO
21
25.
37,
34,
101, 102,
105, 106,
109, 110,
113. 114,
117, 118,
121, 122.
125, 126,
129, 130.
133, 134,
137, 138,
141, 142,
145, 146
149, 150
153, 154
Base veterinary hospitals :
No. 2. Camp Lee, Va.
Services of Supply veterinary
tals:
No. 7. Camp Lee, Va.
No. 8. Camp Lee, Va.
No. 9. Camp Lee, A'a.
No. 10. Camp Lee, Va.
No. 11. Camp Lee, Va.
No. 12. Camp Lee, Va.
No. 13. Camp Lee, Va.
No. 14. Camp Lee, Va.
No. 15. Camp Lee, Va.
No. 16. Camp Lee, Va.
No. 17. Camp Lee, Va.
No. 18. Camp Lee, Va.
No. 19. Camp Lee, Va.
. Co. and Field
Hosp. No.
, 12, and
, 16, and
, 26, and
, 28, and
, 38, and
, 39, and
, 35, and
, 103, and 104
, 107, and 108
, 111, and 112
, 115, and 116
, 119, and 120
123. and. 124
127, and 128
131, and 132
135, and 136
139, and 140
143. and 144
147, and 148
151, and 152
155, and 156
hospi-
Ambulance sections — Continued.
No. 617. Camp Crane, Pa.
No. 618. Camp Crane, Pa.
No. 619. Camp Crane, Pa.
No. 620. Camp Crane, Pa.
Division s:
Sanitary
train.
115th
116th
117th
301st
302d
303d
304th
305th
306th
307th
308th
309th
310th
311th
312th
313th
314th
315th
316th
317th
anitar
Divi-
sion.
40th
41st
42d
76th
77th
78th
79th
80th
81st
82d
83d
S4th
85th
S6th
S7th
88th
S9th
90th
91st
92d
y trains—
Amb.
157, 1.58
161, 162
165, 166
301, 302
305, 306
309, 310
313, 314
317, 318
321, 322
325, 326
329. 330,
333, 334
337, 338
341. 342
345, 346
349, 350
353, 354
357, 358
361, 362,
365, 366,
-Continued.
. Co. and Field
Hosp. No.
, 1.59, and 160
, 163, and 164
. 167, and 168
, 303, and 304
307, and 308
311, and 312
, 315, and 316
, 319, and 320
, 323, and 324
, 327, and 328
331, and 332
, 335, and 336
, 339, and 340
. 343, and 344
347, and 348
, 351, and 3.52
. 355, and 356
, 3.59, and 360
363, and 364
367, and 368
Services of Supply veterinary hospi-
tals— Continued.
No. 20. Camp Lee, Va.
No. 21. Camp Lee, Va.
Corps mobile veterinary hospitals :
No. 2. Camp Lee, Va.
No. 3. Camp Lee, Va.
No. 4. Camp Lee, Va.
No. 5. Camp Lee, Va.
No. 7. Camp Lee, Va.
No. 8. Camp Lee, Va.
No. 9. Camp Lee, Va.
Army Mobile Veterinary Hospital
No. 1:
Section A. Camp Lee, Va.
Section B. Camp Lee, Va.
In addition to the above, approxiinately 17,500 men were sent
abroad for replacement among medical troops in the American Ex-
peditionary Forces.
The following units were organized and would have been ready
for shipment within a short time :
41 base hospitals.
19 evacuation hospitals.
16 division sanitary trains.
12 hospital trains.
2 convalescent camps.
1 convalescent depot (3 sections).
20 evacuation ambulance companies.
1 Army sanitary train.
1 corps sanitary train.
21 field hospitals.
21 aml)ulance companies.
32 sanitary squads.
17 ambulance sections.
3 mobile surgical units.
1 stationary laboratoiy.
1 base veterinary hospital.
4 Ser^^ces of Supply veterinary hos-
pitals.
1 corps mobile veterinary hospital.
1 Army mobile veterinary hospital.
1184 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
VII. FINANCE AND SUPPLY DIVISION.
Medical and Hospital Supplies.
The greatest difficulty the department experienced in distributing
supplies to the troops \vas the lack of coordination between the move-
ment of men and material, especially as regards priority schedules.
Tonnage allotted for troop movements seemed out of proportion to
that allotted for supplies. Full significance did not attach to the
value of material until the troops were trained and ready for action.
Supply bureaus were criticized for not providing materiel to keep
pace with personnel. It seemed to be forgotten that men already
existed and could be had immediately on call, while supplies, without
which personnel was useless, did not exist and time was required to
produce them ; that weeks and even months must elapse before they
could be put in the hands of the men. In many instances the ma-
terials had not been mined or the crops planted out of which the
supplies were to be made. Trees even had to be felled and lumber
sawn and transported before buildings could be erected in which
to house the stores.
The task of furnishing adequate supplies for its proper service
which confronted the Medical Department at the beginning of the
current year was even greater than that which confronted it at the
beginning of the fiscal year 1918. The volume of the supplies on
hand, which had been steadily rising since the beginning of the war
and which had already reached proportions sufficient to equip and
maintain an army of 2,000,000 men, had to be further augmented
to meet urgent needs abroad. Men were being called to the colors
in great numbers and the stream of troops flowing overseas had by
the beginning of the year reached proportions incredible six months
previous. Owing to a multitude of transportation difficulties the
effort to accumulate a reserve of supplies adequate for combat needs
in France had not been wholly successful. Wliile the needs of the
troops in training could have been met with comparative ease, it
required strenuous efforts to provide supplies adequate for the major
offensives which were shortly to begin, and the demand for an in-
creased flow became daily more urgent and more insistent. The need
for man power was in the limelight and the limited tonnage was
largely used for transporting troops, which resulted in an acute
shortage of freight tonnage and made it seem doubtful for a time
whether medical and hospital supplies in sufficient quantities could
be delivered to the overseas forces. The situation was further com-
plicated by the toll of trained workmen which the draft had taken
from the various industries and which had been replaced by other
personnel less skilled and capable, resulting necessarily in an output
reduced both in quantity and quality. Due to the shortage of labor
and the excessive quantities required the stocks of raw materials
became depleted. Restrictions designed to prevent waste, to promote
economy, and to insure equitable distribution were so rigidly enforced
as to make very difficult the procurement of necessary materials for
fabrication. The number of instrumentalities set up to vise procure-
ments servedto increase the difficulties in placing orders, to further
delay deliveries of the finished products, and to enhance prices.
SUPPLY DIVISION. 1185
The Medical Department was able, moreover, to secure harmony
and good feeling with the Railroad Administration, the Director of
Inland Transportation, and the Shipping Board. Cars were secured
and shipments made to the ports, existing conditions considered, with
a minimum of friction and a maximum of efficiency. The diplomacy,
constant watchfulness, and persistent efforts of port medical supply
officers, assisted by the influence of port surgeons, secured the ship-
ment of the major portion of the medical and hospital supplies in
spite of the many difficulties. With the beginning of the major offen-
sive came doubled efforts to procure and transport medical supplies
in sufficient quantities to meet all needs. The insistent demands from
the expeditionary forces resulted in a modification of priority sched-
ules and an increase in the tonnage allotted for medical and hospital
supplies, so that shipments gradually increased from 10.155 tons in
July to 19,712 in October, the last full month's shipment before the
armistice, or a total of 52,762 short tons, approximately 6,331,44:0
cubic feet, for the four-month period. In November, 18,000 tons
additional were shipped. Of the shipments made during this period,
the following items of equipment are of special interest :
Floated from July to October, inclusive, in addition to those taken until
organizations:
Regimental combat equipments 150
Camp infirmaries 201
Camp infirmary reserves 150
Ambulance company equipment, medical supplies only 130
Field-hospital equipment, medical supplies only 80
Evacuation hospitals .54
Chests, mess 966
Chests, tableware 2, 079
Chests, cooking utensils 1,349
Bedsteads 102,484
Cases, general operating 1, 646
Cots, folding metal 55,369
Mattresses and cot pads 122, 310
Complying with an urgent request for surgical instruments made
in August, 52 tons of all kinds were floated from New York and
arrived in France about the middle of September. They entirely
relieved the situation, in so far as surgical instruments were con-
cerned.
At the time of the signing of the armistice the Medical Depart-
ment had on hand or on order sufficient beds, mattresses, cots, cot
pads, pillows, and other articles of bedding and ward equipment
to provide hospital facilities for 1,000,000 men. There were being
assembled at the port Newark terminal 60 base hospitals of 1,000
beds each, and had hostilities continued they would probably have
been floated within 30 days thereafter. Very great difficulties were
experienced during September and October in securing the sheets,
pillowcases, blankets, and cooking utensils with which to complete
the equipment of these hospitals. Deliveries were beginning to as-
sume satisfactory volume in the latter part of October, and sufficient
quantity would have been available by the end of March to provide
for the*^needs of an Army of 5,000,000 men, with the major part of
the forces in active combat.
1186 REPORT OF THE SURGEON GENERAL OF THE ARMY.
0\ring to lack of hospital ships, which could have been utilized
for the shipment of medical supplies to the Expeditionary Forces
on return trips, unit equipment for divisional organizations, as well
as evacuation and base hospitals, could not, as a rule, be forwarded
with the organizations, and often not in its entirety on any one ship.
The different vessels on which such equipment was forwarded did
not always arrive at the same port. It was not of infrequent occur-
rence that articles of equipment intended for the same organization
were landed at from two to five different ports, making it impossible
under existing traffic conditions in France to issue to an organization
its original equipment.
The main distributing depots at Atlanta, Chicago, Philadelphia,
St. Louis, San Antonio, and San Francisco had been fairly well
stocked during the previous year and little difficulty was experienced
in maintaining this stock. Their location proved satisfactory and
fully justified their selection. The depot personnel, by keen interest
and efficient teamwork, met promptly all the demands made upon
them, even during the influenza epidemic. Plans to anticipate the
needs of these depots and to keep them stocked without awaiting
requisitions from them were well under way and supplies were
shipped to them for storage and distribution as the situation indi-
cated. The need for additional domestic storage did not arise, since
the ever-increasing demands for supplies overseas required practi-
cally all that the vendors could produce and for a time threatened
to deplete many items of stock at the distributing depots. A six
months' stock, based on reported issues, was maintained at these
depots in so far as possible.
The activities of the depot at New York were devoted to the
procurement of supplies for general hospital equipment and use.
The depot in Washington continued to be the assembling point for
field equipment. Owing to the increasing governmental control of
raw materials and the resultant need of a more effective liaison be-
tween the procuring agency of the department and the War Indus-
tries Board, the Fuel Administration, and other governmental agen-
cies for allotting commodities of which there was an actual or a
threatened shortage, the central procurement office, which was estab-
lished in Washington during the last quarter of the previous fiscal
year, was expanded to take over the procurement of practically the
entire needs of the department, especially of medicines, surgical
supplies, surgical, dental, and veterinary instruments. Efficient
buyers, selected respectively from the drug and surgical instrument
trade, were placed in charge of the procurement of supplies for
their respective specialties. While they were not professional men,
their services, properly controlled, directed, and coordinated by the
medical officer in general charge, proved of inestimable value to the
department. New sources of supply continued to be developed and
existing sources to be augmented. This was especially true of sur-
gical instruments and dressings. So urgent was the need for instru-
ments that the enrollment of even manufacturing jewelers and tool-
makers proved insufficient to meet the demands, and it was necessary
to order from drop-forging firms blanks for forceps and surgical
scissors, and to parcel them out to various individuals who had the
equipment necessary to convert them into finished instruments.
Surgical needles continued to be made by domestic firms in ample
SUPPLY DWISIOF. . 1187
quantity and of a quality equal to that of the best imported needles.
Embroidery manufacturers undertook the preparation of special sur-
gical dressings, particularly bias muslin bandages, of which some
5,000,000 were forwarded overseas. Various bleacheries were in-
duced to aid the regular surgical dressing manufacturers in the
bleaching and finishing of absorbent gauze and crinolin. Due to
the curtailment by the War Industries Board of the nonessential in-
dustries, many firms, although without previous experience, under-
took tlie production of supplies for the department, and delivered in
due time very satisfactory articles.
The camp medical supply depots developed at the several canton-
ments during the previous year proved a most valuable asset, both
for the prompt and efficient supplying of medical units at the camp,
and for the training of enlisted and commissioned personnel in the
nomenclature and handling of medical supplies. " These depots were
maintained on a three-months' basis, two months' stock on hand
and one in transit. Requisitions for replenishment were forwarded
monthly, and showed for the items entered, the quantities issued
during the previous month, the quantities remaining on hand, and
the amount required to bring the stock on hand up to three times
the actual issues of the previous month. Emergency requisitions
could be forwarded at any time and telegraphic requests made when-
ever conditions warranted it.
The need for competent medical supply officers continued to in-
crease, and the plan of establishing training schools for them, which
had been inaugurated during the previous fiscal year, was continued
and further developed. Enlisted personnel at various camp supply
depots who showed any aptitude were promoted to the several grades
of noncommissioned officers. The best of these were selected and sent
to various training schools for medical supply officers. The principal
schools were at Newport News, Camp Meade, and Canp Upton.
On finishing the course at these schools the men who qualified were
commissioned as second lieutenants in the Sanitary Corps for duty
at camps, general hospitals, or overseas as the need might require.
At Newport News were orcanized and equipped 13 depot companies
for service in France. Of this number 8 had actually boen sent
abroad and the remainder were awaiting transportation at the time
of the armistice. These companies consisted of 3 officers and 45 men
each, all especially trained and selected for the purpose.
Great difficulty was experienced in securing personnel for the
larger depots, especially competent clerks, stenographers, a^xl ^killed
labor. This was finally overcome by calling into the servcie limited-
service men, qualified for duty in the home country but unfit for
active military service. Many of them were secured through adver-
tisements inserted in trade journals. Others were obtained through
the various draft boards. They were directed to report at the depots
in New York, Chicago, St. Louis, and Atlanta, where they were
examined by the officer in charge and the best men selected for duty
as clerks, accountants, bookkeepers, and other specialties at those
depots and elsewhere. These men. for the most part, rendered faith-
ful and efficient service. The results in procuring laborers by this
method were, however, quite unsatisfactory since many of those called
rendered very poor service.
142367— 19— VOL 2 14
1188 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Arrangements were made with the United States Customs Service
whereby the appraisers of that service were detailed to the inspection
of the Medical Department supplies at the mills and factories of the
various contractors. The services rendered by them were very satis-
factory. As time passed and the need for supplies became more
urgent it was found necessary to develop a field force of officers to
keep in touch with the various contractors in order to assist them in
procuring raw materials, fuel, and labor, to stimulate production of
supplies and delivery thereof under their respective contracts, and
to prevent them from sidetracking Government orders in favor of
civilian business. "\"\niile the number actually on this duty was en-
tirely inadequate, the results obtained in speeding up production
fully demonstrated their value and the need for such a force under
similar conditions.
That every tactical division would require an active, energetic,
and competent medical supply officer to keep its various medical units
fully equipped with proper supplies was seen early in their equipment
and training. Such officers were authorized and their equipment and
transportation defined in the latter part of 1917. The 42d Division
was the first to be provided with one. In the early days of training-
camp activities it was practicable, owing to the limited number of
qualified men available, to have only one medical supply officer at
each training camp. As time passed and more men were qualified
an additional medical supply officer was assigned to each division
in the camp. The results obtained in France fully justified the posi-
tion, and the men individually rendered inestimable service.
The motor ambulance supply depot at Louisville, Ky., continued
to render active and efficient service as a Medical Department institu-
tion until August 31, 1918, when, under the provisions of General
Order No. 75, War Department, 1918, it was transferred to the newly
formed Motor Transport Corps. The spare-parts trailer designed to
meet the roadside repair requirements of an ambulance company for
six months, which had been perfected during the previous j'ear, was
brought into production and a number completely packed and ready
for immediate field service were shipped overseas. It is understood
that they did not arrive in France in time to be distributed to ambu-
lance companies in active service prior to the armistice. Such as did
get into service later are reported to have given satisfaction and
proved to be very convenient.
The standard large motor ambulance had attained a high state
of development, and reports received from overseas indicate that
these vehicles rendered most excellent service. One evacuation am-
bulance company, which went into service in July, 1918, is reported
to have operated as far forward as the third-line trenches, and dur-
ing its service to have transported 35,000 patients and its machines
to have averaged 25,000 miles.
To meet the pressing need for competent drivers and mechanics
for the ambulance service, a training school for drivers had been
developed at Fort Oglethorpe. Ga., and was turning out qualified
drivers at a satisfactory rate. From the best of the drivers thus trained
were selected men with aptitude and some preliminary experience for
the ISIedical Department motor mechanics' school at Louisville, K3\
Here they were given a six weeks' course in the theory and practice
of gas engine construction, operation, and repair, and the construe-
SUPPLY DIVISION. 1189
tion, assembly, and repair of ambulance chassis. They were also
given ample road experience and a rigid examination. Very little
shop work was included in the course, the prime object being to
make the men proficient in roadside repairs or first aid to vehicles
of this sort. Those who actually graduated from the school had
demonstrated their ability to take care of ambulances in the field.
The various X-ray units were further developed and perfected.
The bedside unit has proved exceptionally valuable. The portable
unit was extensively used in France. Fifty-five ambulance chasses
with bodies adapted to mount these units were sent overseas to pro-
vide suitable mobile equipment. The training school for X-ray
technicians at Fort Oglethorpe was most successful in turning out
men qualified for the proper handling of this highly technical equip-
ment. These men were not only able to operate the equipment, but
to adjust and repair it when necessary. Coolidge tubes were pur-
chased in large numbers and a single shipment to France carried
900 of them.
The automatic-supply table, which became effective in June, 1918,
proved ver}^ valuable. This table represented the quantities of medi-
cal supplies of all kinds which Avould be required for the mainte-
nance of 25,000 troops for one month, irrespective of the duties per-
formed, whether in the zone of combat or in the zone of supply. The
actual quantities shipped each month represented the automatic
supply table multiplied .by a suitable factor corresponding to the
aggregate of troops which would be in the expeditionar}^ forces dur-
ing the ensuing month. While the quantities on this table did not
prove ideal the results obtained by its use fully demonstrated its
value. The table was being revised at the time of the armistice in
accordance with the experienced gained during the months it was in
operation. A satisfactory automatic-supply table, based on actual
experience, will hereafter be available for the outfitting and mainte-
nance of expeditionary forces, should they again be called into
service.
With the cessation of hostilities the need for supplies greatly di-
minished. Steps were taken at once to stop production and to ter-
minate contracts. There was an ample stock on hand to meet all
prospective needs of the Army for many months to come, once the
great battle casualties ceased. Over a thousand contracts were ter-
minated on the most advantageous terms obtainable for the Gov-
ernment. ■
The act making appropriations for the support of the Army for
the fiscal year 1919 and for other purposes, approved July 9. 1918,
appropriated $267,108,918 for the Medical and Hospital Department.
The first deficiency act, approved November 4, 1918, added $30,000,-
000 more, and authorized the incurrence of indebtedness up to $65,-
000,000 in addition thereto.
At the beginning of the year the Chemical Warfare Service was
created and was charged with all matters pertaining to gas warfare,
defensive as well as offensive, and to this service was transfen^ed
early in July all personnel engaged in the production of gas masks,
together with all property, obligations, and funds pertaining thereto.
These funds amounted to $13,017,500 of the 1918 appropriations and
$68,697,000 of the 1919 appropriation, or a total of $81,714,500.
1190 REPORT OF THE SURGEON GENERAL OF THE ARMY.
When the procuieinent, assembly, issue, and maintenance of motor
ambuhinces and motor cycles were transferred to the Motor Trans-
port Corps August 31. 1918, there was also transferred $23,122,614.79
of the 1919 appropriation and $1,750,393.45 of the 1918 appropria-
tion, together with all motor ambulances and motor cycles previously
acquired bv the department, including those under contract.
Of the total of $297,408,948 appropriated for the Medical Depart-
ment for the year, therefore. $23,117,614.79 were transferred to the
Motor Transport Corps. $68,697,000 were transferred to the Chemical
^Yarfare Service, $54,000,000 returned to the Treasury, $9,000,000
remained unobligated, and $166,589,333.21 were expended or obli-
gated for supplies and services. There was disbursed during the
year $14,767,893.95 also of the appropriations for former years. A
complete financial statement, as furnished by the director of finance,
appears on pages — to — , inclusive.
On November 15, 1918. the procurement activities of the Medical
Department were transferred to the director of purchase of the Pur-
chase. Storage and Traffic Division of the General Staff; the dis-
tribution of supplies and depot activities to the director of storage;
the finance ancl accounting activities to the director of finance; and
the requirements activities to the directors of purchase and storage.
The Medical Department was thereby divested of all its supply
activities except those pertaining to the procurement and distribution
of artificial limbs; orthopedic and prosthetip appliances; biologicals,
arsphenamine. and other arsenicals; books, journals, and reprints;
printing and binding; and the administrative examination of cer-
tain vouchers, civilian medical attendance, medicines, and laundry.
The net result of the consolidation as regards all its phases have, for
the most part, been most unhappy. For the sake of economy, ef-
ciency. and facility of supply the supply functions should be returned
to the Medical Department as they were prior to the war.
From November 15, 1918. to the end of the year the department
functioned only in an advisory capacit.y in so far as its supplies,
other than those reserved to it, are concerned.
Medical and Hospital Department, 1919.
Appropriated by act approved July 9, 1918 $267, 408, 948. 00
Appropriated by act approved November 14, 1918 30, 000, 000. 00
Refundments during the year 10, 174. 81
Treasury transfers from other appropriations on account of
erroneous payments 256, Oil. 39
Total to be accounted for 297, 675, 134. 20
Disbursed during the year :
Hospital equipment —
Instruments and appliances $5, 206. 275. 80
Hospital equipment, furniture, sup-
plies 12, .516. 182. 57
X-ray saipplies 1, .517, 608. 32
Fabrics and textiles 7, 387, 608. 91
Rubber goods 743, 773. 63
Hardware and metal supplies 638, 766. 37
Wooden articles 255, 892. 13
Tin containers 48, 993. 05
Kitchen utensils and tableware 909,643.46
Orthopedic equipment and supplies___ 309. 87
29, 225, 054. 11
FINANCIAL STATEMENT. 1191
Disbursed during the year — Continued.
Medical supplies —
Medicines, antiseptics, disinfectants,
and anaesthetics $10, 40S, 597. 42
Surgical dressings 6, 095, 218. 67
Sutures 1, 006, 030. 83
Food, beverages, and condiments 766, 131. 62
Biologicals 3, 009. 67
$18, 278, 988. 21
Dental supplies —
Medicines 192, 672. 26
Materials 1, 127, 839. 26
Instruments and appliances 1, 002, 593. 47
Laboratory equipment and supplies,
including animals and food therefor_ 648, 247. 16
2, 971, 352. 15
Veterinary supplies —
Medicines, antiseptics, and disin-
fectants 124, 266. 41
Instruments 174, 519. 03
Horse blankets 8, 866. 00
Miscellaneous 181, 606. 70
489, 318. 14
Laundering hospital linen 2, 115, 802. 52
Sick and wounded transport service —
Npw motor equipment 48, 270. 79
Replacements and repair motor equip-
ment 32, 175. 14
Litters, pack supplies, and field chests 244. 508. 53
Other transports 1, 815. 07
326, 769. 53
Gas-mask materials 123, 994. 59
Civilian medical service —
Medical care and treatment 676, 613. 08
Dental treatment 6, 203. 50
"Veterinary treatment 2, 702. 31
Medicine on prescription 7, 885. 02
Physical examination and vaccination- 1. 971. 02
Ambulance service 1, 565. 50
696, 940. 43
Administrative —
Pav roll civilian emplovees 2, 916, 865. 29
Stationery 431, 656. 78
Printing and binding 44, 233. 15
Expressage on medical property 32,588.64
Gas and electricity for laboratory ap-
paratus — 7, 161. 38
3, 432, 505. 24
Miscellaneous —
Additional articles on dental supply
table 335. 62
Items not otherwise grouped 2,249,465.31
2, 249, 800. 93
59, 910, 525. 85
Transferred to American Expeditionary Forces, Europe (not
to be accounted for to the Surgeon General United States) — 8, 196, 000. 00
Transferred to Chemical Warfare Service $68,697,000.00
Transferred to officer in charge Construction
Division 5,728.09
Transferred to Motor Transport Corps 23, 117, 614. 79
Transferred to Department of Agriculture 5, 000. 00
Transferred to Director of Finance 6. 226, 020. 28
Transferred to Bureau of Aircraft Construc-
tion 63, 440. 00
Transferred to Chief of Ordnance 72, 664. 82
Transferred to Quartermaster Department — 25,877,863.44
123, 565, 331. 42
1192 REPORT OP THE SURGEON GENERAL OF THE ARMY.
Treasury settlements $845. 003. OS
Amount rei^ealed act of Congress F'ebruary 25, 1919 54, 145, 513. 73
Balance on hand June 30, 1919 :
In hands of disbursing officers $29,089.77
In transit from disbursing officers 12, 107. 62
In United States Treasury 50, 971, 562. 73
51, 012, 760. 12
Total accounted for 297,675,134.20
Medical and Hospital Department, 1918.
Balance on hand July 1, 1918 $35,528,369.22
Appropriated by act approved July 8, 1918 33,000, 000. 00
Refundments during the year 187, 684. 41
Treasury settlements 1, 357. 52
Treasury transfers from other appropriations on account of
erroneous payments 176, 218. 98
Total to be accounted for 68,893,630.13
Disbursed during the year :
Hospital equipment —
Instruments and appliances $2, 075, 600. 96
Hospital equipment, furniture, sup-
plies 2, 803, 798. 76
X ray supplies 996, 045. 92
Fabrics and textiles 7,680,-579.64
Rubber goods 273, 151. 58
Hardware and metal supplies 198, 926. 67
Wooden articles 141, 800. 85
Tin containers 37,634.89
Kitchen utensils and table ware 324, 161. 60
Medical supplies —
Medicines, antiseptics, disinfectants,
and anesthetics 3, 126, 194. 20
Surgical dressings 10, 081, .500. 66
Sutures 255, 366. 25
Food, beverages, and condiments 65, 390. 14
14, 531, 700. 87
13, 528, 451. 25
Dental supplies —
Medicines 24, 936. 79
Materials 311, 316. 81
Instrument and appliances 91, 842. 15
Laboratory equipment and supplies,
including animals and food there-
for 47, 148. 93
475, 244. 68
Veterinary supplies —
Medicines, antiseptics, and disinfec-
tants 91,772.28
Instruments 142, 589. 30
Horse blankets 172, 199. 75
Miscellaneous 74, 278. 69
480, 840. 02
Laundering hospital linen 195,670.59
Sick and wounded transport service —
New motor equipment 2, 019, 477. 20
Replacements and repair motor equip-
ment 373,120.42
Litters, pack supplies and field
chests 401, 587. 74
Other transports 22, 027. 05
2, 816, 212. 41
Gas-mask materials 3, 816, 671. 10
FINANCIAL STATEMENT. 1193
Disbursed during the year — Continued.
Civilian medical service —
Medical care and treatment $-158,558.91
Dental treatment 1, 183. 80
Veterinary treatment 2, 410. 09
Medicine on pre.scrlption 1,406.67
Physical examination and vaccination. 1, 346. 50
Ambulance services 482. 46
Administrative —
Pay-roll civilian employees 222. 625. 84
Stationery 171, 437. 88
Printing and binding 29,988.59
Expressage on medical property 11, 213. 04
Gas and electricity for laboratoi"y ap-
paratus 771. 20
Miscellaneous —
Additional articles on dental supply
table , 121. 53
Items not otherwise grouped 400,311.67
$165, 388. 43
436, 036. 55
400, 433. 20
36, 846, 649. 10
Transferred to American Expeditionary Forces, Europe, (not
to be accounted for to the Surgeon General, (United
States) 16, 897. 866. 07
Transferred by Secretary of War to Chemical Warfare Service 12, 105, 000. 00
Transferred by Secretary of War to administrative control of
Motor Transport Corps 1,750,393.45
Treasury settlements 605, 871. 92
Balance on hand June 30, 1919:
In hands of disbursing officers $115. 00
In transit from disbursing officers 2. 10
In United States Treasury 687, 732. 49
687, 849. 59
Total accounted for 68,893,630.13
Medical and Hospital Department, 1917-18, act June 15, 1917.
Balance on hand July 1, 1918 $2, 914, 176. 50
Refundments during the year 1, 411. 82
Treasury transfers from other appropriations on account of
erroneous payments ^ 7, 001. 40
Auditor settlements with claimants * 1, 476. 86
Total to be accounted for 2, 924, 066. 58
Disbursed during the year :
Hospital equipment —
Instruments and appliances $272, 619. 97
Hospital equipment, furniture, sup-
plies 102, 809. 24
X-ray supplies 2.57. 54
Fabrics and textiles 280, 781. 77
Rubber goods 2, 071. 86
Hardware and metal supplies 1, 235. 02
Wooden articles 15, 537. 41
Tin containers 2, 016. 00
Kitchen utensils and tableware 3, 484. 40
680, 813. 21
Medical supplies —
Medicines, antiseptics, disinfectants,
and anesthetics 115,802.79
Surgical dressings 28, 058. 57
Sutures 848. 22
144. 209. 68
1194 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
Disbursed during the year — Continued.
Dental Supplies —
Materials $41. 35
Instruniei!ts and appliances 234. 00
Lalmratory equipment and supplies,
including animals and food tlaere-
for 9,816.15
.$10, 001. 50
Veterinary supplies, miscellaneous 125. 5S
Laundering hospital linen 6,382.70
Sick and Wounded Transport Service —
Litters, pack supplies, and field chests- 128, 036. 80
Other transports 16. 00
■ 128, 052. 80
Civilian Medical Service —
Medical care and treatment IS, 040. 01
Dental treatment 187. 50
Veterinary treatment 282. 75
Medicine on prescription 628. 70
Physical examination and vaccination_ 501. 20
Ambulance services 10.00
Administrative:
Stationery 23,74.5.35
Printing and binding 898. 82
Expressage on medical property 128. 37
Gas and electricity for laboratory
apparatus 17. 67
19, 650. 16
24, 790. 21
Miscellaneous, items not otherwise grouped 48,865. 84
1, 062, 981. 58
Treasury settlements 23, 419. 83
Balance on hand June 30, 1919 :
In hands of disbursing ofBcers, American
Expeditionary Forces $475, 065. 51
In United States Treasury 1,362,599.66
1, 837, 665. 17
Total accounted for 2, 924, 066. 58
Medical and hospital department, 1917.
Balance on hand July 1, 1918 ' $58,879.00
Refundmeots during the year 292.82
Transfer by auditor from appropriation " increase of compen-
sation. Military Establishment, 1918," to correct erroneous
payment 731.32
Total to be accounted for 59, 903. 14
Disbursed during the year:
Civilian medical service, medical care and treatment 122. 00
Transferred to American Expeditionary Forces, Europe (not
to be accounted for to the Surgeon General, United States 6, 328. 97
Treasury settlements 50, 217. 52
Balance in United States Treasury (to be carried to surplus
fund) 3, 234. 65
Total accounted for 59, 903. 14
Medical and hospital department, 1916-17.
Balance on hand July 1, 1918 $17,302.16
FINANCIAL STATEMENT. 1195
Disbursed during the year :
Hospital equipment —
Hospital equipment, furniture and supplies_ $87. 90
Fabrics and textiles 474. 70
Wooden articles- 21. 60
Kitchen utensils and tableware 1, 906. 41
$2, 490. 61
Treasury settlements 68. 34
Balance in United States Treasury (to be carried to surplus
fund) 14, 743. 21
Total accounted for 17,302.16
Medical and Hospital Department, certified claims,
Appropriated by act approved July ^, 1918 $17.00
Appropriated by act approved Nov. 4, 1918 11. 65
Total to be accounted for 28. 65
Disbursed during the year : 28. 65
Total accounted for 28. 65
Replacing medical supplies, 1919-20.
Amounts accruing to this fund during the year :
On account of supplies sold to —
States for use of militia $1. SO
Other branches of the Government 105, 008. 57
Panama Canal 2, 929. 88
Civil government, Dominican Republic 911. 50
Civil government, Manila 427. 25
Soldiers' Home 6, 349. 02
American Red Cross 490. 01
Officers . 98
Civilians 89, 039. 38
On account of medical property lost or destroyed 1, 623. 18
Balance in United States Treasury June 30, 1919 ■ 206, 781. 57
Total accounted for 206, 781. 57
Replacing medical supplies, 1918-19.
Balance on hand July 1. 1918 $230, 874. 42
Amounts accruing to this fund during the year on account of —
Supplies transferred to other branches of the Govern-
ment 105, 926. 03
Supplies sold 68, 593. 99
Collections 2, 001. 31
Refundments to appropriation 2, 082. 72
Total to be accounted for 409,478.47
Funds furnished American Expeditionary Forces 235, 000. 00
Balance in United States Treasury June 30, 1919 174, 478. 47
Total accounted for 409, 478. 47
1196 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Replacing medical supplies, 1917-lS.
Balance on band July 1, 1918 $139, 158. 86
Amounts accruing to this fund during the year on account of —
Supplies transferred to States for militia 1,239.15
Supplies sold to civilians 15. 15
Collections from officers on account of property lost 70.01
Supplies sold 970. 30
Total to be accounted for 141. 453. 47
Funds furnished American Expeditionary Forces — England_-- 140, 000. 00
Balance in United States Treasury June 30, 1919 1,453.47
Total accounted for 141, 453. 47
Replacing medical supplies, 1916-1911.
Balance on hand July 1, 1918 $1,0.52.15
Carried to surplus fund 1. 052. 15
Tota). accounted for 1,052.15
Hospital care, Canal Zone garrison, 1919.
Appropriated by act approved July 9, 1918 $60. 000. 00
Disbursed during the year 56, 375. 65
Balance in hands of disbursing officer June 30, 1919 3, 624. 35
Total accounted for 60,000.00
Hospital care, Canal Zone garrison, 1918.
Balance on hand July 1, 1918 $12,602.00
Treasury transfer from other appropriations to correct er-
roneous payments therefrom 15.00
Total to be accounted for 12, 617. 00
Disbursed during the year 9. 651. 00
Balance in United States Treasury June 30, 1919 2, 966. 00
Total accounted for 12,617.00
Hospital care. Canal Zone garrison, 1917.
Balance on hand July 1, 1918 $2, 759. 80
Treasury transfers to other appropriations to correct er-
roneous payments therefrom 15. 00
Carried to surplus fund 2,744.80
Total accounted for 2, 759. 80
Library, Surgeon General's Office, 1919.
Appropriated by act approved .July 9, 1918 $20, 000. 00
Disbursed during the year 2, 575. 76
Balance in United States Treasury June 30, 1919 17, 424. 24
Total accounted for 20,000.00
FINANCIAL STATEMENT. 1197
Library, Surgeon General's Office, 1918.
Balance on hand July 1, 1918 $7, 503. 80
Disbursed during the year 6,289.82
Balance in Unitetl States Treasury June 30, 1919 1, 213. 98
Total accounted for 7,503.80
Library, Surgeon GeneraVs Office, 1917.
Balance on hand July 1. 1918 $4,046.^3
Disbursed during the year 925.24
Carried to surplus fund 8,121.29
Total accounted for 4, 046. 53
Army Medical Museum, 1919.
Appropriated by act approved July 9, 1918 $5. 000. 00
Disbursed during the year 3,539.70
Balance in United States Treasury June 30, 1919 1, 460. 30
Total accounted for 5,000.00
Army Medical Museum, 1918.
Balance on hand July 1, 1918 $4,543.94
Disbursed during the year 4, 541. 67
Balance in United States Treasury June 30, 1919 2. 27
Total accounted for 4. 543. 94
Army Medical Museum, 1917.
Balance on hand July 1. 1918 $586. 25
Carried to surplus fund 586. 25
Total accounted for 586. 25
Increase of compensation, Military Establishment, 1919.
Appropriated by act approved July 3, 1918 $72, 224. 33
Refundments to appropriation 47. 33
Transfer by auditor, reimbursement from appropriation 27. 00
Balance due United States Treasury 1, 926. 83
Total to be accounted for 74, 22.5. 49
Disbursed during the year 48,968.91
Excess payments deducted 24, 468. 08
Balance In hands of disbursing officers 788. 50
Total accounted for 74.225.49
1198 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Increase of compensation, Military Establishment, 1918.
Balance on hand July 1, 1918 $12, 785. 48
Kefuudmeuts to appi-opriation 19. 57
Treasury transfers from other appropriations to correct errone-
ous payments therefrom 331. 71
Balance due United States Treasury 340. 67
Total to be accounted for 13, 477. 43
Disbursed during the year 476. 59
Treasury transfers to other appropriations to coi-rect erroneous
payments therefrom 10, 000. 84
Balance in hands of disbursing officer, American Expeditonary
Forces 3, 000. 00
Total accounted for 13,477.43
Civilian military training camps, 1916-17.
Balance on hand July 1, 1918 $5, 892. 00
Balance in United States Treasury June 30, 1919 (to be carried
to surplus fund) 5,892.00
Artificial limbs, 1919.
Appropriated by act approved July 1, 1918 $70, 000. 00
Disbursed during the year 57, 548. 40
Balance in United States Treasury June 30, 1919 12, 451. 60
Total accounted for 70,000.00
Artificial limbs, 1918.
Balance on hand July 1, 1918 $37, 748. 00
Disbursed during the year 2, 075. 00
Balance in United States Treasury June 30, 1919 35, 673. 00
Total accounted for 37, 748. 00
Artificial limbs, 1917.
Balance on hand .July 1, 1918 $5, 726. 24
Treasury settlements 119. 64
Carried to surplus fund 5,606.60
Total accounted for 5, 726. 24
Trusses for disabled soldiers, 1919.
Appropriated by act approved July 1, 1918 $2,000.00
Disbursed during the year 760. 30
Balance in United States Treasury June 30, 1919 1, 239. 70
Total accounted for 2,000.00
Trusses for disabled soldiers, 1918.
Balance on hand July 1, 1918 $1,230.13
Disbursed during the year 70. 75
Balance in United States Treasury June 30, 1919 1, 159. 38
Total accounted for 1, 230. 13
FINANCIAL, STATEMENT. 1199
Trusses for disabled soldiers, 1917.
Balance on hand July 1. 1918 $1. 410. 91
Carried to surplus fund 1,410.91
Total accounted for 1,410.91
Appliances for disabled soldiers, 1919.
Appropriated by act approved July 1, 1918 $1, 000. 00
Disbursed during the year 446. 44
Balance in United States Treasury June 30, 1919 553. 56
Total accounted for 1, 000. 00
Appliances for disabled soldiers, 1918.
Balance on hand July 1, 1918 $573. 66
Disbursed during the year 38. 25
Balance in United States Treasury June 30, 1919 535. 41
Total accounted for i__ 573.66
Appliances for disabled soldiers, 1917.
Balance on hand July 1, 1918 $505.90
Carried to surplus fund 505. 90
Total accounted for 505. 90
Armament of fortifications " C"
Transfers to appropriation by the Secretary of War from -
Ordnance Department $1, 078. 00
Disbursed during the year 514.00
Transferred by Secretary of War to Chemical Warfare Service. 78. 00
Balance in United States Treasury 486. 00
Total accounted for 1,078.00
National security and defense, War Department, 1919 ; allotment Feb. 28, 1919.
Appropriated to cover allotment made by the President Feb.
28, 1919, from appropriation of $50,000,000 made bv sundrv
civil act, July 1, 1918 $3, 172. 00
Balance in United States Treasury 3, 172. 00
Total accounted for 3,172.00
National security and defense, War Department, 1919; allotment Apr. 16, 1919.
Appropriated to cover allotment made by the President Apr.
16, 1919, from appropriation of $50,000,000 made bv sundrv
civil act, July 1, 1918 $1,784.05
Disbursed during the year 170.00
Balance in United States Treasury 1, 614. 05
Total accounted for 1, 784. 05
1200
REPORT OF THE SURGEON" GENERAL OF THE ARMY.
General summary of all appropriations.
Balances on hand July 1, 1918 $38,987,726.95
Appropriated 330,644, 157.03
Accrued to replacing funds, act June 6, 1906 387,680.23
Refundments during the year 190, 630. 76
Treasury transfers and settlements - 443, 171. 18
Deficit, increase compensation Military Estahlishment 2, 267. 50
Transfers to otlier bureaus 1,078.00
Total to be accounted for 370, 665, 711. 65
Disbursed during the year 98, 017, 765. 27
Treasury transfers and settlements 1, -534, 716. 17
Transfers to other bureaus 137, 420, 802. 87
Ti-ansferred to American Expeelitionary Forces in Europe (not
to be accounted for to Surgeon General, United States) 25, 953, 260. 55
Excess repayments, increase compensation IMilitary Establish-
ment, 1919 24. 468. 08
Amount repealed by Congress, Feb. 25, 1919 54, 145, .513. 73
Carried to surplus fund 38,897.76
Balances on hand June 30. 1919 53, .530, 287. 22
Total accounted for 370,665,711.65
VIII. THE VETERINARY DIVISION.
I. Personnel.
The personnel of the Veterinary Corps increased in strength
steadily up to the signing of the armistice and after a delay of sev-
eral weeks incident to perfecting plans for the sale of surplus ani-
mals, its strength declined even more rapidly. The following table
shows the monthly strength for the entire Army. The enlisted
strength is too low, being based on incomplete returns :
June 30, 1918.
July 31, 1918.
Aug 31, 1918.
Sept. .30, 1918
Oct 31,1918.
Nov. 30, 1918
Dec. 31. 1918.
Jan 31, 1919.
Feb. 28, 1919.
Mar. 31, 1919.
Apr. 30, 1919.
Mav 31, 1919.
Jiuie 30, 1919.
Commis-
sioned.
Enlisted,
1,542
1,803
1,8^5
1.954
2,185
2,234
2,000
1,663
1,494
1,365
1,244
1,167
1,024
10,114
10.652
12,422
14,924
18, COT
15,079
14,572
12, 358
11 245
9,914
8.532
7,224
2,711
Total.
11,656
12,455
14,307
16, 878
20, 192
17,313
16, 572
14, 021
12, 739
11,279
9,776
8,391
3,735
VETERINAEY.
Officers on active duty by grades.
1201
1918
1919
3
CO
"3
n
bo
3
<
o
i
O
>
o
2
Q 1
a
03
1-J
e>5
a
3
—>
[
1
3
78
193
655
1,068
2
1
3
84
182
597
794
2
Lieutenant colonels..
Majors
Captains
First lieutenants
Second lieutenants . .
Retired
1
47
96
395
1,000
2
1
3
58
132
501
1,106
2
1
3
61
155
566
1,097
2
1
4
66
188
635
1,058
2
1
4
73
200
673
1,233
2
41
73
2.-)6
676
1,273
2
2
80
167
559
684
2
2
80
190
507
5S6
2
75
175
473
519
2
73
171
442
479
4
70
187
390
372
1
Contract veterinar-
ians . . .
(
Total
1,542
1,803
1,885
1,954
2,185
2,234
2,000
1,663
1,494
1,365
1,244
1,167
1,024
The increasing demand for officers was met by the Reserve Corps
until it became exhausted in August, 1918. when examining boards
were convened in different parts of the country. As rapidly as ap-
plicants qualified, they were ordered to take a course of training at
the medical training center, Camp Greenleaf , before assignment with
troops.
Regular Army 120
National Guard 70
Civil life (commissioned in Veterinary Officers Reserve Corps) 1,560
Civil life (commissioned in Veterinary Corps, United States Army) 207
Civil life (commissioned in National Army) 17
Enlisted forces (commisioned in Veterinary Officers Reserve Corps) 185
Enlisted forces (commissioned in Veterinary Corps, United States Army_ 110
Retired list 2
Contract veterinarians . 2
Total 2,273
Examinations were in progi'ess when the armistice was signed.
Veterinarians who graduated prior to 1918 and who had been per-
mitted to enlist in the Medical Enlisted Reserve Corps were called
to active duty as enlisted men and examined for commission after a
course of training. It was also planned to require the gi'aduates of
1918 in the Medical Enlisted Reserve Corps on their being ordered
to active duty subsequent to gi'aduation. to undergo three months'
training in their enlisted status at Camp Greenleaf, after which they
would be eligible for examination for commission. Much delay was
encountered in getting the orders to these men and they were several
months late in reporting. Eventually. 192 were assembled and about
125 more were left on duty by request with the Bureau of Animal
Industry, State live-stock commissions, and colleges. The need for
officers was becoming so urgent that the enlisted gi'aduates were per-
mitted to take the examination for commission as fast as they com-
pleted two months of training. About 50 per cent were thus exam-
ined, but the signing of the armistice ended further action and none
of these men succeeded in getting commissions. There was a small
but steady influx of commissioned officers from the ranks.
1202 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The following table shows the source of all veterinary officers
on active duty during the war :
Rejailar Army 120
National Guard , '''4
Civil life (coimiiissioned in Veterinary Officers Reserve Corps) 1. o96
Civil life (conimisioned in Veterinary Corps, United States Army) 207
Civil life (commissioned in National Army) 17
Enlisted force (commissioned in Veterinary Officers Reserve Coi-ps) 185
Enlisted force (commissioned in Veterinary Corps. United States Army)_ 110
Retired list 2
Contract veterinarians 2
Total — 2,313
Especial difficulty was encountered in filling by promotion the
senior grades in organizations proceeding overseas, and in many in-
stances such units departed in charge of junior officers. These officers
were under observation so short a time in this country and were so
deficient in training that no adequate conclusions as to their fitness
for promotion seemed justified. All vacancies in grade in over-
seas units were consistently regarded as pertaining to the American
Expeditionary Forces as soon as the units left the United States and
no attempt was made at any time to consider such grades as available
for promotions in the United States in excess of the proportion au-
thorized for the troops remaining in this country.
Since November 11, 1918. a considerable number of recommenda-
tions for promotion have been submitted, of which only three have
been approved.
The Veterinary Corps of the Kegular Army held its own until
demobilization got well under way, when resignations, particularly
in the junior grade, became numerous. The losses during the year
have been:
Retired for disability, one captain, one second lieutenant 2
Died, one second lieutenant 1
Rpsigned. second lieutenants 5
The strength of the corps was as follows:
June 30, 1918 :
Majors 6
Captains 20
First lieutenants 20
Second lieutenants 72
Total 118
Vacancies 0
June 30, 1919 :
Majors 8
Captains 17
First lieutenants 22
Second lieutenants .* — 64
Total 111
Vacancies 7
DECISIONS OF THE COMPTROLLER.
The organization of the Veterinary Corps was threatened and its
efficiency seriously impaired by decisions of the Comptroller of the
Treasury regarding the commissioned status of officers. These de-
cisions ruled, successively, that there is no authority in section 16 of
the national defense act for the appointment or promotion of a vet-
erinarian to the grade of major; and that tlie President was without
authority under the selective service act of May 17, 1917, to make
temporary appointments in the grades of major, lieutenant colonel,
or colonel of the Veterinary Corps raised under the provisions of that
act, for the reason that such grades were not considered to be author-
VETERIXAEY. 1203
ized in the national defense act. In decision of December 6, 1918,
the Auditor for the War Department further held there was no
authority for the promotion of veterinary officers from the grade of
second lieutenant until they had completed five years' service; this
opinion likewise being based on the provisions of section 16 of the
national defense act of 1916. The disastrous effects of these rulings
were promptlv brought to the attention of the War Department in
letters dated September 20, 1918, October 29, 1918, and February 8,
1919, and reconsideration of the comptroller's decisions or legislative
relief was urged. In order that the activities in the senior grades
ri light not be paralyzed, all the field officers were reeommissioned in
identical gi'ades in the United States Army at large and assigned
to duty with the A'eterinary Corps. In the meantime the majors of
the Regular Army, both active and retired, were demoted to the
grade of captain.
The contention of the Surgeon General was upheld in effect by the
Judge Advocate General and the Attorney General, and a reconsid-
eration of these opinions was requested by the War Department.
Finally, on April 9, 1919. the comptroller handed down a decision
vrhich practically nullified his former findings, and which, after eight
months of agitation, restored the commissioned status of veterinary
officers.
ENLISTED PERSON XEL.
The enlisted men for overseas units have been supplied from special
increments of the draft on request. The men for the divisional, camp,
and station service were secured by transfer at the station. The men
for overseas were generally of a desirable type, although utterly in-
experienced for service either with field units or divisions. The qual-
ity of those assigned to the auxiliary remount depots and other sta-
tions was much less satisfactory owing to the admixture of illiterates,
conscientious objectors and defectives.
The progressive changes in enlisted strength are shown in table
above.
The demobilization of the Army and the discharge of selective
service men threatened the extinction of the enlisted force of the
Veterinary Corps. On November 11, 1918, there were less than 30
v.^ho were not eligible for discharge. The national defense act pro-
vides for no enlisted men in the corps. Authority was obtained to
enlist for the Medical Department with assignment to the Veterinary
Corps (Cir. 141, A. G. O.) . Unless pending legislation should author-
ize an enlisted force, these men who are actually enlisted in the Med-
ical Department would naturally be continued on the same duties,
but charged against the Medical Department quota. A strenuous
campaign for securing recruits was enjoined on the veterinarians of
all camps and auxiliarv^ remount depots. Recruiting literature was
circidated and appeals made through the press. Two Veterinary
Corps recruiting posters designed and painted by Second Lieut. Horst
Schreck, Veterinary Corps, have been very favorably commended.
The results have been increasingly good and are shown below :
142367— 1&— VOL 2 15
1204 EEPOKT OF THE SURGEOl? GENERAL OF THE ARMY.
Enlistments in the Regular Army.
White.
Colored.
127
12
215
12
265
14
309
35
Total.
Period ending:
Mavl5,1919 127 12 139
Mav31,1919 215 12 227
June 15, 1919 1 265 14 279
June30,1919 j 309 35 344
2. Service of the Interior.
horse purchasing boards.
All plans were laid for resuming purchasing on an extensive
plan. Operations began about October 25, 1918, but were promptly
terminated by the armistice. Careful instructions had been sent to
purchasing zone veterinarians pointing out the necessity of proper
supervision of the work of officers on boards and of making sure
that they were thoroughly familiar with their duties. Circular
Letter Xo. 35 is a complete discussion of the examination for soimd-
ness and enters into a classification of the causes for rejection con-
sidered by regions. This ground is covered for the first time in an
official military publication. During the war 306,000 animals were
purchased in the United States, and each animal w^as required to
pa&s a veterinary examination for soundness.
REMOUNT DEPOTS.
The routine veterinary service at the four permanent remount de-
pots has been increased by the assembling of stallions and breeding
mares thereat in connection with the plans for suppljdng the Army
with remounts. This service is special, having to do with the han-
dling of breeding animals and of colts. Circular Letter Xo. 37
presents a resume of these important subjects including artificial
impregnation for the guidance of veterinary personnel.
AUXILIARY REMOUNT DEPOTS.
The great volume of veterinary service was, of course, rendered
at the veterinary hospitals located in the 34 auxiliary remount de-
pots. Three of these depots had an official capacity of 10,000 ani-
mals. 8 of 75,000, and 23 of 5,000. The corresponding veterinary
detachments comprised 12 officers and 150 enlisted for the largest,
9 officers and 100 enlisted for the intermediate, and 6 officers and 75
enlisted for the smallest depots. Besides having supervision of the
veterinary hospital service, the veterinarian of the depot is respon-
sible for advising- on the veterinary sanitary conditions, for the
physical examinations of animals and their malleinization at receipt,
issue, etc.. and for the daily inspection for the detection of the sick.
These duties are exacting and important and require for their han-
dling a man of professional ability, energy, tact, and judgment. Ade-
quate rank is essential. Such men were not always available, but the
general average was exceedingly high, and it is felt these officers
from civil life filled new and difficult positions in the militaiy serv-
ice with extreme credit to themselves and to their profession.
%rETERINARY. 1205
ANIMAL, EMBARKATION DEPOTS.
' The principal depot was located at Newport News, Va.. with a
capacity of 10,000 animals and a veterinary detachment of 12 officers
and 175 enlisted. The depot at Charleston. S. C, of the same ca-
pacity was completed and ready for operation when the armistice
was signed. These depots were the normal adjuncts of the ports of
embarkation, and the veterinary service thereof was analogous to
that of an auxiliary remount depot plus the examination and prepa-
ration of animals for embarkation. Sanitary conditions at Newport
News were extremely bad much of the time because of the conges-
tion of animals and the mud-infested corrals.
PORTS or EMBARKATION.
Only one port veterinaiy service was developed, and that at New-
port News. An important duty devolving on the port veterinarian
at this point has been the supervision of the quarantine for Army
animals returned from France. The regulations of the Department
of Agriculture are very rigid res})ecting the importation of horses,
but it was found desirable to return certain officers' mounts and
other valuable animals, consequently with the cooperation of the
Chief of the Bureau of Animal Industrj- of the Department of Agri-
culture a set of quarantine regulations was drawn up and put into
operation at Newport News, the only authorized port of entry.
The port veterinarian has been allowed a colored detachment of 250
enlisted men of the Veterinary Corps for this duty. These measures
are considered extremely important to avoid the danger of trans-
mitting to the live stock of this country any of the serious animal dis-
eases which are prevalent in Europe.
\-ETERINARY TRANSPORT SERVICE.
The veterinary service of animal transports sailing from Newport
News was provided by permanent transport veterinarians and b}'^
casual officers detached from units proceeding overseas. Such tem-
porary details were always unsatisfactory, and arrangements were
finally completed for the permanent assignment of 25 enlisted Vet-
erinary Corps men and one officer to each transport. This detach-
ment was necessary to care for the sick, to supervise the sanitation
of the animal quarters on the outward voyage, and on the return to
attend to the cleaning and disinfection of the ship.
Animal shipments from Newport News were divided into two
phases. From October 15. 1917. to May 5, 1918. 28.473 animals
were shipped with a total loss of 163, or 1.6 per cent. In this total
are included 217 animals lost on the steamship Hercules, which en-
countered a severe storm. During the second phase, August 11-
November 30. 1918, 18,764 animals were shipped with a loss of 49,
or 0.26 per cent.
Animal shipments were abruptly inaugurated at Hoboken in Oc-
tober, 1918. with practically no opportunity for assembling in ad-
vance the required personnel and supplies. An acting port veteri-
narian was hastily assigned and personnel from overseas veterinary
hospital units was utilized. A total of 18,834 animals were shipped
1206 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
up to November 30 with a loss of 149, or 0.79 per cent. A grand total
of 66,071 horses and mules were sent to France and the losses
en route aggregated 660, or 1 per cent, which is considered a very
creditable showing.
CAMPS.
A camp veterinary service was established at all the divisional
cantonments when the division departed for overseas and was re-
tained after new divisions were formed. Increased personnel was
required in many of the technical training camps depending upon
the use of additional animals. The development of separate lines of
veterinarv service in the camp and at the auxiliary remount depot
is a direct result of the policy which excludes the latter from the
control of the camp commander. There is no question but that the
veterinary service of the depot and the camp could be combined un-
der the camp commander with an increase of efficiency and some
saving of personnel, provided the entire depot were to be placed
under the camp commander. Otherwise the service should remain
separate and distinct.
MILITART POSTS,
Requests for veterinary service at posts and other miscellaneous
stations have been numerous and difficult to fill. Whenever the
size of the command has appeared to justify, the assignment of a
veterinary officer has been recommended: and in some of the larger
stations equipped with veterinary hospitals enlisted detachments have
been authorized.
DEPARTMENTS.
The isolation of the Philippines, Hawaii, and Panama and the
volume of veterinary activities in the Southern Department have
made necessary the assignment of veterinarv officers to assist the
surgeons of these departments in coordinating and supervising the
service. This was particularly true of the Southern Department,
where a second veterinary officer was assigned because of the volume
of work. For the best results, it is necessary that frequent inspec-
tions be made of the veterinary service in the departments as well as
elsewhere.
MEAT AND DAIRY INSPECTION SERVICE.
The meat and dairy inspection service was one of the most marked
developments of the Veterinary Corps during the war and has been
well established as a permanent function of the corps. The responsi-
bility for its operation is based on the national defense act. Special
Regulations No. 70, and on a series of War Department decisions
made as disputed points have been raised for settlement. This serv-
ice at the central purchasing point, with headquarters in Chicago, but
ramifications to all the important packing-house centers had the ad-
vantage of being in the hands of qualified officers and secured an
early start. The inspection service at camps and stations developed
more slowly, and much of the personnel required special training at
Chicago before assignment to duty.
VETERINAEY. 1207
The meat-inspection service of a station covers the inspection of
meats bought locally, inclndino; the establishments used for slaugh-
tering, preparing, etc.. and methods used therein, the inspection of
the meats received, issued, or stored by the supply officer, and the
inspection of dairies and milk herds. An example of the need for
such inspection is shown in an early report made by the camp meat
inspector at Camp McClellan, Ala., as follows :
1. All meat-producing animals slaughtered in or near Anniston received no
Inspection whatever.
(a) There is nothing to prevent animals affected with infectious or paracitic
diseases communicable to man from being slaughtered and their meat being
offered for sale in the open market.
(6) Upon inspection of one or more mess-hall kitchens in every battalion in
this camp I found poi-k loins, beef, veal, and mutton carcasses, also liver and
other eatable organs, which had been purchased in open market, free from- in-
spection.
2. The city of Anniston has no abattoir. The slaughtering of meat-producing
animals is performed in back yards, sheds, or in a shack 2i miles in the country
on a Mr. Edmondson's place. The majority of the local stock is killed in this
shack. This shack is 12 feet wide by 22 feet long, built 20 years ago ; no
windows, but has several holes sawed out for light, ^yhen I approached this
shack turkey buzzards in gi-eat numbers flew out of every opening in this
building. There is no water on the place, the nearest source being 80 rods
away. The floor was completelj' carpeted with old dry blood and fecal matter,
with no evidence of ever being washed. A meat rack, saturated with blood
and fecal matter which had been pasted on by feet of turkey buzzards perching
thereon, was used for hanging and collecting carcasses and eatable organs.
All meat was collected on this rack until the slaughter was completed. The
butcher (a colored boy) had one-half gallon of water with him, which he used
for washing his hands and sponging the carcass. He would free his hands
from blood and fecal matter in the water and tlien use it for sponging the in-
terior of the carcass with the intention of removing blood and undesirable
spots. With the above equipment the butcher had instructions to kill 30
head of cattle at double time.
3. Many of the Anniston meat markets are very insanitary ; rooms for
storings meats, for making sausages, hamburgers, etc., have open toilets and
unscreened open windows in same. Old hides and decomposing bones and
many dangerous and uneatable products are kept in the same room with meat.
Flies were flying about at free will ; no conception of sanitation whatsoever.
(S. G. O. 400.16, Eastwald, J. D.) «
In theory the camp service in the divisional and other large camps
was in charge of the camp veterinarians. In practice the Quarter-
master Corps had applied for and secured the assignment of lay
inspectors from the Bureau of Animal Industry for the inspection of
meats at the local commissary, the camp sanitary officer had been con-
ducting the dairy inspections, and the local butchers and concerns
handling meat products had gone uninspected excepting as the local
representative of the Public Health Service included them within the
range of his extra-cantonment activities. The situation resulting was
most unsatisfactory, and, with a view to coordinating these various
agencies and to placing the duties of the Veterinary Corps as regards
meat and dairy inspections on a sound working basis, a conference
was requested by this office. Authority was secured from the several
departments involved, and on May 6, 1918, representatives of the
Bureau of Animal Industry of the Department of Agriculture, of the
Public Health Service, of the depot quartermaster, Chicago, and of
the Veterinary Corps met at the Surgeon General's office. As a
result of this conference the Secretary of War directed the continu-
ance of the meat and dairy inspection service by the Veterinary
1208 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Corps and authorized the issue by the Surgeon General of instruc-
tions governing its operation. Circular letter No. 34 was published
for this purpose, and an additional circular containing detailed
instructions for the professional conduct of all meat and dairy inspec-
tion will shortly appear. As rapidly as possible the lay inspectors
of the Bureau of Animal Industry were replaced by enlisted men of
the Veterinary Corps, persons with packing-house experience being
selected when available. The civilian inspectors of the Bureau of
Animal Industry had been of very material assistance in conducting
this work at a time when no veterinary personnel was available. As
the meat inspection of stations developed as a part of the veterinary
service it came into conflict with tentative arrangements of the pur-
chasing service which aimed at the formation of a meat purchasing
inspection service. There is every reason to believe that the inspec-
tion for compliance with specification requirements can be conducted
with the utmost facility simultaneously with the sanitary meat inspec-
tion by the same veterinary officer. Any other procedure would
unnecessarily duplicate personnel. Meat inspection is essentially a
sanitary provision for the protection of the health of men and
can be most efficiently developed and conducted as a part of the entire
veterinary service of a station under the immediate control of the
commanding officer. All veterinary officers are required to qualify
themselves in this duty.
The inspection service at time of purchase, with the Chicago depot
as the headquarters required a large personnel, which reached its
maximum about October 1, 1918, of 82 officers and 143 enlisted,
including those undergoing instruction. This detachment, which was
built up from three officers, inspected during the two-year period,
April 1, 1917-1919, the following quantities :
Pounds.
Beef, fresh frozen 448, 525, 595
Beef, corned 185, 253, 027
Beef, corned, hash 100,331,228
Beef, other products 128.683,579
Mutton, fresh 214,700
Pork, fresh :*_ 12, 524, 635
Bacon 296, 864, 734
Ham _• 19, 007, 921
Deviled ham 26, 412
Pork, salt 4, 000
Pork, sausage 4, 942, 504
Lard _ 2, 196, 628
Lard compound 45, OOO
Lard substitute 8, 370, 038
Sausage, Vienna 6, 144! 405
Oleomargarin 15,' 332," 303
Cheese 8, 811, 026
Butter S, 522, 689
Turkey, frozen 2, 137,699
Total 1, 247, 988, 123
There were also inspected 31.454.56G ]>ounds of meats for the
civilian relief work in Europe and 976,687 pounds of fresh frozen
beef for the Italian Government.
Practically all the fresh beef shipped to the American Expedi-
tionary Forces in France was inspected by this detachment.
A veterinary inspection service was maintained at the port storage
office, New York City, and at the port of embarkation, Newport
VETERINARY. 1209
Ts''ews, Va., for the examination of meats transshipped into refrigerat-
ijig boats, this being practically a reinspection. Veterinary officers
have also been on duty at other points where a purchasing service
has been conducted, as at Tsingtau, China (supplying chiefly the
Philippines and troops in China), in Hawaii, the Canal Zone, and
Porto Eico.
The camp meat-inspection service was planned for all camps of
1,000 population or more, but the war ended Ijefore sufficient per-
sonnel could be trained and assigned, although all the divisional and
many other camps had been supplied. The inspection of meats pur-
chased locally was the most important Avork. since the supplies re-
ceived by the supply officer by interstate shipment had, as a rule,
been subjected to veterinary or other efficient inspection, and the
subsequent reinspection was largely for the detection of signs of
deterioration. The inspection of dairies and milk herds supplying
milk to troops receives attention as a part of the veterinary service
of each station. Although these establishments are as a rule under
civilian control, ver}^ little opposition in securing improvement on
conditions has been encountered.
The delay in establishing the regular rendition of meat and dairy
inspection reports mhkes it impossible to show • complete statistics
from the camps for the year 1918. As an index of the volume of
work accomplished, the following figures will show the amounts of
meats and meat-food products rejected at time of inspection and the
causes of rejection :
Pounds.
P'resh meat products (beef, veal, mutton, pork, edible organs, etc.) 595,777
Cured meat products (ham, bacon, sausage, etc.) 47,207
Canned meat products (beef, pork, milk, tisli, etc.) 38,311
I.ard, butter, cheese, etc 6,299
Miscellaneous meats 84,282
Total 721, 876
The causes of rejection were:
Pounds.
Abscesses 1,478
Bronchitis, pneumonia, pleurisy 3,750
Emaciation 1, .547
Forage poisonings 2, OCX)
Hemorrhagic conditions 875
Hepatitis 500
Icterus 500
Immaturity 740
Melanosis 625
Parasites 8, 447
I-yemia 2, .500
Traumatisms 125, 276
Tuberculosis 2, 250
Total pathological lesions 150,488
Fermentative and putrefactive changes 254,116
Noncompliance with specifications 235,330
Improperly dressed 397
No marks of prior inspection 1,815
Cause not stated 79,730
Total 721,876
1210 REPORT OF THE SURGEON GENERAL OF THE ARMY.
In a total of 1.196 dairies reported as inspected it was recom-
mended that the milk from 86 be not used. The causes of rejection
"were :
Insanitary conditions 82
High bacterial count of milk 2
Herd not tuberculin tested 1
Herd infected with contagious abortion 1
Total 86
In some instances dairies rejected as sources of milk supply were
passed later after defects were corrected.
LARORATORY SERVICE.
The veterinary laboratory occupying quarters at the University
of Pennsylvania', in Philadelphia, has continued in operation, and in
addition a veterinary officer has been detailed to each department
laboratory for glanders and other necessary veterinary work. These
laboratories have been indispensable in the work of controlling com-
municable animal diseases. Because of the reduction in volume of
veterinary work at the Southeastern Department Laboratory, due to
closing most of the camps in the \4cinity, the veterinary officer was
relieved on June 30, 1919. The Philadelphia laboratory has con-
tinued to be the main source of supply of intradermic mallein for
Army use. Besides the making of several thousand blood tests for
glanders and dourine and a considerable number of tissue examina-
tions for miscellaneous conditions in these laboratories, special in-
vestigations have been undertaken into the value of immune serum
and cacodylate of sodium in treatment and prevention of influenza,
into the potency of commercial mallein disks, and into the effect of
intradermic mallein injections on subsequent serological tests.
3. Service of the American Expeditionary Forces, France.
When Gen. Pershing's headquarters sailed for France in May,
1917, neither personnel nor plans for a veterinar}' service went along.
Officers were sent abroad in small numbers as requested, but the calls
for them did not become urgent until shipments of animals in con-
siderable numbers began in October of the same year.
A memorandum dated September 18, 1917, covering the service of
the rear, originated in the American Expeditionary Forces, outlined
the proposed veterinary service. The organization described therein
formed the basis of the Tables of Organization subsequently au-
thorized by the War Department. With some minor changes, units
Avere organized in accordance with these recommendations and were
sent to France as called for in the priority schedules. The project
of the service of the rear could not constitute a comprehensive veter-
inary program, since the veterinary service is not confined to the rear,
but its activities proceed wherever there are animals. Xo provision
was made for veterinary officers in higher administrative positions
with.corps and armies or with base and lines of communication sec-
tions, consequently the close contact necessary between the troops
and the service of evacuation and hospitalization was lost. General
Order No. 39, Headquarters American Expeditionary Forces, dated
VETEEIKARY. 1211
September 18, 1917, attaching the veterinary service to the remount
service made it verv clear that the veterinary service vrould function
outside the Medical Department, and that a need for veterinary
administrative officers was not anticipated. The inevitable result
was the development of one veterinary service as a part of the re-
mount service and of another quite independently in each division,
while all these services were out of touch with each other and ex-
cluded from the jurisdiction of the Medical Department. It was an
extraordinary procedure to enroll veterinary personnel in the Medical
Department, train them a few weeks in their special duties, and then
to ship them to France to begin all over again under the remount
service.
As soon as the proposed arrangement was understood, work on the
organization plans in this office was expedited, every effort being
made to make such plans fit in with the expressed wish of the au-
thorities in the American Expeditionary Forces, except in the matter
of jurisdiction. It was felt inadvisable under any circumstances to
depart from the principle that the veterinary service should be con-
trolled by the Medical Department. To facilitate the adoption of this
viewpoint and to assist in organizing the veterinary service, two
specially selected and well-qualified veterinary officers were sent to
France. After an experience of more than two months at various
headquarters, they returned to the United States, reporting that their
mission had proven a complete failure and that the veterinary service
of the American Expeditionary Forces would continue to be directed
and supervised by the remount service. Their report, too long to
reproduce here, forms an interesting chapter in the early history of
the Veterinar}' Corps.
It is believed that the limited number of troops and of animals in
France at that time, and the formative stage through which the ex-
pedition was passing, constituted a most propitious opportunity to
install the machinery of the new veterinary service. It would seem
that the defects could have been eliminated and a smooth, running
organization established by midsummer and before the demands upon
it should become trying. This was not permitted, however. There-
after this office devoted its energies to the organization of the divi-
sional veterinary service and to the field units called for, as well as
of the service in this country. Officially the service in the American
Expeditionary Forces became a closed book, and when veterinary per-
sonnel left the port of embarkation it practically passed out of the
Medical Department.
In Julv, 1918, however, a cable request was received for a senior
veterinary officer to be sent to France for administrative work, and
it became apparent that conditions not then understood, but sus-
pected, demanded a very material modification in the method of
operating the veterinary service and implied its return to the juris-
diction of the Medical Department. Reports received about this
time showed an enormous amount of sickness and disability among
public animals. For weeks the noneffective rate was above 30 per
cent, and the prospects seemed excellent for a complete breakdown
of the veterinary service and the practical immobilization of animal
organizations. After much careful consideration Lieut. Col. D. S.
^^-liite was sent to France to act as chief veterinarian. He served
1212 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
in that capacity for about two months and was replaced early in
Xoveniber by a Cavalry officer. Xo complete report of the activities
of Lieut. Col. White has been received in this office. Coincident with
them, the veterinary service was placed under the control of the
Medical Department, where it continued, and Special Reflations
Xo. 70 for its operation were adopted. There was soon apparent a
material diminution in the sick rates and the signing of the armistice
allowed apportunity to get the animals in much better shape and
to relieve the overcrowded hospitals. Shipments from the United
States, suspended since May, began again, and the arrival of replace-
ments made possible much more thorough evacuation and prompt
treatment of the sick. The fact nmst not be overlooked that failure
to provide animal replacements during the active offensive opera-
tions of our troops was a most important causative factor in steadily
increasing the number of sick. It repeatedly happened that veterin-
arians recommended the evacuation of unfit animals only to be
opposed b}' the unit commanders, who protested that sick and emaci-
ated animals were better than none, and that the activities of their
units would be crippled or wholly suspended unless the sick animals
were left or were replaced. Consequently animals were worked
until they starved to death or died in the harness or got into such
shape that when they could be taken care of recovery was impossible
or prolonged beyond reason. Under these conditions also, com-
municable diseases, especially mange, spread like wildfire, and the
entire animal strength of some organizations was affected.
DIVISIONS.
The authorized divisional veterinary service, including the mobile
veterinar}' section, was organized and proceeded overseas with the
divisions with the following excei^tions: The 1st, 2d, and 26th pro-
ceeded without personnel : the 41st and l:2d had 6 officers and no en-
listed men assigned, and the 32d had 3 officers and 15 enlisted. The
mobile veterinary sections of the foregoing 6 divisions were subse^
quently organized and sent to France as part of the first phase. The
service was also partly or wholly organized for the divisions still in
training when overseas shii:)ments ceased.
The service of the 15th Cavalry Division was completely organ-
ized and functioned until the division was demobilizecl.
Veterinary personnel was also sent to France with 4 Cavalry
regiments, 6 Engineer regiments, and 29 remount squadrons.
A'ETEEINARY FIELD HOSPITAL UNITS.
The following organizations were completed and sent to France:
Veterinary Hospitals Xos. 1 to 21, inclusive (7 officers, 300 men,
capacity 1.000 patients), and Xo. 25, a total of 22.
XoTE. — The enlisted men of Veterinary Hospitals Nos. 3, 4, 5, 19,
20, and 21 were colored.
Base Veterinary Hospitals Xos. 1 and 2 (lofficers, 144 men, ca-
pacity 500 patients).
Army Mobile Veterinary Hospitals X"os. 1 and 2 (4 officers, 144
enlisted).
VETERINARY. 1213
Corps Mobile Veterinary Hospitals Nos. 1, 2, 3, 4, 7, 8, and 9 (2
officers, 35 enlisted).
Eeplacemenb Units Nos. 1 to 4, aggregating 50 officers and 795
men.
Forty-five officers were sent over for duty with horse-purchasing
boards.
All of the above-enumerated units except those of the first phase
were formed at the veterinary training school, Camp Lee, and there
were also at this point, with ranks comj)letely or partly filled :
Veterinary Hospitals Xos. 22, 23, 24.
Base Veterinary Hospital No. 3.
Corps Mobile Veterinary Hospital Xo. 5.
Veterinary Replacement Unit Xo. 5 (40 officers, 210 enlisted).
These units were held intact until about the middle of December
when they were demobilized, it becoming apparent they would not
be required in France.
The organization and training of the field units is intimately con-
nected with the history of the veterinary training school. Camp Lee.
It was inevitable that units raised and sent forward under the con-
ditions of haste, inadequate training and equipment and painful
ignorance of their duties on the part of both officers and men should
be far from satisfactory. There was no opportunity to study and
perfect the basic plans for the organization and there was no as-
surance tliat personnel was adequate or equipment suitable for the
work proposed. Satisfactory plans for administering the interior
economy of the units were lacking. In brief, if unpreparedness for
war existed in this country, it was exemplified to perfection in the
state of organization of the veterinary service.
4. Service of the American Expeditionary Forces, Siberia.
The animal strength of the American Expeditionary Forces, Si-
beria, is under 1,000, and a large veterinary service has been unneces-
sary. Capt. J, A. McKinnon, Veterinary Corps, proceeded to Vladi-
vostok with troops from Manila in August, 1918, and has since acted
as chief veterinarian, assisted by three officers and six men. Both
morbidity and mortality rates amongst the animals have been exceed-
ingly low and no hospital units have been requested.
5. Instruction and Training.
Officers and men were trained in their duties in the detachments
at their stations and at the training schools. In January, 1918, a
schedule of instruction for personnel attached to divisions and auxil-
iary remount depots covering 10 weeks was promulgated and fol-
lowed in August by completely revised and amplified schedules, all
of which were complied with more or less faithfully in the different
organizations. Instruction in the detachments of the auxiliary re-
mount depots was always interfered with by the overcrowding of
the depots and the overworking of the personnel. The considerable
percentage of conscientious objectors, illiterates, and defectives,
physical and mental, did not always conduce to the maintenance of
high standards of instruction.
1214 REPORT OF THE SURGEON GENERAL OF THE ARMY.
VETERINARY SECTION, MEDICAL OFFICERS' TRAINING CAMP, FORT RELET,
KANS.
This section operated from February 4, 1918, to September 30,
1918, when the remaining personnel and property were transferred
to the Veterinary Training School, Camp Lee, Va. During this
period 527 enlisted men were received, of whom 488 were assigned
to duty with troops after receiving a part or all of the course of
training.
VETERINARY SECTION, MEDICAL OFFICERS' TRAINING CAMP, CAMP GREEN-
LEAF, GA.
Both officers and enlisted men were trained in this section. The
officers were placed in training companies and given two months of
intensive instruction mainly in their military duties. Professional
training was not attempted to any great extent. Besides instruction
per se, the senior veterinary instructor was required to report on the
qualifications of each officer for future assignments, to recommend
promotions and to take active steps to eliminate the unfit by bring-
ing them before efficiency boards.
A total of 738 officers reported and were assigned to training com-
panies, of whom 650 were ultimately sent to duty with organizations.
This was more than 25 per cent of the maximum strength of the
corps.
The enlisted men of the Veterinary Corps were organized as
Company A which functioned to train men for the duties of vet-
erinary soldiers. It comprised graduate veterinarians and non-
gi'aduates. The company was utilized as a training depot for
the graduate veterinarians who were enlisted in the Medical Enlisted
Reserve Corps and it offered excellent facilities for giving them the
basic training of the enlisted man considered most desirable before
they should be eligible for the status of commissioned officers. A
total of 652 graduate veterinarians were assigned to this company
and were disposed of as shown below :
Qualified for commission :
Oral examination 248
Written examination 9
' 257
Rejected for commission :
Physical examination 22
Oral examination 42
Written examination 5
^— 69
Total examined 326
Discharged to accept commission elsewhere 7
Transferred from company for duty 26
Refused examination (wanted immediate active service or did not
want commissions by reason of financial conditions, failure to
qualify for State license, etc.) 83
Not examined from lack of time, arrived late 210
Total not examined 326
Grand total ^52
roo.^if ^7;?!^ actually received commissions. The papers of the others failed of action by
reason of the signing of the armistice. »v « jr
VETERINABY. 1215
VETERIJS'ARY TRAINING SCHOOL, CAMP LEE, VA.
The essential purpose of this school was to organize veterinary
field hospital units for overseas service. A veterinary hospital for
training purposes was a necessary adjunct to the school. The lat-
ter was j)i'Ovided first. The officers and noncommissioned officei^s
as instructors and the necessary shelter were ready when tlie first
men reported in June, 1918. Barracks were originally provided for
1,600 men but the official strength exceeded 5,000 for several weeks.
Approximately 8,200 men reported up to the signing of the armistice,
of whom nearly 6,500 proceeded overseas in units. The routine
usually followed in securing personnel was to call for an increment
from the draft sufficient to organize the units of one phase of the
priorit}' schedule. As soon as the men could be given a few weeks
or days of basic military training, they were assigned to units and
shortly sent overseas. Officers quite as inexperienced as the men
were obtained from Camp Greenleaf or from civil life. Extremely
creditable work was done by those responsible for this school in
assembling and training units under great pressure of urgent demand
and limited time.
The veterinary hospital, so much needed for training men in the
care of the sick and in hospital duties, was slow in materializing
but was finally opened too late to be of any value in the emergency.
Classes in horseshoeing and saddlery were maintained, although it
Avas necessary to improvise most of the facilities. The veterinary
training school was kept in operation for several weeks after the
armistice was signed until it was clear that no additional veterinary
personnel would be required overseas and then it was demobilized.
HORSESHOEING SCHOOLS.
Horseshoeing forms an important part of the veterinarian's cur-
riculum and the Arm}^ veterinarian in theory is the logical instructor
hi this art. In actual practice during the war, the great bulk of
instruction in hoi-seshoeing in the schools maintained in the auxiliary
remount depots has been given by veterinary officers. A well-qual-
ified veterinary officer was detailed to organize several of these
schools with much success.
MOUNTED SERVICE SCHOOL, FORT RILEY, KANS.
The department of hippology at the mounted service school was in
charge of Maj. D. B. Leininger, Veterinary Corps, from September
26, 1917. to May 13, 1919, when he was relieved of this position by
a line officer, continuing, however, the duties of senior instructor of
the horseshoeing school and of the school for stable sergeants, which
he had performed throughout the war. From three to four veteri-
nary officers as assistant instructors have been continually under his
supervision.
INSTRUCTION IN OPERATIVE SURGERY.
Dr. John W. Adams, professor of veterinary medicine at the Uni-
versity of Pennsylvania, school of veterinary medicine, volunteered
1216
REPORT OF THE SURGEON GENERAL OF THE ARMY.
his services for improving the eflSciency of the Veterinary Corps. As
■c\ contract veterinarian, he was directed to proceed to various auxili-
ary remount depots for temporary duty of about 10 days for the pur-
pose of instructino: veterinary personnel in surgical procedures.
Dr. Adams visited 12 depots in this way, inspecting and improving
equi^oment and supplies, lecturing, and conducting clinics, and was
released only to permit him to return to his collegiate duties. The
services he rendered even in this short period were most valuable and
satisfactory.
6. Supplies.
The issue of veterinarj- supplies was controlled by the finance and
supply division of the Surgeon General's Office until November, 1918,
when it was taken over bv the office of the Director of Purchase and
STRENGTH BY WEEKS
HORSES AND MULES
325000
300000
1918
UNITED STATES AND FRANCE
RATIO
PER IboO
^
^^
—
/
y
^
^
^ 1
\
—
—
-~-
275000
250000
225000
200000
175000
150000
125000
100000
75000
50000
25000
7^
TTl
r/L
MJ
j:s
,
»,^
vj
/__
•
'
y 1
^
'"
■—
'''
*■■
— -
—
—
HOR
S^S
\
^
1
\
'
\% \<i X^ Z 3 15 23 30 6 13 ZC iL7 4 II 18 Z5 I
JULY AU&. SEPT. OCT
Fig. 142.
8 15 ZZ 19 6 13 20 Z7
NOV. DEC.
Storage. The veterinarj^ officer who had been acting on veterinary
suppl}^ papers continued in this duty. The supply tables based orig-
inally on the British equipment have remained unchanged, and
monthly replenishments for the American Expeditionary Forces
have been forwarded as required. Xo reports of serious shortages
have come to hand.
Plans are afoot for tlie revision of these tables, and the experience
of veterinary officers who have served in the field will be utilized in
this work.
7. Hospital Coxstructiox.
In spite of the fact that the veterinary hospitals at the auxiliary
remount depots are gi'ossly inadequate, it has been deemed inadvis-
able to attempt to improve them and thereby establish more firmly
the principle, considered thoroughly incorrect, of locating the only
VETERI^STARY. 1217
veterinaiy hospital in a camp at tlie auxiliary remount depot. The
question of the availability of funds from the current appropriation
" Construction and repair of hospitals "' for the construction and re-
pair of veterinary hospitals was decided in the negative by the Judge
Advocate General of the Army. The inclusion of such construction
in the annual appropriation bill will therefore require si^ecific change
in the wording of the bill and create an entirely new precedent.
Two veterinary hospitals have been constructed from the appropri-
ation *■' Construction and repair of hospitals." One of these, at Camp
Humphreys, Va., is now in operation, and has a capacity of 110 pa-
tients. The other, of 500 animals capacity, was completed at Camp
Lee about December 1, 1918, having been contemplated as an adjunct
to the veterinary training school, but was finished too late to be of
value for training purposes. This hospital functioned effectively as
a camp utility for several months following the closing of the
training school, but in the efforts to release temporary personnel dur-
ing demobilization it was closed and the personnel consolidated with
the veterinary detachment at the auxiliary remount depot. The
hospital facilities at this depot being, like those of all other depots,
extremely limited, the plant of the camp hospital was taken over
and is now being operated as a depot hospital. At Camp Bragg and
Camp Knox hospitals approximating 500 patients capacity, based on
the type plans, have 1:)een built, their cost being included in the con-
struction of the camp. Projects are under consideration for veteri-
nary hospital construction at the remount depots at Forts Keogh and
Reno, at Fort Bliss, and at Corozal, Canal Zone.
8. Sanitatiox.
The overcrowding of the auxiliary remount depots at the divisional
cantonments continued with slight relief during the first six months
of the fiscal year. The outgoing divisions had turned in their ani-
mals and those newly authorized failed to draw up to their allowance,
consequently depots planned for 5.000 animals were called upon to
shelter 7.000 to 10.000. and the result was excessive disability and
losses. The ever-present picture of large herds of animals running
loose in corrals, extensive areas of Avhich were knee deep with mud
and manure did not change with time, in fact, could not be changed
until the animals died or were disposed of. Continual efforts were
made to keep the con-als clean with poor success. There was no
avoiding these insanitary conditions based, as they were, on an
inherently incorrect principle. The corral system for general use in
the United States is a failure and should not be tolerated in future.
Individual dry standings for every animal should be considered to
be a minimum requirement. For the reason that the animals were
more or less conditioned the losses usually noticeable amongst gi'een
animals were absent. When purchasing was resumed for a few weeks
(Oct 25-Xov. 11, 1918) the incidence of shipping fever and in-
fluenza promptly increased.
The sale of surplus animals began soon after January 1, 1919. and
about 170,000 were disposed of during the ensuing four months.
The problem of overcrowding was promptly solved, and the reduc-
tion in the number of animals permitted the abandonment, with few
exceptions, of the most undesirable auxiliary remount depots. The
1218 REPORT OF THE SURGEON GENERAL OF THE ARMY.
ARMY ANIMALS
ADMISSIONS
RATIO PER iOOO
ALL CAUSES
-ifn "" ''" 7" ]^
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lUNCOCK
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DIX
JOHU'STOri
■JR NEWS
T!IW1RII««
SRECNE
.06AN
FREMONT
JACKSON
.ftCELER
SHERflAN
DEUENS
5HERI0AN
TRAVIS
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SHELBY
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-Et
FT RENO
DODGE
YLOH
r^AOSWORTHli
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UPTON
CySTER
FT BLISS
SEVIER
PIKE
HOvpiin«k
FUNSTON
f«CflRTHl*i
FT KEOOH
III /IPIII I Ml
956.96 AVERAGE ANNOAt RATE
I4 26a8
1207.44
i2.oaeo
iieazo
1191.44
I I 5 ISO
103792
1035.84
I02a04
991.12
990.08
Sr7S.00
938.60
93IS4
923.52
919.68
396.48
886.60
873.08
S6S.I6
833.04
830.S6
82^28
821.08
809.64
797 6
786.76
771.16
7S4 00
750 36
731 12
692 .64
693.90
682.24
672.88
571.48
524.68
484 64
421 RQ
NON-EFFECTIVE RATE
DEATHS
ARMY ANIMALS RATIO PES IOOO
ARMV ANIMALS RATIO PER lOOO ALL CAUSES
-EE
DIX
GREENE
SEVIER
tf NEWS
<1E*0E
JPTON
^WIS
■"TSILL
1
JNUA
106,60
95.68
9S.I6
77 48
,
. R
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^^^^
RAG
,
70 72
70 20
:
■■■-I
2?
ATE
65 52
62 92
6 188
S9S0
59.80
5928
5824
5772'
54 60
S044
49.92
49.92
4888
4836
47 32
4628
43 68
42.64
42 12
4a 12
41.60
4l 60
3692
3374
32 76
31.72
3068
30.16
28 60
seoe
«IJ84
2r
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XAURfMflO
JACKSON
^
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AVE
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SHELBY
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FT KEOGH
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TRAVIS
JCHNSTON
DODGE
TACABTMW
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CUST£«
■ nomWNK
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Fig. 143.
VETEEINAEY.
1219
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-16
1220 REPORT OF THE SURGEON GENERAL OF THE ARMY.
sanitary conditions of most of those remaining have shown material
improvement.
The work of the general veterinary inspectors has continued
throno-li the year and has been of the greatest advantage in improv-
ing sa'iiitary conditions and the efficiency of the veterinary service.
A veteriiiarv sanitary inspection report (Form 103, M. D.) based
on Form 50,' Medical' Department, contemplated to be rendered
monthly by the veterinarian of every station and forwarded to the
War Department through military channels was devised and sub-
mitted for approval. Its use was authorized in paragraph 87^,
Special Keoulations, No. TO, Changes No. 1, except that it was
directed to be filed by the commanding officer. It has required much
effort to secure the correct and routine rendition of this report at
stations, but even when that has been accomplished none of the
valuable information contained therein is available for the use of
the department.
NON-EFFECTIVE ANNUAL RATE
DISEASES
CASES JULY TO DECEMBER,I9I8
HORSES AND MULES
10 20 30' 40 50 60 70 80 90 100 110 120 130 140 150 150 170 180 190 210 2Z0
RATIO PER 1000
■■ DERMATITIS GANGRENOSA
PICKED-UP NAIL
■B_
SCRATCHES
INFLUENZA
PODODERMATlTIS
STRANGLES
GLANDERS
PNEUMONIA
CQLIC
ZI0.4Z
131 33
98.83
7027
4960
4671
1780
II 58
10,37
-3AL.
Fig. 145.
9. Communicable Diseases.
The faulty sanitary conditions reported during the fiscal year
ending June 30, 1918. were in evidence during the larger part of the
present fiscal jenr. The most important of these Avere overcrowd-
ing of animals in large corrals; insanitary conditions of the corrals
which were often deep with mud and manure; lack of dry stand-
ings; the use of single fences between corrals, and the use of hay
racks in forming the divisions between corrals.
Crowding of large numbers of animals together and failure to
keep those in adjoining corrals from coming into direct contact at
the hay racks resulted in many being exposed in infection and
caused large numbers of animals to be held in quarantine for long
periods, thus delaying shipments, and seriously hampering the effi-
cienc}" of the depots. The lack of double fences between corrals
often necessitated abandonment of corrals on either side of an in-
VETERINARY. 1221
fected one, in order that an exposed or infected group might be
proi^erl}^ segregated; this occasioned great inconvenience in an al-
ready crowded remount depot. With the sale of many surplus
animals, the sick rates took a marked drop. Veterinary officers as
stock^'ard inspectors working with inspectors of the Bureau of
Animal Industry, in supervising the cleaning and disinfection of
cars, stockyards, barns, and other premises used in the handling of
horses and mules, have accomplished much in controlling infectious
diseases. The importance of this work can hardly be overestimated,
and shippers and dealers have expressed themselves as highly grati-
fied with the results in reducing losses.
GLANDERS.
Glanders is an infectious disease caused by the B. nwllei, which is
practically incurable; it affects not only man}' species of animals
but man as well. Unless radical measures are adopted for its con-
trol, it tends to become widely disseminated, occasioning great losses
among horses and mules. In communities in which the disease is
prevalent, the occurrence of the disease in man is not at all rare and
it is equally incurable. The disease has been reported in the Army
from practically all sections of the United States. It has been most
prevalent in the Southern Department. This is probably due to the
movements of large numbers of animals in this department when the
British and French were actively engaged in buying and shipping
animals in this country. It is known that glanders was very prev-
alent during this time, and it is quite probable that the disease was
thus widely spread throughout the area.
As the disease may exist in an animal in a chronic form for years
and may not be accurately diagnosed clinically owing to the simi-
larity of the symptoms with those of other conditions, and in view
of the fact that the infection may be disseminated to other animals
before the clinical manifestations are well defined, an early diag-
nosis is of great importance, and extensive work has been done along
the lines of perfecting tests for the early recognition of the disease.
The most important have been the various mallein tests (intradermic,
ophthalmic, and subcutaneous), in which a toxin produced by the
bacillus during growth under artificial conditions is used; and the
serological tests (complement fixation and agglutination). The sero-
logical tests can be made only in a completely equipped laboratory
and are used when the results of a mallein test are doubtful or in-
determinate in character.
Ophthalmic test. — This procedure consists in the instillation of a
concentrated mallein into the conjunctival sac and observations of
the treated eye between the eighth and twentieth hours. In glan-
dered animals it occasions a reaction which is marked b}' a conjunc-
tivitis and a purulent discharge. It is quite reliable but very careful
observations are necessary for an accurate interpretation and errors
are possible as a result of removal of the discharge by accident or
otherwise. Errors are also probable if animals suffering with in-
flamed conjunctiva? from any cause are tested. Early or later re-
actors may also be overlooked. The ophthalmic test has been grad-
ually displaced by the intradermic method and is now authorized
only with purchasing boards or by officers who have not been in-
structed in the intradermic method.
1222 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Intradeimiic tests. — ^Under the auspices of the Philadelphia labora-
tory, the technique of the intradermic method was developed. Sev-
eral thousand experimental tests and readings were made by prop-
erly qualihed veterinary officers on animals at different auxiliary re-
mount depots, and the dosage, type of syringe and needle, operative
procedure and the interpretation of the test were worked out in de-
tail. Circular Letter No. 30, Surgeon General's Office, veterinary
division, based on this work, was issued for the guidance of all
officers.
The intradermic mallein test consists of the injection of a specially
prepared mallein into the derma of the lower eyelid, with observa-
tions of the injected area at the twenty-fourth, forty-eighth, and
seventy-second hours. The reaction in a glandered animal consists of
a prominent, painful, and persistent swelling, often accompanied by
a purulent discharge and conjunctivitis. This test takes three to four
days for its completion and is more reliable than the ophthalmic test,
as it is not subject to the same external influences which may cause
error in interpreting an ophthalmic reaction. Owing to the length of
time required for the intradermic test, it has not replaced the oph-
thalmic test for use at time of purchase of animals. It is believed
that the ophthalmic test, if carefully made and a careful physical
examination is conducted at time of purchase, will be sufficiently re-
liable to protect the Government, especially in view of the quaran-
tine and test requirements at time of receipt of the animals at a re-
mount or other station.
The subcutaneous test is a thermal test. The reaction in a glan-
dered animal consists in a rise in temperature, malaise, and local
swelling following the injection of mallein. It has not been recog-
nized officially for Army use.
Animals which give a positive reaction to a mallein test are im-
mediately destroj'ed. Suspicious reactors are tested immediately in
the other eye and a sample of blood is submitted to one of the depart-
ment laboratories for test. If the blood test is positive, the animal is
immediately destroyed.
On the discovery of glanders in any lot of animals, the veterinary
officer is required to make suitable recommendations relative to quar-
antine and further testing of all of the exposed animals ; also clean-
ing and disinfection of the infected stables, equipment, etc. Other
veterinary officers having any official interest and the State authori-
ties are notified in order that all precautions may be taken to prevent
the spread of the disease.
A post-mortem examination is required for each animal destroyed
as a positive reactor to a glanders test, provided no clinical symp-
toms of the disease are in evidence. In order that important scien-
tific data may be obtained, veterinary officers are instructed to for-
ward specimens of diseased fissures, found on post-mortem, of all ani-
mals destroyed for glanders, to a laboratory for examination.
In order that the public might be safeguarded in the purchase of
animals from the Army, instructions were issued that all animals
should be mallein-tested prior to sale. A total of 1,354 animals were
sold during the period June 30-December 31, 1918, and no com-
plaint has been received relative to glandered animals being sold.
Glanders in the United States. — Reliable reports of mallein tests
first began to arrive in February, 1918, and for the 47 weeks' period,
VETERINAKY.
1223
February-December, there were reported a total of 1,346,007 such
tests (of these 11,866 were mtradermic), an average of 28,638 tests
each week, not inchiding retests. The small number, comparatively,
of intradermic tests was due to the fact that veterinary officers in
the United States were prohibited from using the test until it had
been demonstrated to them by a competent officer. This took con-
siderable time, and the test did not come into general use before the
end of the year. As the system was perfected with the use of the
revised Form 102, separate records of the horses and mules and of
retests upon doubtful cases have been kept since September, 1918.
As the result of the 1,346,007 mallein tests and 5,041 retests, 2,963
animals were destroyed. The proportion of animals destroyed to
the total strength of the Army animals (based on an average of
295,000) was a weekly average of 0.20 per 1,000, or about 1 to every
5,000 animals. On the average, approximately one-tenth of the
Army animals were mallein-tested each week, and, based on the total
deaths, there Avas an average of 56.51 animals destroyed each week.
During the four months' period, September-December, when sepa-
rate records were kept of the horses and mules, there were 377,976
mallein tests applied to horses and 236,490 mallein tests to mules,
as a result of which 566 horses and 161 mules Avere destroyed. There
were 3,841 retests applied to horses and 1.200 retests to mules, as a
result of which 225 horses and 71 mules were destroyed. These fig-
ures are included in the totals given above.
Considering the horse and mule group separately for the Septem-
ber-December, 1918. period, it is found that, based upon the total
strength of each group, the average number of horses destroyed was
0.27 to 1,000 in the horse group, and the average number of mules
destroyed in the mule group was 0.11 to 1,000. Irrespective of the
proportion of horses and mules, there were 145 per cent more horses
destroyed in the horse group than there were mules destroyed in
the mule group for glanders.
Whether or not the mule shows glanders more acutely when once
developed, the above figures would indicate that the disease is much
less frequently found in the mule.
Weekly report of animals killed for glanders during 1918.
Prior to Mar. 29 352
Week ending —
Apr. 5 6
Apr. 12 18
Apr. 19 44
Apr. 26 66
May 3 74
May 10 98
May 17 144
May 24 67
May 31 41
June 8 96
June 15 98
.Tune 22 80
June 29 79
July 5 86
July 12 49
July 19 57
July 26 119
Aug. 2 74
Aug. 9 66
Aug. 16 73
Week ending-
Aug. 23__
Aug. 30- _
Sept. 6—
Sept. 13_
Sept. 20_
Sept. 27-
Oct. 4_—
Oct. 11—
Oct. 18—
Oct. 25—
Nov. 1— -
Nov. 8—
Nov. 15—
Nov. 22_-
Nov. 29—
Dec. 6— -
Dec. 13—
Dec. 20—
Dec. 27_-
71
82
103
63
31
77
88
62
39
57
94
72
20
40
101
44
22
28
Total 2,963
1224 REPORT OF THE SURGEON GENERAL OF THE ARMY.
From September 6, 1918. to December 31, 1918, the separate rec-
oi'ds for horses and mules show as follows :
Horses.
Mules.
Horses.
Mules.
Sept 6
70
91
56
25
67
37
58
31
51
63
12
12
7
6
10
51
5
8
6
31
Nov. 15
69
11
34
69
29
16
21
9
Nov.22
9
Spnt 20
Nov.29
6
Sept 27
Dec. 6
32
Dec. 13
15
Oct 11
Dec. 20
6
Oft 18
Dec. 27
7
Total
798
232
Nov 8
The following table, showing absolute numbers of animals de-
stroyed for glanders at auxiliary remount depots, remount depots,
and animal embarkation dejDOts only for the 10 months' period from
March, 1918, to December, 1918, indicates where the greatest losses
occurred :
Fort Sill 279
Greene 212
Travis (consolidated) 189
Jackson 180
Newport News 136
Shelby 122
Beauregard 108
Wadsworth 107
Lewis 105
Fremont 101
Cody
Bowie
Grant
Pike
Custer
Gordon
Kearny
Sevier
Fort Keogh_
Sherman
McArthur __
79
78
71
70
62
48
37
29
24
22
22
Fort Bliss
19
McClellan
14
Lee
11
Taylor
11
Devens
5
North Charleston
5
Upton
4
Sheridan
3
Dodge
3
Dix
2
El Reno
2
Wheeler _
1
Meade
0
Hancock
0
Funston _
0
Logan
0
Johnston
0
Front Royal
0
Total 2,161
Of the 2,963 animals destroyed, autopsy reports were received for
a total of 2,192 animals; of these 2,057 were reported positive, 87
negative, and 48 doubtful on post-mortem examination. A negative
post-mortem examination does not imply that an animal which has
given a positive reaction to a test (mallein or blood) is not glan-
dered. There is no relation between the character of a reaction to
test and extent of the lesions; the lesions may be so minute as to be
entirely overlooked on post-mortem examination. To the contrary,
animals extensively diseased (clinical cases) may occasionally fail to
react to a mallein test. The great value of the test lies in the ability
to pick out, through their use, infected animals before they have
reached the stage of spreading the disease to healthy animals.
Glanders in the American ExpeditionaTy Forces^ France. — During
the period October-December, 1918, a total of 217,305 mallein tests
were reported, averaging 16,716 tests each week. The returns from
France did not differentiate between horses and mules, nor were re-
tests of doubtful cases indicated. As the result of the above tests,
633 animals were destroyed. On the average, approximately one-
VETERINAKY.
1225
eleventh of the Army animals were mallein tested each week. Based
on the total deaths, there was an average of 48.69 animals destroyed
each week. The proportion of animals destroyed to the total strength
was a weekly average of 0.27 to 1,000, or about 1.36 to every 5,000
animals. The result shows a close but slightly higher average than
in the United States.
The number of animals destroyed for glanders each week in the
American Expeditionary Forces from October to December, 191S.
is as follows:
Oct. 4__.
Oct. 11—
Oct. 18_-
Oct. 25_.
Nov. 1_-
Nov. 8—
Nov. 15-
Nov. 29 28
Dec. 6 53
Dec. 13 89
Dec. 20 157
Dec. 27 223
Total 633
Nov. 22 34
Xo cases of glanders have been reported from the American Ex-
peditionary Forces in Siberia.
Owing to the probability of animals being tested at short intervals,
especially during frequent exchanges, and the possibility that such
repeated injections might influence subsequent blood tests througli
the production of antibodies, and in view of the scarcity of literature
on the subject considerable experimental work has been done. The
objects of such investigations were to determine how soon antibodies
could be demonstrated and for how long a period they persisted in
the blood of horses after the injection of single and double doses of
mallein. Horses which had not been previously injected with mal-
lein, also a number of horses which had received repeated injections,
were used in the following experiments conducted by Maj. Gilliland.
Veterinary Corps, and Capt. Kelser, Veterinary Corps, at the Phila-
delphia laboratory : In 10 healthy animals which had not been in-
jected with mallein prior to the test, antibodies were demonstrated
in three on the third day following the injection of 0.1 c. c. of con-
centrated mallein. On the twelfth day one of the animals gave a
100 per cent reaction (positive complement fixation) and in two of
the animals antibodies were demonstrated on the sixteenth day. This
experiment was incomplete, as the blood was not tested until the third
day nor after the sixteenth da}*.
In the case of 20 animals which had received several injections of
mallein prior to the test, it was shown that antibodies could be demon-
strated as early as the forty-eighth hour, and they persisted in small
numbers in one animal for 30 days and in another for 28 days. The
test was made by first injecting 0.1 c. c. of mallein and later was re-
peated using 0.2 c. c. of mallein. In a total of 911 blood specimens
from animals (75 from mules) which had received repeated injections
of mallein (the last injection at least 21 days prior to blood test)
909 were entirely negative. One horse gave a 25 per cent reaction
and one mule a reaction of about 10 per cent. The reaction in the
horse specimen was undoubtedly due to a previous injection of
mallein, while the reaction in the mule serum may have been en-
tirely nonspecific (mule serum normally possesses hemolysis inhibit-
ing elements."
1226 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The following conclusions were stated :
1. The injection of tlie prescribwl close of intradermic mallein gives rise to
the production of complenient-fixinR bodies and asglutinins in demonstrable
numbers in the blood serum of a percentage (in our test 40 per cent) of the
animals thus injected.
2. An overdose of mallein increases the percentage of animals that develop
comploment-tixing bodi(>s and the degi-ee of reaction to the serological test.
(In our test TO per cent reacted to tlie serological test following the injection
of 0.2 c. c. of mallein.)
3. While complement-fixing bodies may be demonstrated as early as 48 hours
subsequent to the injection of the mallein, and may continue for 30 days, the
average case develops complement-tixing bodies on the fourth or fifth day and
they disappear within approximately two weeks.
4'. The percentage of animals that develop complement-fixing bodies and the
degrees of reaction to the complement-fixation test, following the injection of
the prescribed dose of mallein is apparently greater in " green " animals which
have never received previous injections of mallein than with horses that have
had a number of injections. In Maj. Gilliland's test with " green " horses 70
INFLUENZA
NON-EFFECTIVE RATE BY WEEKS
HORSES AND MULES, UNITED STATES AND TRANCE
700
600-
500-
400-
300-
250-
200-
150-
I00\
75-
50
25
1£18
(RANCE
RATIO PER 1000
5 12. 19 Z6 2 9 16 23 30 £ 13 ilO 27 4 II 18 25 I
JULY AUG-. SEPT. OCT.
Fig. 14G.
8 IS ZZ 29 6 13 20 27
NOV. DEC.
per cent reacted as against 40 per cent in our test with previously injected
horses.
5. Due to the fact that the greater percentage of animals at present in the
Army have been subjected to numerous intradermic mallein tests, it is be-
lieved that generally comparatively little difficulty will be experienced with
serological tests subsequent to the mallein tests of these animals, particularly
if the blood specimen is procured immetliately after the 48-hour reading of the
mallein test.
6. Greater difficulties in the complement-fixation test are likely with the
specimens from animals which have recently received their first injection of
mallein."
DERMATITIS GANGRENOSA.
This disease has been second amongst communicable diseases in
importance in the United States and occasioned heavy losses from
deaths and unserviceable animals which were sold for but a small
fraction of their cost. It has been reported from nearly all sections
of the country and was very prevalent at many of the remount sta-
VETEKIIifARY.
1227
tions. The number of cases actuall}' reported in the United States
for the period July-December, 1918, was 4,036 ; of these 212 died or
PNEUMONIA
NON-EFFECTIVE RATE BY WEEKS
19
ja
J "■
RATIO PER 1000
/'
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,.'
'-.
'
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/'
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/
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300
275
250
225
200
175
ISO
IZS
100
75
50
25
S IZ 19 26 Z 9 16 U 30 6 13 XO X7 * W \8 ZS \ 8 15 U 19 6 13 %0 X7
JULY AUG.. SEPT. OCT. NOV. DEC.
Fig. 147.
were destroyed as incurable. This number is well under the real
total for this period of six months for the reason that the returns
are incomplete for July and August, The largest number reported
DERMATITIS GANGRENOSA
300
275
250
225
200
175
ISO
125
100
75
SO
25
19
fl
NON-EFFECTIVE RATE BY V\/EEKS
HORSES AND MULES, UNITED STATES
RATIO PER 1000
I
\
/
\
/
\
/
1
/-
k
/
\
/
s.
/
N
—
s.
/
\
V
,/
/
\
^
N,
/
\
/
S
^
/
V
f
\
/
•
_^
S IZ 19 26 X 9 16 Z3 30 6 13 ZO 27 ^ II 18 2S I 8 IS 2Z Z9 6 13 ZO Z7
JULY AUG. SEPT. OCT. NOV. DEC.
Fig. 148.
from any station was at Camp Beauregard, La., with a total of
737 cases.
The cause is an anerobic bacillus (B. necrophorus) which thrives
indefinitely in the soil. Ideal conditions prevailed at man}- of the
1228
REPORT OF THE SURGEON GENERAL OF THE ARMY.
depots for the existence and rapid growth of the organism, viz,
mud and manure infested corrals and overcrowding. While the
disease is connnon in muddy places, it is sometimes prevalent in
sand}^, well-drained soils. This probably is due to the fact that the
manure readily mixes with the sand to a considerable depth, retains
moisture and thus creates a very favorable condition for the exis-
tence and propagation of the baccillus.
The organism gains entrance into the tissues through any wound.
Wounds resulted in large numbers through animals running loose in
corrals. They were self-inflicted or inflicted by other animals, by
contact with stumps, sticks, hay Avire, and other foreign bodies.
I'hey were common from crowding at the feed troughs and from the
frequent passage through the chutes for purposes of inspection. The
bacillus gi'ows very rapidly in the depths of a wound and causes
gangrene and extensive sloughing of the invaded tissues.
STRANGLES
NON-EFFECTIVE RATE BY WEEKS
300
275
250
225
200
175
150
125
100
75
50
25
19
8
" 1
■
RATIO PE
R 1000
^
/
^
^
■^
—
/
,
-^
1 "
12 19 26 2
JULY
9 16 Z3 30
AUG-.
6 13 20 27 4
SEPT.
Fig. 149.
II 18 2S I
OCT.
8 IS M 29 6 13 20
NOV." DEC.
Superficial treatment is obviously of limited value and agents
which are caustic in character prove of greater value that milder ones.
The best results have been obtained from the adoption of surgical
measures for the removal of necrotic tissues, followed by cauteriza-
tion of the infected area. Practically every medicinal agent likel}^
to be of any benefit has been tried in the treatment of this condition.
After extensive observations of this disease, instructions in the fonn
of a circular letter (Xo. 29) were issued to all veterinary officers
relative to the prevention and treatment of gangrenous dermatitis.
It is essential that clean, dry standings be provided for animals un-
der treatment. Prevention of the disease is of prime importance,
especially in view of the difficulty of treating it successfully. At
some of the remounts the standings about the feed racks and water
tj-oughs have been built up and graded, dry standings provided on
picket lines and in open sheds, and proper attention paid to drainage
of corrals. In some instances it was impossible to provide adequate
VETERIXAKY. 1229
drainage and improve sanitary conditions to a satisfactory degree
owing to soil conditions incident to the location of the depots and
tlieir abandonment proved to be the only solution.
Eecent preliminarj' investigations have been made b}' Capt. E. A.
Kelser, Veterinarj' Corps, at the Philadelphia laboratory', into the
effect of acetic acid on the B. necrophorus. Tissue specimens which
had been treated with acetic acid (strong vinegar) and which were
Iniown to contain the organism (demonstrated in large numbers by
microscopic examination) were tested for virulency with the follow-
ing results : The organism could not be recovered culturally nor was
it possible to infect rabbits through inoculation. This demonstrated
that the organism had been killed or attenuated to such a degree that
it was incapable of gi^owth on artificial culture media and was a
virulent for rabbits. Yeterinar}' officers at stations where the disease
is most prevalent have been instructed to treat it with acetic acid in
different strengths and report the results of their observations with
conclusions as to its value as compared with other agents. Further
investigation is being carried on at all the veterinary laboratories to
determine whether or not biologic agents, of value for producing
immunity to the disease or of value in its treatment, can be produced.
MANGE.
Of the three varieties of mange parasites which affect horses and
mules, one only (sarcoptus scabei equus) has been demonstrated
amongst Army animals in the United States. Seven cases of sar-
coptic mange were reported and verified by qualified laboratory ex-
perts. One case was reported at the auxiliary remount depot, Camp
Sherman, Ohio, in July, 1918, four cases at auxiliary remount depot.
Camp Hancock, Ga., and two cases in organizations at Camp Han-
cock, Ga. In each case quarantine was established, animals showing
any skin lesions were placed in isolation, and all animals v»ere dipped
in an arsenical solution. Stable areas occupied by suspected animals
and equipment used by them were thoroughly disinfected. Twenty-
eight animals were reported as suspects, but proved to be negative
on laboratory examination. Mange suspects are commonly reported,
but no positive diagnosis is accepted without laboratory verification.
Sarcoptic mange was of extreme importance in the American Ex-
peditionary Forces in the field owing to the rapidity of its spread and
the great difficulty of eradicating it. There were 15.121 cases actu-
ally reported for the period ending December 31, 1918, and many
more undoubtedly occurred. The intense itching caused by the para-
site results in rapid loss of flesh and emaciation. To combat the
great loss in flesh and strength, extra rations are necessary ; these arc
difficult to obtain in the field where it is frequently impossible to
obtain even the normal ration. The efficiency of mounted organiza-
tions was seriously hampered \ry this disease.
The most convenient and efficacious method of treatment consists
of clipping the animals and dipping them at regular intervals to-
gether with frequent and thorough groomings. Special dipping
vats with heating plant, draining pens, etc.. and means for the treat-
ment of infected blankets and other equipment must be provided.
It is difficult if not impossible to supply these requirements at or
r.ear the front, hence it is essential that affected animals be sent to
the rear for proper treatment. Sprayers were found to give efficient
1230 REPORT OF THE SURGEON GENERAL OF THE ARMY.
service at some of the hospitals not equipped with dipping vats and
were used until the vats were installed.
In order that the evacuation of mangy animals may be permitted,
it is necessary that a large number of remounts be available. The
lack of available remounts was frequently the cause for retention of
animals in organizations and their treatment b}^ the application of
antiparasitic solutions by hand usually with indifferent results. One
of the difficulties met in' combating the spread of mange was that of
impressing upon officers and men the importance of thorough groom-
ing as a preventive measure. All parasitic diseases are favored by
dirt and inattention to hygiene. Absence of proper care of animals
was in general a very noticeable defect, probably due to general lack
of interest in the horse in this age of motors. This defect w^as re-
sponsible for greatly reduced efficiency in mounted organizations.
THRUSH
NON-EFFECTIVe RATE BY WEEKS
300
275
Z50
225
200
175
ISO
125
100
75
50
25
19
8
r
lun
*
') ^
RATIO PER 1000
^
<.
/
\
/
r\
\
1
\
/
\
^
k
/
\
/
/
y
y
\X 19 26 Z
JULY
9 16 23 30
AUG.
6 13 20 IT 4
SEPT.
Fig. 150.
II 18 25
OCT.
8 IS Vt. 29 6 13 20 27
NOV. DEC.
DOURINE.
Xo cases of this disease have been reported, but its great importance
both to Army and civilian animals has not been overlooked. Being
transmitted by coitus, it is a disease which is of prime importance
to the breeding operations at remount depots. It has been reported in
10 States, but is most prevalent in the western range country.
The most satisfactory method of detecting dourine in its incipient
stages, during which apparently well animals may transmit the dis-
ease, consists in subjecting the blood to the complement-fixation and
agglutination tests. As Government breeding stations are main-
tained in the West at remount depots at Forts Keogh, Mont., and
El Eeno, Okla., in.structions have been issued requiring all Govern-
ment-owned stallions and mares, also private mares presented for
service to a Government stallion, to pass a negative blood test before
service. An exception to this rule was made in the case of the depot
at Front Royal, Va. As the disease has never been rei)orted in
VETERINARY.
1231
Virfrinia, animals which have been raised and practically maintained
in the State need not be tested.
SCRATCHES
NOM-EFFECTIVE RATE BY WEEKS
HORSES AND MULES, UNITtO STATES
300
Z75
250
225
200
175
150
125
100
75
50
25
19
R
"
' 5 "
RATIO PER 1000
\
k,
y
\
/
—
' — i
\
\
^
^
/
\
\
^
—
■^
\
/
-—
\
^
L
IZ 19 26 Z
JULY
9 16 23 30
AUO.
13 20 27 4
SEPT.
Fig. 151.
II 18 25 I
OCT.
8 IS 22 29 C
NOV.
13 20 2T
DEC.
ULCERATIVE LYMPHANGITIS.
No cases of this disease were reported in this country. The disease
was reported in the American Expeditionary Forces as quite preva-
PICKED-UP NAIL
NON-EFFECTIVE RATE BY WEEKS
300
275
250
225
200
175
150
125
100
75
50
25
ia.8
HORSES
AND MULES
,w
NIT
CO
STATES
RATIO
PER 1000
/
"~"
X
^^
, ^
^
^
/
y
\
. —
/
/
1
,
^
1
12 10 26 Z
JULY
9 IS 23 30 6
AUG-.
13 20 27 4 II 18 2S
SEPT. OCT.
Fig. 152.
8 IS 22 29 6 13 20 27
NOV. DEC .
lent in certain localities and occasioned extensive losses. Treatment
was not very satisfactory under field conditions. The infection
spreads rapidly through the tissues, producing multiple abscesses and
1232 REPORT OF THE SURGEON GENERAL OF THE ARMY.
ulcei-s. Septicaemia frequently develops, and animals are usually
destroyed as incurable -when the disease becomes well established.
EPIZOOTIC LYMPHANGITIS.
Xo cases of this disease have been reported in the United States,
and only a small number of cases were reported in the American Ex-
peditionary Forces. This disease is amenable to treatment if dis-
covered early, while the lesions are strictly localized, but when
disseminated throughout the body treatment is useless and the
animal is usually destroyed to prevent spread of the infection.
ANTHRAX.
No cases of this disease have been reported among Army animals
in the United States, although the disease is common.
In the American Expeditionary Forces an outbreak occurred at the
third Army remount clepot at Wengerohr, Germany. Clinical diag-
nosis was confirmed by positive laboratory findings. The disease was
of the acute type and in the majority of cases (7) caused death in
24 hours or less, 70 hours being the longest time an infected animal
lived. As soon as the positive laboratory report was received imme-
diate steps were taken for vaccination of all animals (10,000) in the
remount, consisting of the injection of Pasteur vaccine (double),
repeated in 10 days. Xo further losses occurred.
10, Animal Morbidity and Mortality.
animal strength.
In the earlier period of the organization of the Veterinary Corps
the animal strength was obtained through weekly telegraphic reports
sent from the auxiliary remount depots, remount depots and animal
embarkation depots. Although these depots contained the great ma-
jority of the animals, there were, nevertheless, numerous animals in
other organizations, not included in the reports, so that the complete
animal strength of the Army in the United States is not available
for the first few months of 1918; nor did the telegraphic reports
differentiate as to the relative number of horses and mules. Based
upon the telegraphic reports, the average animal strength at the
camps, including the auxiliary remount and embarkation depots and
remount depots, was 269,701 horses and mules for the first 6 months,
January-June, inclusive. This is approximately 30,000 under the
actual strength.
Although weekly returns Avere received on Form 102 as early as
February, the receipt of the returns was partial and incomplete until
some months later. It was found that while Form 102 gave some use-
ful information, it lacked much that was desired for statistical pur-
poses and it was superseded by a revised form which was put into
operation in the month of August.
The complete average animal strength for the Army in the United
States, based upon the revised Form 102 for the second 6 months'
period, July-December, inclusive, was 292,862, of which 173,708 were
horses and 119,151 were mules, giving a horse strength of .59.32 per
VETEEINAKY. 1233
cent and a mule strength of 40.68 per cent, an approximate ratio of
nearly 3 hoi*ses for every 2 mules or, more precisely, there Tvere 45.78
per cent more horses than mules in the Army. The average animal
strength for the year 1918, based on the two 6 months periods, of
which the first period is incomplete, was 281,281 horses and mules.
The average of 292.862 for the July-December period is more repre-
sentative of the real conditions, and this is doubtless somewhat under
the true average for the whole year.
ADMISSIONS.
An animal is admitted to sick report when considered unservice-
able for duty because of disease or injury. The admission rate is
determined on the per thousand basis. The annual admission rate
is obtained by determining the average weekly rate and multiplying
it by the 52 weeks of the year. Based upon the six months period,
July-December, the annual admission rate for the United States for
all causes was 856.96 per thousand. The total admissions for the
same period irrespective of the proportion of horses and mules,
showed that 126.73 per cent more horses than mules were admitted
to sick report. Considering the admission rate for horses in the
horse group and the admission rate for mules in the mule group inde-
pendently, there was an annual admission rate of 1.002.04 for every
1,000 horses and an annual admission rate of 644.28 for every 1,000
mules. Although the horse strength exceeded the mule strength by
45.78 per cent, the annual admission rate among the horses was 55.53
per cent greater than among the mules, showing that the admission
rate for horses was even greater than might be expected from the
difference in the number of animals in the two groups.
XONEFFECTIVES.
An animal remaining under treatment at the time a weekly report
is submitted is considered a noneffective. As in the case of the ani-
mal strength, the report of the noneffectives for the January-June
period is based upon the telegraphic reports from the camps, includ-
ing the auxiliary remount and embarkation depots and remount de-
pots, which, included with the reports on Form 102 for the July-
December period for all the Army animals, show an average non-
effective rate of 51.96 per 1,000. Based upon the Juh—December
period, the total noneffectives carried along on sick report, irrespec-
tive of the proportion of horses and mules, showed 127.67 per cent
more horses than mules. Considering the noneffective horses in the
horse group and the noneffective mules in the mule group separately,
there was an average of 50.37 noneffectives among every 1,000 horses
and 32.25 noneffectives among eveiy 1,000 mules. Allowing for the
difference in the number of horses and mules, as in the case of the
admission rate, the average rate of noneffectives among the horses
exceeded that of the mules by 56.18 per cent.
DEATH RATE.
The death rate includes animals which died or were destroyed for
various reasons. Based upon the telegraphic reports and Form 102,
1234 REPORT OF THE SURGEON GENERAL OF THE ARMY.
the total number of deaths was 15,065, giving an annual death rate of
53.56 per 1.000. Based upon the July-December period, the total
number of deaths, irrespective of the proportion of horses and mules,
showed 125.32 per cent more deaths among the horses than the mules.
Considering the death rate for horses in the hoi^e group and the
death rate for mules in the mule group separately, there was an
annual death rate of 45.76 for every 1,000 horses, and an annual death
rate of 28.60 for every 1.000 mules. Again allowing for the cliflfer-
ence in the number of horses and mules, the annual death rate among
the horses exceeded that of the mules by 60 per cent.
It is worthy of note that there is a consistently higher rate of
more than 50 per cent among the horses for admissions, noneflfectives,
and deaths than among the mules.
OTHERWISE DISPOSED OF.
The animals designated as " Otherwise disposed of " were those
which had been inspected and condemned as unfit for further use in
the service. Such animals were usually, but not always, upon sick
report, and. although susceptible in many cases to restoration to
health, there were defects or economic reasons which made their sale
desirable. Since these animals were lost to the service, they shoidd
be considered with the death rate in estimating the total loss to the
Army. During the July-December period there were 1,651 animals
thus disposed of, of which 1,240 were horses and 411 were mules.
Based upon this period, the total number of animals, irrespective of
the proportion of horses and mules, showed that 201.70 per cent more
horses than mules were thus disposed of. The rate of disposal for
horses in the horse gi'oup and the rate of disposal for mules in the
mule group separatelv showed that the annual rate for horses
was 14.04 per 1,000 and that for mules 6.76 per 1,000. With due
allowance for the difference in the number of horses and mules there
was an annual rate of disposal for horses 107.69' per cent greater
than that for mules.
RETURNED TO DUTY.
The animals returned to duty represent those on sick report which
had sufficiently recovered from the disease or injury to be consid-
ered! serviceable. The number of recovered or cured animals was
obtained by deducting from the numbeu admitted to sick report
the number of deaths and animals otherwise disposed of. On this
basis for the July-December period it was found that out of every
1,000 admissions 939.84 animals were returned to duty. In the
horse group there were 938.84 recoveries for every 1,000 of admis-
sions, and in the mule group 942.09( for every 1,000, showing but
slight difference in this respect in the two groups of animals.
RELATION OF ANIMALS ON SICK REPORT TO DEATH RATE.
Although the reports show a greater sick and death rate among
horses than mules among effective animals, the relation of the non-
effective animals to the death rate is of interest in connection with
the separate horse and mule groups. Based upon the July-Decem-
VETERINAKY.
1235
Otherwise disposed of : Per 1,000.
Horses 5.45
Mules 4.11
ber period, the following table indicates the proportion of deaths
and animals disposed of among the noneffective horses and mules :
Died : Per 1,000.
Horses 6.02
Mules 6.47
Destroyed :
Horses 11.62
Mules 10.96
The figures for horses and mules show but slight differences and
indicate that the mule once influenced by disease or injury is quite
as likel}' to succumb as the horse. The data relative to effective
animals in connection with their admission, noneffective, and death
rates, however, indicate that the mule is much more resistant tlian
the horse to the ordinary ravages of disease.
THE AMERICAN EXPEDITIONARY FORCES IN FRANCE.
Although the monthly reports were made for August and Septem-
ber, 1918, they were found to be unsatisfactory for comparison with
the weekly returns on Form 102 used in this country. In October
weekly returns were forwarded by the chief veterinarian of the
American Expeditionary Forces in France, and these for the three-
month period, October-December, have been used for comparison
with the data obtained in the United States. This period is about
equally divided by the armistice into two portions, one of which was
associated with the activities of actual campaign and the other with
a gradual adjustment of veterinary affaii's to a quiescent basis ap-
proximating peace conditions. In the returns from the American
Expeditionary Forces in France no differentiation was made between
the horses and mules, the totals only being given. The following
table is based upon the data for the three months, October-December
period, for the American Expeditionary Forces in France and for
the six months, July-December period, for the United States :
United
States,
6 months,
July-
December.
A. E. F.,
France,
3 months,
October-
December.
Average animal strength
Noneffectives, average rate per 1,000
Admissions, annual rate per 1,000
Deaths, annual rate per 1,000
otherwise disposed of, annual rate per 1,000
292,862
43.01
856.96
40.56
11.44
176, 973
151.24
3,050.72
282. 36
113. 36
THE AMERICAN EXPEDITIONARY FORCES IN SIBERIA.
Weekly returns on Form 102 were not made out until December,
and only one month is therefore available for comparison with the
data obtained from the other branches of the veterinary service for
the year 1918. The data for a single month is not a fair criterion,
because the report deals with animals which have been subjected to
a long voyage, were unacclimated, and more subject to disease and
injury. As a matter of fact, all of the deaths and 58 per cent of the
a(hnissions occurred in the first week of the month and during the
142367— 19— VOL 2 17
1236 REPORT OF THE SURGEON GENERAL OF THE ARMY.
same week 3(5 per cent of the total admissions were dropped from sick
report. Subsequent reports may bo expected to show much better
averages for admission, noneffective, and death rates. The statistics
for the month of December are arranged in the following table :
AvenifTO total uniiual strength ^ 1,014
Horses 277
Mules '737
Total noneffectives, average rate per thousand _ 14.05
Horses 18- 05
Mules 12. 55
Total admissions, annual rate per thousand 973. 9G
Horses 1, 079. 00
Mules 934.44
Total deaths, annual rate per thousand 63.90
Horses 46. 80
•Mules 70. 72
No animals were " otherwise disposed of."
Although the brief period covered renders the data unsatisfactory
in various ways, it is of interest to note that while the mules out-
number the horses nearly 3 to 1, there are per thousand of each group
n\ore admissions and noneffectives among the horses than the mules.
COMPARATTVE STATISTICS.
Through the courtesy of the British War Office, statistics of the
British veterinary service were obtained for the first and last years
of the war, 19M and 1918, respectively. The statistics include all
theaters of operations (France. Italy, Salonika, Egypt, Palestine,
and Mesopotamia), also commands in the United Kingdom. The
statistics for the United States for the July-December period and
the American Expeditionary Forces in France for the October-
December period are included in the table and the data reduced to a
percentage basis for more ready comparison with that of the British.
British.
1918
France,
A. E. F.,
October-
December.
Tnited
States .
July-
December.
.\verage total daily sick (per cent of strenirth i
,\11 admissions (per annum per cent of strength)
Mortality from all causes (per annum per cent cfstrength)...
Cured ( per cent of admission )
I ied or destroyed (per cent of admission)
Cast and sold for farm work (per cent of admission)
Sold to butchers (per cent of admission)
21.00
120.00
27.00
75. 00
18.00
7.00
9.45
70.00
18.00
74.00
4.00
4.00
18.00
15.12
305. 76
28.08
87.12
9.16
13.72
4.30
85.28
4.05
93.98
4.70
11.32
' Otherwise disposed of.
CAUSE OF DEATH.
In considering the death rate, emphasis should be placed upon the
fact that it includes animals which v.ere destroyed as well as those
that died. In the United States the proportion was approximately
60 per cent destroyed to 40 per cent that died. In the American
Expeditionary Forces, France, more animals were reported died than
destroyed. Among the animals destroyed a number of causes were
VETEKINAEY.
1237
reported which of themselves were not fatal, but which caused such a
degree of disability as to render the animal unserviceable, and for
economic or other sufficient reasons it was deemed proper to take the
life of the animal.
In the United States the diagnoses associated with the death of
the animal are given in detail and cover the July-December period.
In the American Expeditionary Forces, France, the diagnoses are
grouped under general headings and cover the August-December
period. The percentage for each diagnosis or group have been based
upon the total number of deaths.
Died and destroyed, United States, 6 months, Jiily-Decemher, 1918.
[Percentage ratio of each group to the total number of deaths.]
Glanders
Injuries '
Other diseases i
Dermatitis (gangrenosa)
Pneumonia
Fractures
Colic
Wounds, contused
Septicemia
Wounds, penetrating
Thrush
Wounds, lacerated
Miscellaneous 2
Influenza
Picked up nail
Impaction, intestinal
Intestinal toxemia and acute indigestion
Pododennatitis
Quittor
Fistula, withers
Enteritis
Exhaust ion
Malnutrition
Accident
Open joint
Useless, destroyed
Hemorrhage
Laminitis
Undiagnosed
Arthritis
Azoturia
Incoordination (paralysis)
Abscess
Tetanus
Found dead
Synovitis
Peritonitis
Strangles
Canker
Anemia
Bum (rope)
Meningitis
Periodic ophthalmia
Pericarditis
Total
Number
of cases.
1,695
424
378
370
313
233
223
164
158
142
136
124
121
110
110
109
98
77
77
71
71
69
63
60
51
43
40
39
39
37
31
31
24
22
21
21
18
15
15
12
11
11
11
10
Per cent
of total.
28.74
7.19
6.41
6.27
5.31
3.95
3.78
2.78
2.68
2.41
2.31
2.10
2.03
1.86
1.86
1.85
1.66
1.31
1.31
1.20
1.20
1.17
1.07
1.02
.86
.73
.68
.66
.66
.63
.53
.53
.41
.37
.36
.36
.31
.25
.25
.20
.19
.19
.19
.17
100.00
1 "Injuries" and "Other diseases" were xmclassified on old Form 102.
s In the mLscellaneous group the mmiber of deaths for any one cause is less than 10. The miscellaneous
causes given for the deaths or destruction of the animals are as follows: Fistula, poll (7); rupture, dia-
phragm (5); ascites (1): conjunctivitis (1): gonitis (7): heaves (5); infection (4); laryngeal hemiplegia (5);
myocarditis (6): purpura hemorrhagica (9); rheumatism (1): ringbone (8): spavin (4); sprain (5); ten-
dinitis (8); treads (2); pleurisy (8); lymphangitis (6); nephritis (4): navicular disease (8); luxation (2)'
poisoning (3); tumor, malignant (8); rupture, esophagus (3); periostitis (1).
1238 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Died and destroyed in the American Expeditionary Forces in France, 5 months,
Angust-Deccmbcr, 1918.
[Percentage ratio of each group to the total number of deaths.]
Injuries
General
Rcspiratorv
Skin "-
Specific
Digestive..
Locomotor.
Ner%-ous . . .
Lymphatic.
Circulatory.
Generative.
Urinary
Visual."
Total.
Number Per cent
of cases, of total.
6,419
3,249
2,966
2,037
1,622
538
219
112
47
43
40
37.10
18.78
17.14
11.77
9.37
3.11
1.27
.65
.27
.25
.23
.04
.02
100.00
SPECIAL DISEASES.
From the large list of diseases reported weekly on Form 102, 10
have been selected which include the frequent communicable and
which, with others, because of their prevalence or leading character,
have a special interest. These diseases are arranged in the following
table, according to the order of their prevalence, on the basis of the
average rate per thousand, Army strength, of the noneffectives. The
data covers the July-December period:
Noneffective rate per 1,000.
Thrush 4. 04
Dermatitis gangrenosa^ 2.52
Picked up nail 1.90
Scratches 1.35
Influenza * . 95
Pododermatitis . 89
Strangles ' . 34
Glanders ' , 20
Pneumonia (all kinds) .19
Colic (not including saijd colic) .18
The diseases are arranged in the following table by actual numbers
representing the totals tor horses and mules for admission, death,
and otherwise disposed of. The tables for individual camps are ar-
ranged on a similar plan and may readily be compared with the total
fisrures of this table.
' Communicable. Cases of glanders arc not considered as noneffective in the ordinary
sense, as they are destroyed promptly after a positive mallein test. Glanders is in-
cluded as a communicable disease, and the figures in the table are based upon the
death rate.
VETERINAKY.
1239
As an example of a condition quite easily preventable, but which
contributes largely to the noneffective rate, picked up nail has been
included. The toll it exacts is indicated by the position of second
place in the list:
Admission.
Horses.
Mules.
Died or destroyed.
Horses.
Mules.
Otherwise disposed
of.
Horses.
Mules.
1. Thrush
2. Picked up nail
3. Dermatitis gangrenosa
4. Scratches
5. Influenza
6. Colic
7. Glanders
8. Pododermatitis
9. Strangles
10. Pneumonia
8,252
3,444
2,993
2,314
2,023
2,074
1,700
1,225
756
397
3,903
1,981
1,216
797
514
375
482
136
346
93
64
111
13
89
97
1,700
40
10
163
57
38
113
10
18
32
20
8
106
34
11. Incidence Of Special Disease At the Larger Camps.
The largest assemblies of animals in the United States -were at the
auxiliaiy remount depots, one of which was located at each divisional
cantonment and served as an animal supply depot for the division
and camp. Considerable numbers were also collected at the pemia-
nent remount depots and the animal embarkation depots.
The following tables show the admissions, deaths, and otherwise
disposed of in absolute numbers of 10 special diseases at these camps.
In each case the figures are based on total animals in camp and
depot for the period. July-December, 1918. For purposes of com-
parison, the average animal strength for hoi-ses and mules sepa-
ratly is shown under each camp.
The only previous statistics concerning these organizations cov-
ered but a relatively short period of the year 1917. For comparison
the figures obtained for that period are arranged in the following
table with those obtained for all of the Army animals for the year
1918:
Noneflectives, average rate per 1,000.
Deaths, annual rate per 1,000
51.96
53.56
During 1918 there were 39 auxiliary remount depots, remount
depots, and animal embarkation depots. Of these, 16 were located
west and 23 east of the Mississippi River. Considering these sta-
tions from the standpoint of their average noneffectives as com-
pared with the average rate per thousand for all of the stations, there
were, west of the Mississippi, 10 better and 6 worse than the standard
average. Of the 23 stations east of the Mississippi, 9 were better and
14 woi*se than the average. The greater number of camps with un-
satisfactory averages were located in the Southeastern States. If the
region east of the Mississippi Avere divided into northern and south-
ern portions by a line coincident with the northern boundaries of
the States of Tennessee and North Carolina, there would be found
1240 REPORT OF THE SURGEON GENERAL OF THE ARMY.
in the northern portion 5 camps better and 6 camps worse than the
average, and in the southern portion 4 camps better and 8 camps
worse tlian the average.
The reasons for the poorer averages at the camps in the eastern
and southeastern regions may be due to several factors. Relatively
many of the animals Avere received from distant areas; they were un-
seasoned and unacclimated. and in this condition were subjected to
the rigors of an unusually severe winter. In these camps also there
was a great prevalence of disorders affecting the foot and lower limb,
such as dermatitis gangrenosa, thrush, scratches, and pododermatitis.
It is not intended t<) convey the impression that, in all cases, the poor
average was due to the presence of dermatitis gangrenosa, although
in many instances its victims remained upon sick report for a con-
siderable time ; but it is interesting to note that in those camps hay-
ing better averages there was, for the most part, no report of this
disease or of but few cases. The lack of dry standings, by means of
which the numerous foot and limb disorders might easily be pre-
vented, is undoubtedly one of the most, if not the most, important
factor in causing and keeping an unnecessarily high rate of noneffec-
tive animals.
CAMP DEVENS, MASS.
Average strength: Horses, 4,095; mules, 3,12'
Admissions.
Died or destroyed. ' Otherwise disposed
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
Thrush
864
25
1
52
81
47
2
27
1
24
352
29
4
3
12
5
22
37
2
1
1
1
2
3
Colic
2
8
2
3
11
4
1
CAMP UPTON, N.Y.
Average strength: Horses, 1,823; mules, 2,465.
Thrush
Picked up nail
Scratches
Influenza
Colic
Glanders
Pododermatitis
Pneumonia (all kinds) .
CAMP DIX, N.J.
Average strength: Horses, 2,850; mules, 3,002.
Thrush
Picked up nail
Dermatitis gangrenosa
Scratches
Influenza
Colic
Glanders
Pododormutitis
Strani;les
Pneumonia (all kinds)
268
144
24
84
5
4
6
1
2
3
197
1
1
15
100
1
92
12
16
2
3
1
1
3
3
4
30
16
71
> Animals lost to the Army by sale after being inspected.
VETERINAKY.
1241
CAMP MEADE, MD.
Average strength: Horses, 4,122; mules, 3,lo2.
Admissions. Died or destroyed. Otherwise disposed
Horses.
Mules. Horses. Mules, i Horses.
Mules.
Thrash
Picked up nail
Dermatitis gangrenosa
Scratches
Influenza
Colic
Strangles
Pneumonia (all kinds)
519
146
74
49
7
41
120
71
9
4
38
13
74
4
5
1
CAMP LEE, VA.
Average strength: Horses, 3,232; mules, 3,032.
Thrush
Picked up nail
Dermatitis gangrenosa
Scratches
Influenza
Colic
Pododermatitis
Strangles
Pneumonia (all kinds)
336
172
46
ai
43
51
179
76
139
6
79
11
10
8
25
4
10
8
CAMP GREEN, N. C.
Average strength: Horses, 4,206; mules, 2,779.
Thrush
Picked up nail
Dermititis gangrenosa.
Scratches
Influenza
Colic
Glanders
Pododerm ititis
Pneumonia (all kinds)
CAMP WADSWORTH, S. C.
Average strength: Horses, 5,583; mules, 3,490.
Thrush
309
87
101
238
2
47
92
159
1
5
151
38
10
70
2
1
I
92
17
3'
10
3
2
1
2
1
i9
IC
97
1
3
1
16
10
3'
Glanders
Strangles
Pneumonia (all kinds)
CAMP. HANCOCK, GA.
Average strength : Horses, 2,741; mules, 1,836.
Thrash
Picked up nail
Dermatitis gangrenosa .
Scratches
Influenza
CoUc
PododermatitLs
Strangles
Pneumonia (all kinds) .
238
36
43
6
493
167
11
2
899
33
3
1
11
1
9
1
5
1
25
1242 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
CAMP McCLELLAN, ALA.
Average strength: Horses, 4,744; mules, 2,921.
Admissions.
Died or destroyed.
Otherwise disposed
of.
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
Thrush
396
111
77
109
27
22
116
52
8
15
107
2
1
4
15
3
1
Picked up nail
2
5
Dermal itis gangrenosa
1
2
Scratches
Influenza
3
CoUc
2
Glanders . . . .
12
12
Straniles
1
4
Pneumonia (all kinds)
3
3 2
CAMP SEVIER, S. C.
Average strength: Horses, 4,098; mules, 3,454.
Thrush
305
66
131
158
3
33
23
1
7
139
36
45
14
11
2
1
1
1
2
23
7
1
1
Picked U'^ nail
Scratches
Influenza
CoUc
5
6
1
6
Olaniers
Pocio iermatitis. . .
Pneumonia (all kinds)
3
CAMP WHEELER, GA.
Average strength: Horses, 4,583; mules, 2,723.
Thrush
340
66
13
3
138
6
21
3
5
122
43
2
6
5
5
3
Picked up nail
Scratches. .
Colic .
10
1
5
5
6
1
Glanders . . ...
1
1
Podo iermatitis
Strangles
1
3
CAMP SHERIDAN, ALA.
Average strength: Horses, 3.489; mules, 2,578.
Thrush
301
69
2
118
64
59
3
38
1
5
2
2
1
1
Picked up nail
Scratches
3
4
Influenza . . . .
CoUc
96
3
22
6
3
1
Glanders
CAMP SHELBY, MISS.
Average strength: Horses, 5,403; mules, 3,567.
Thrush
397
2
114
115
8
135
89
155
3
2
54
65
1
9
12
1
2
1
CoUc
9
89
1
12
4
1
VETERINAEY.
1243
CAMP BEAUREGARD, LA.
Average strength: Horses, 3,168; mules, 3,286.
Admissions.
Died or destroyed.
Otherwise disposed
of.
Horses.
Mules.
Horses.
Mules.
Horses. ; Mules.
Thrash
436
52
597
81
118
12
77
2
1
229
40
140
16
19
3
10
6
4
1
1
1
1
77
2
1
Colic
1
10
1
1
1
1
i
CAMP JACKSOX, S. C.
Average strength: Horses, 5,684; mules, 3,066.
Thrush
208
85
13
21
9
156
108
4
6
52
36
5
2
2
17
71
5
1
1
4
1
2
1
2
1
1
4
108
Colic
2
71
3
1
CAMP GORDON, GA.
Average strength: Horses, 1,583; mules, 3,728.
Thrush
PicVed-up nail
Dermatitis gangrenosa
Scratches
Influenza
Colic
Glanders
Pododermatitis
Pneumonia (all kinds)
152
26
3
67
12
9
26
23
10
139
43
16
16
8
6
21
24
18
6
CAMP PIKE, ARK.
Average strength: Horses, 2,383; mules, 3,644.
Thrush
PicVed-up nail
Scratches
Influenza
Colic
Glanders
Pododermatitis
Pneumonia (all kinds)
103
55
5
55
5
5
4
30
CAMP SHERMAX, OHIO.
Average strength: Horses, 3,897: mules, 3,350.
Thnish . . ...
13
159
270
12
48
5
10
71
16
5
20
41
115
4
7
3
1
24
1
2
5
11
3
4
1
2
2
io'
Colic
1
1
Straii'-'les
4*
1
1244 Heport of the surgeok generai. of the army,
CAMP TAYLOR, KY.
Average strength: Horses, 3,367; mules, 2,665.
Admissions.
Died or destroyed.
Otherwise disposed
of.
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
Thrush
125
104
14
24
2
5
11
4
6
so
120
1
13
3
1
2
3
1
Colic
1
11
1
2
4
CAMP CUSTER, MICH.
Average strength: Horses, 3,458; mules, 3,078.
Thrush
69
106
52
71
1
3
2
Dermatitis i;an°;renosa
20
2
80
43
29
5
10
5
7
22
15
9
Colic
1
43
2
i
22
Pneumonia (all kinds)
3
CAMP GRANT, ILL.
Average strength: Horses, 3,308; mules, 2,951.
Thrush
189
77
2
49
26
11
24
15
105
67
1
18
6
2
2
6
1
1
Picked up naU
Dermatitis gangrenosa
1
Scratches ,
Influenza
Colic
2
24
1
Glanders
2
Pododermatitis
Pneumonia (all kinds)
CAMP DODGE, IOWA.
Average strength: Horses, 3,625; mules, 3,058.
Thrush
115
95
28
15
15
1
5
1
1
2
104
97
17
21
8
2
7
5
1
Picked up nail
Dermatitis gangrenosa
Scratches
1 • 4
3 1 2
1
1
Influenza
1
Colic
Glanders
5
Pododermatitis
Strangles
2
Pneumonia (all kinds)
1
CAMP FUNSTON, KANS.
Average strength: Horses, 4,235; mules, 3,6
Thrush
69
66
16
24
14
1
2
6
7
63
76
7
'I
i
Picked up nail
Scratches
1 ! 2
1
1
Influenza
2
Colic
1
Glanders
1
Pododermatitis
1
2
3
Strangles
1
Pneumonia (all kinds)
VETEEINARY.
1245
CAMP HUcARTHUR, TEX.
Average strength: Horses, 3,687; mules, 3,442.
Admissions.
Died or destroy ed.
Otherwise disposed
of.
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
Thrush . .
137
171
3
3
1
7
43
12
7
27
68
4
1
Picked up nail
1
i
1
1
CoUc
2
10
7
1
2
1
!
Pneumonia (all kinds)
i
4
1
1
CAMP LOGAN, TEX.
Average strength: Horses, 2,936; mules, 3,819.
Thrush
Picked up nail
Dermatitis gangrenosa .
Scratches ,
Influenza
Colic
Strangles ,
Pneumonia (all kinds) .
200
212
04
44
197
123
39
15
50
10
5
0
37
2
17
7
CAMP CODY, N. MEX.
.\.verage strength: Horses, 4,782; mules, 3,328.
Picked up nail
Influenza
CoUc
Glanders
Pododermatitis
Strangles
Pneumonia (all kinds) .
76
FORT SILL, OKLA.
Average strength: Horses, 0,2&8; mules, 2,5S3.
Thrush
Picked up nail ,
Dermatitis gangrenosa.
Scratches ,
Influenza
CoUc
Glanders
Pododermatitis
119
116
46
17
12
22
277
13
2
277
CAMP BOWIE, TEX.
Average strength: Horses, 4,405; mules, 3,256.
Thrush
Picked up nail
Dermatitis gangrenosa .
Scratches
Influenza ,
CoUc
Glanders
Pododermatitis ,
Strangles ,
Pneumonia (all kinds) .
171
39
2
146
61
16
84
1
2
11
128
42
1
0
52
3
1246 REPORT OF THE SURGEON GENERAL OF THE ARMY.
CAMP TRAVIS, TEX.
Average strength: Horses, 12,672; mules, 4,385.
Admi
ssions.
Died or destroyed.
Otherwise disposed
of.
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
582
366
60
102
26
40
37
2
8
153
132
26
5
5
1
4
8
Picked up nail
2
3
1
40
Colic ...
1
1
Strangles
1
3
2
CAMP KEARNY, CALIF.
Average strength: Horses, 4,809; mules, 3,246.
Thrush
87
52
4
3
57
6
6
3
6
21
14
3
4
6
1
Colic
5
6
Podndprmf^titis
1
I^neumonia (all kinds)
3
4
1
CAMP LEWIS, WASH.
Average strength: Horses, 3,631; mules, 3,214.
Thrush
38
129
6
119
16
24
23
2
19
2
3.-,
105
2
46
6
3
3
PicVedupnail
1
1
Dermatitis gangrenosa
Scratches T
2
2
1
1
3
Colic
Glanders
23
Pododermatitis
2
Pneumonia (all kinds)..
CAMP FREMOXT, CALIF.
Average strength: Horses, 2,613; mules, 1,785.
Thrush
27
43
8
37
24
22
1
1
0
26
48
9
18
8
21
Picked up nail
1
Scratches
Influenza
CoUc
3
22
Glanders
21
Pododermatitis
Strangles
2
3
1
1
Pneumonia (all kinds)
2
■•■"
CAMP JOHNSTON, FLA.
Average strength: Horses, 2,343; mules, 1,292.
Thrush
86
33
346
3
2
185
1
3
1
11
22
40
8
1
1
10
Picl ed UP nail
1
Dermatitis gans'renosa
Scratches
Influenza
i
4
Colic
10
Pododermatitis
Strantrles
Pneumonia (all kinds)
VETEKINAKY.
1247
REMOUNT DEPOT, FRONT ROYAL, VA.
Average strength: Horses, 902; mules, 27.
Admissions.
Died or destroyed.
Otherwise disposed
of.
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
Thrush
4
1
Picked up nail
6
1
l: . :::
2
1
Scratches
6
101
Influenza
2
1
1
2
Colic
11 1
36 2
1
Pneumonia (all kinds)
6
1
REMOUNT DEPOT, FORT KEOGH, MONT.
Average strength: Horses, 2,034; mules, 41.
7
4
27
11
14
89
11
14
2
Colic
Glanders
Strangles
REMOUNT DEPOT, FORT RENO, OKLA.
Average strength: Horses, 1,337; miiles, 73.
Thrush
3
7
9
2
119
1
1
4
Picked up nail
Colic
Glanders. .
2
Strangles
67
1
Pneumonia (all kinds)
FORT BLISS, TEX.
Average strength: Horses, 9,190; mules, 2,362.
Thrush
116
170
1
67
14
302
8
52
47
1
1
7
1
1
3
1
Picked up nail
Influenza
Colic
Glanders
14
9
1
7
Pododermatitis
Pneumonia (all kinds)
2
ANIMAL EMBARKATION DEPOT, NEWPORT NEWS, VA.
Average strength: Horses, 4,599; mules, 3,759.
Thrush
146
68
2S6
122
28
71
112
268
10
9
110
35
220
39
26
19
50
191
2
16
1
Picked up nail
Dermatitis gangrenosa
7
Scratches
1
6
112
2
Colic
6
50
3
1
11
Glanders
Pododermatitis
Stran. les
Pneumonia (all kinds)
6
ANIMAL EMBARKATION DEPOT, CHARLESTON, S. C.
Average strength: Horses, 1,362; mules, 2,253.
Thrush
42
18
3
6
6
51
4
3
115
19
2
Picked up nail
Dermatitis gangrenosa
1
Scratches
1
5
8
1
Influenza
Colic
1
4
4
1
1
Glanders
Priftiimnnift (aU kinrl<5) ^,
1248 REPORT OF THE SURGEON GENERAL OF THE ARMY.
12. Absolute Number of Diseases.
For United States and insular possessions, coveriny period July 1 to December
31, WIS.
Diseases.
Abrasions.
Absi-esses.
Acne
Alopecia
Amaurosis
Anemia
Ankylosis
Arthritis
Ascites
Atrophv
Autointoxication
Azoturia
Balanitis
Bites
Blepharitis
Blister
Bronchitis
Bums
Bursitis
Calculus
Canker
Capped elbow
Capped hock
Capped knee
Carcinoma
Cardiac disorder
Carpitis
Castration
Cataract .'
Catarrh, bronchial
Catarrh, intestinal
Catarrh, nasal
Celuhtis
Choke
Chondroma
Chorea
Choroiditis
Cicatricia
Colic
CoUc, sand
Concussions
Conjunctivitis, simple
Conjunctivitis , traumatic.
Constipation
Contrai^ture
Contusions
Corns
Coronitis
Coryza
Cracked hoof
Cribber
Cr->T)torchidism
Curb
Cyst
Cystitis
Dental diseases
Dermatitis gangrenosa . . .
Dermatitis traumatic
Dermatitis imclassified. . .
Dermatitis verrucosa
Diarrhea
Dislocation of joint
Dobieitch
Eczema
Edema
Elephantiasis
Emaciation
Empyema sinus
Emphysema
Enteritis
Epistaxis
Epithelioma
Exanthema
Admissions.
Deaths.i
Noneftectives.2
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
381
1,116
9
314
490
10
10
20
20
8
148
3
lt>
2
10
1
28
10
1
9
1
4
936
3,307
9
20
195
318
761
2
90
10
54
21
234
50
3
81
308
332
2
488
554
87
4
8
8
16
57
46
1
29
116
28
1
880
1,346
53
6
37
62
1
4
4
7
70
53
14
250
1
3
8
18
105
11
511
8
37
1
1
2
60
9
62
10
7
14
2
9
2
88
119
10
1
25
3
17
9
80
48
1
109
23
24
3
14
98
116
4
3
5
229
163
2
1
240
185
1
1
1
281
102
21
83
2
2
2
1
7
2
1
1
7
18
11
6
9
1
1
21
9
34
2
2
3
2
3
3
369
52
32
172
160
10
11
291
51
3
53
14
3
1
31
57
63
10
2
7
9
2
4
1
8
6
20
8
10
93
320
234
990
1,075
33
98
1,731
604
40
123
15
5
115
77
44
16
411
13,240
314
407
2,128
81
16
398
276
325
36
574
28
234
61
19
36
1
10
3
4
3
8
2,131
430
142
487
90
12
6
25
5
1
33
32
71
399
445
353
54
21
795
297
1
1
7
1
1
1
13
29
648
220
10
I
42
32
79
11
26
2
45
20
5
10
23
1
70
1,414
11
16
194
4
3
8
24
103
7
31
2
16
15
5
3
1
8
2
10
59
24
50
10
198
2,622
14
118
410
74
9
71
65
190
11
143
11
66
84
10
14
1
7
i
100
4
2
112
1
74
6,711
201
123
6
1
2
5
515
4
5
9
152
3
169
21
7
1
234
5
6
38
2
7
1
39
43
1
9
2
> Deaths include animals destroyed.
2 This column is aggregate for entire period.
VETERINAKY.
1249
Absolute number of diseases for United States and insular possessions, covering
period July 1 to December 31, 1918 — Continued.
Admissions.
Deaths.
Noneffectives.
Diseases.
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
53
59
2
82
39
257
17
26
148
1,558
16
38
1
12
44
4
1
6
21
349
3
374
319
1,930
16
41
379
3,360
5
82
1
12
361
35
18
113
5
24
47
1,269
1
4
1
2
30
6
232
Fistula poll
45
7
2
460
7
51
Fracture
65
34
1
77
Gall
1,793
7
4
3
1
22
1,700
1,7
00
Glossitis
4
73
2
84
90
1
1
18
11
256
9
88
283
1
1
21
Gonitis
77
1
29
212
1
2
236
3
Heat stroke
9
2
7
1
18
420
1
9
3
18
3
2
40
10
14
4
11
5
28
11
2
49
1
3
2
1
385
400
1
26
1,729
613
23
8
118
813
2,234
44
16
9
37
109
318
1
7
21
14
4
3
6
1
1
2
130
21
9
217
3
9
2
10
176
326
2
183
4,961
1,368
32
12
294
2,565
3,010
81
34
29
88
321
1,299
7
30
165
17
4
16
18
99
2
14
201
2
1
10
84
86
30
90
4
30
82
65
Infection .
22
474
198
11
5
18
471
241
1
102
19
1
25
10
65
1,453
536
10
10
7
44
3
26
1
3
1,207
651
75
51
40
1
2
150
1
19
108
3
577
2
7
47
2
Myelitis
3
1
48
23
184
10
1
36
43
289
8
16
11
348
2
1
5
6
5
16
13
54
14
17
14
8
6
8
3
74
78
1,223
96
65
46
1,583
3
4
17
14
1
24
27
133
71
36
37
19
4
9
7
81
5
10
1
12
31
Necrosis...
740
8
9
183
1
10
50
18
4
19
68
Ophthalmia periodic
702
1
i
2
13
19
4
9
7
5
4
1
8
9
9
2
71
7
6
1
13
15
16
2
1
4
5
Phlegmona-diffusa.
i
1250 REPORT OF THE SURGEON GENERAL OF THE AHMY.
Absolute number of diseases for United States aJid insular possessions, covering
period July 1 to December 31, 1918 — Continued.
Phthiriasis
Picked up nail
Pleurisy
Pneumonia
Podddermatitis
Poor condition
Proctitis
Pruritus
Pulmonary congestion . .
Purpura hemorrhagica . .
Pyema
Quarter crack
Quittnr
Ranula
Rheumatism
Rhinitis
Ringbone -.- - •
Ringworm
Rope-burn
Rupture of blood vessel .
Rupture of eye
Rupture of intestine
Rupture of musc.e
Ruptiu-e of stomach
Rupture of tendon
Sandcracks
Scabies
Scirrhous cords
Scratches
Screwworm
Seedy toe
Separation of hoof
Separation of sole
Septicemia
Sessmoid
Thermic fever
Side bone
Skin diseases
Spasm
Spavin bog
Spavin bone
Spiints
Sprains
Stenosis
Stomatitis
Strains
Strang.es
Strangulation
Stringhalt
Strongyloides
Synovitis
Tender feet
Tendinitis
Tendovaginitis
Tetanus
Thoroughpin
Thrush
Toe crack
Toxemia
Tarsitis
Treads
Tumor
Timafaction
Ulcer
Under observation
Undiagnosed
Uremia
Urticaria
Valvular insufficiency. . .
Varicose veins
Verruca
Vertigo
Vulvitis
Wounds:
Contused
Extensive
Gimshot
Incised
Admissions.
Horses. Mules,
,299
2
4
6
1
6
2
101
1
9
,202
157
59
5
49
5
1
120
4
4
17
101
52
463
3
9
310
387
4
43
122
,053
50
18
7
,179
11
322
2
272
60
2
14
175
451
4
12
3
32
,431
21
5
873
2,070
322
470
29
1
7
10
3
12
220
1
10
18
71
13
858
5
850
59
39
1
24
3
1
75
7
4
11
65
5
278
144
56
7
3
35
37
522
31
14
5
638
7
66
7
113
54
1
8
87
213
1
5
2,360
17
295
Deaths.
Horses.
52
5
203
32
Mules.
132
18
Noneffectives.
Horses.
27
6,758
18
776
4,701
149
7
21
17
78
2
168
5,590
3
22
52
282
208
3,507
377
8
39
7,935
182
144
2
11
32
11
3
330
3
4
45
236
106
941
8
19
542
1,897
2
46
2
130
462
1,350
199
77
14
19, 206
32
303
2
1,660
245
3
99
262
744
3
17
8
1
64
15
14,222
78
13
2,215
MEDICAL SCHOOL.
1251
Absolute number of diseases for United States and insular possessions, covering
period July 1 to December 31, 1919 — Continued.
Diseases.
Admission.
Deaths.
Noneffectives.
Horses.
Mules.
Horses.
Mules.
Horses.
Mules.
Wounds— Continued.
Iniectei;
25
379
4,243
88
3
3.882
259
822
247
4
225
1,949
57
1
1,45S
86
467
64
2
5
40
2
37
1,136
15,002
1S3
11
8,190
717
2,180
524
23
Kicks
6
5
2
670
Lacerated
6,833
Mu'tlp'e ...
266
Operative
2
Penetrating
Perforated
Punctured
Unclassified
45
8
6
5
25
10
3
2
3,238
234
467
126
Note. — Rates have not been ca'cu'.ated from this table because a large number of reports received during
July and August were not rendered upon Revised Form 102.
IV. ARMY MEDICAL SCHOOL, WASHINGTON, D. C.
TWENTY-SECX)ND SESSION.
The third section began July 10, 1918, and ended October 7, 1918.
TWENTY-THIRD SESSION.
The session began November 12, 1918, and ended February 1, 1919.
The number of accepted candidates appointed in the Medical
Reserve Corps and ordered to the school for instruction in the
regular course was 76. Of this number, 11 elected not to pursue
the course and were either discharged the service on their own
application or transferred to other stations for duty.
No members of the Organized Militia attended either session.
The postgraduate course for officers of the Medical Corps was not
given; however, a number of officers of the Medical Corps were
ordered to the school for special instruction in Roentgenology. This
class is still in session at the close of the fiscal year. One lieutenant
colonel, one major, three captains, and four first lieutenants, Medical
Corps, are in attendance in this course.
The entire 65 student candidates who completed the regular course
of instruction qualified at the final examinations and were recom-
mended for commission in the Medical Corps.
The twenty-fourth session of the school will commence on or about
October 1, 1919.
1. Orthopedic Section.
The section of orthopedic surgeiy of the Army Medical School
was continued during the past fiscal year, and the course was made
an integral part of the rurriculum of the Army Medical School by
direttion of the commandant.
On July 1. 1918, a three-story and basement bri'k building at 472
Louisiana Avenue was leased and placed in condition for occupancy
by the orthopedic section, largely by the enlisted personnel. Thi-
building has light practically on four sides and contains approxi-
mately 22,000 square feet of floor space.
142367— 19— VOL 2 18
1252 REPORT OF THE SURGEON GENERAL OF THE ARMY.
On July 1, 1918, tliere were 35 enlisted men on duty in this de-
partment, and during the year 226 additional men reported. These
men received instruction in litter drill, first aid, hygiene, anatomy,
physiology, Medical Department administration, metal, shop, brace,
leather, plaster work, carpentry, machine work, and blacksmithing.
Two hundred and forty-six hours were devoted to this instruction.
As the men became proficient they were promoted to the grade of ser-
geant or corporal, and were sent as orthopedic technicians to the
several general hospitals; 182 men were transferred as technicians, 18
as clerks, 41 discharged, 3 awaiting discharge, and 18 on duty at the
end of the year.
During the year, a special course for officers was given, embracing
drafting and mechanical principles of the production and construc-
tion of the United States Army standard splints, preparation and
technique of the application of plaster bandages and casts, welding
and brazing, anatomy, with reference to operative orthopedics,
splints, and artificial limbs, operative surgery on the cadaver, lectures
on shoes and feet, including the study of the component parts of
shoes and their function, the method of repair and the inspection of
shoes for Army use. Six officers attended this course, upon comple-
tion, three being sent to Fort Oglethorpe, two to Boston, Mass., and
one to Camp Lee, Va., for duty. One hundred and twelve hours of
instruction were given in the course.
In addition to the course of instruction, the orthopedic section has
undertaken the work of investigations of various appliances and
products and the source of same ; experimented with the manufacture
of braces and appliances, and it has supplied a number of standard
United States Army splints to different hospitals throughout the
country and filled all orders for special splints as they came in. There
were 14 special investigations made, 11 applications for patents on
orthopedic and allied appliances, 229 special draAvings made, 97
special apparatus manufactured and shipped, 170 special appliances
made and shipped, 22,079 plaster bandages, and 3,592 United States
Army standard splints made and shipped during the year.
Up to November 11, 1918, a number of officers of the Medical Re-
serve Corps and Sanitary Corps have been sent to this school from
the Rockefeller Institute of Medical Research, for additional labora-
tory instruction. Approximately 100 officers received this instruc-
tion. This course is of one montli's duration and is given each month.
The course embraces the following subjects : Culture media, bacillus
typhosus, bacillus paratyphosus "A," bacillus paratyphosus " B,"
isolation and identification from stools, dysentery bacillus, meningo-
coccus, standard agglutination method, anaerobes, staining of tu-
bercle bacillus, gonococcus malarial parasites, intestinal parasites.
Enlisted men of the Medical Department, some of whom were sent
here, and others enlisted at the school for the purpose, were given
training in laboratory technique. These men were grouped in three
classes; the beginners' class of laboratory technicians, the advanced
class of laboratory technicians, and the class of X-ray technicians.
The beginners' class of laboratory technicians received instruc-
tion in the cleaning of glassware, sterilization, the use of the micro-
scope, routine stains, elementary cultural bacteriology, and elements
of serolog}\ This course was of two months' duration, and was given
every two months.
MEDICAL SCHOOL. 1253
The advanced class of laboratoiT technicians received instruction
along the same lines as the regular officers' class, with the addition
of staining the gonococcus, tubercle bacillus, influenza, hemolitic
streptococcus, and the examination of urine. This course was of two
months' duration, and was given ever}' two months.
Half of the time of these two classes was spent in the chemical
laboratory, where the}' received practically the same instruction as
was given the regular officers' class, and included special topics in
volumetric analysis and certain laboratory methods of the Medical
War Manual No. 6, and the sanitary analysis of water and sewerage.
Four hundred and eighty-eight men received instruction in these
classes. Of these men 62 have been commissioned as second lieu-
tenants in the Sanitary Corps, and 40 more were recommended for
commission as second lieutenants in the Sanitary Corps.
The class of X-ray technicians were given lectures and practical
laboratory instruction in X-ray technique.
By direction of the Surgeon General, a postgraduate course in
roentgenolog}'^ has been established at this school, for officers of the
regular Medical Corps. The lack of roentgenologists in the regu-
lar Medical Corps, and the need for them in the X-ray laboratories
of the large Army hospitals in this country after the temporary
roentgenologists are retired from duty, has created a demand for this
course.
The outline of instruction is planned to be covered in 12 weeks,
divided into three periods of four weeks each, requiring the students'
full time.
The activities in which the Army Medical School is engaged aside
from its functions as a teaching institution are sunmiarized under
the various heads as follows :
2. Department of Pathology.
The department of pathology includes laboratories of bacteriology,
serology, parasitology, clinical pathology, pathological anatomy,
and chemistry. The work performed falls under five heads: (1) In-
struction of officers and enlisted men: (2) routine analyses; (3)
preparation and issue of laboratory supplies; (4) manufacture of
prophylactic vaccines; (5) investigation.
Instruction of officers and enlisted men will be taken up later in
this report.
Routine analyses include, especially, identification of cultures, ex-
amination of tissues, testing of chemicals, stains, etc., examination
of water and serological examination of blood for syphilis, etc.
An important work in this department is the preparation of diag-
nostic sera, which, of course, must be made from well-identified and
suitable cultures, especially in case of paratyphoid B.
PROPHYLACTIC VACCINES.
Xext to the instruction of officers and enlisted men. the most im-
portant practical work carried on in this department is the manu-
facture of antityphoid vaccine for compulsory use in the Army and
Navy. According to present regulation no antityphoid vaccine can
be used except that prepared at the Army ^ledical School. This
1254 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
arranc:ement makes it necessary for this department to maintain an
equipment and tecliniqne which shall be equal to this responsibility.
From July, 1918. to February, 1919, a triple typhoid lipo vaccine
was issued which Avas adopted as a war measure on account of the
api^arent advantage of a single immunizing dose. Difficulties have
been found, however, in producing a sterile product, and the pro-
tective powere of lipo vaccines is open to some question. A return
has therefore been made to the well-established saline vaccine. The
present triple saline vaccine is made of a single strain of the typhoid
bacillus and paratvphoid bacilli A and B, each cubic centimeter con-
taining 1,000.000,000 typhoid bacilli and 750.000.000 paratyphoid
bacilli A and B. After the rush of war production was over the
entire equipment and technique have been reorganized. During the
year there have been manufactured in these laboratories 2.830,250
c. c. of triple typhoid lipo vaccine and 7,098,585 c. c. of triple typhoid
saline vaccine.
Vaccination against pneumococcus pneumonia has been used by the
Medical Department, and some favorable evidence of protection has
been secured by voluntary use of this vaccine. There have been
manufactured here during the past 12 months 3,678,000 c. c. of pneu-
mococcus lipo vaccine and 92,000 c. c. of pneumococcus saline vac-
cine. Efforts are being made to improve the technique of the manu-
facture of this vaccine.
Investigation is recognized as an essential part of the work of
the department, and during the year a number of officers have been
engaged in research problems relating to the diseases of soldiers.
As a result of the experiences of the war work in diseases of the
respiratory tract is planned which will take the place of work hith-
erto on diseases of the intestinal tract and venereal diseases.
CHEMISTRY.
Research has been carried out in the chemical laboratory during
the past year on the chemical and physical a'ction of ultra-violet rays
on certain vegetable oils and the sterilization of oils by means of
ultra-violet rays.
3. X-Ray axd Photography.
In September, 1918, the X-ray department was called on to train
48 X-ray manipulators per month. The space assigned to the depart-
ment in the main Army Medical School building was inadequate for
this purpose and additional space acquired at the annex, 472 Louisiana
Avenue. Instruction dark rooms and laboratories for elementary
instruction were installed in this additional space. A testing labora-
tory was also established in the annex, where electrical control boards
were put up both for alternatino- and direct current, with recording
meters, circuit breakers, etc. Since the Army Medical School is in
the direct-current district of the local electric-power company, it
became necessary to bring alternating current into the building. The
company tapped their main distributing feeder, and enlisted men on
duty at this school installed the necessary transformer for the con-
version of the high-voltage line to 220 volts.
MEDICAL SCHOOL. 1255
In addition to the instruction work, this department has done a
large amount of work in the form of examinations and treatment of
medical officers and enlisted men and their families stationed in and
near Washington. A medical officer roentgenologist is in attendance
and sees all patients, obtains a short history directl}^ bearing on the
examination, personally makes the fluoroscopic examinations, and
directs the manipulator in making plates in the positions necessary to
show the pathology in question. Plates are filed numerically ' for
future reference, and certain ones are filed separately for instruction
purposes.
A large number of X-ray negatives have been received from the
Army hospitals in this country and abroad. These are being cata-
logued for instruction purposes. In addition, the school has on file
a collection of lantern slides that are quite valuable for lectures and
demonstrations.
4. Physical Examixations.
The making of physical examinations for the year covered hj this
report has been a very important function of this school. This' work
has not only been conducted on a scale of considerable magnitude,
but its scope has broadened to include physical examinations of prac-
tically every nature and for any purpose demanded of it.
During the year beginning July 1, 1918, and ending June 30. 1919,
approximately 13,000 physical examinations have been made. In-
cluded in this number are physical examinations made for all branches
of the service. The majority of applicants in the earlier months of
the year were civilian candidates for the several sections of the Offi-
cers' Reserve Corps, and, later, with the suspension of hostilities in
November, 1918, examinations for this purpose were supplanted by
examinations of officers for discharge. In addition to the physical
examinations just referred to, a considerable number were made
throughout the year for other purposes, chief among which being:
For promotion of officers; to determine physical fitness for overseas
duty; upon entry or reentry active service: for induction; for dis-
charge on surgeon's certificate of disability ; for furlough to the Reg-
ular Army Reserve; and for voluntary enlistment.
5. Mimeographing.
This department of the school is an important one. Examination
questions for entrance to the Medical Corps, Dental Corps, Veter-
inary Corps, and the Medical Reserve Corps, examination questions
for the final examinations at the school, bacteriological and chemical
technique cards, labels for all the vaccines shipped from the school,
bulletins, circulars, miscellaneous cards and blank forms for use at
the school, are among the many varieties of work turned out in this
department.
The following exhibits the course of instruction : Military surgery ;
bacteriology, pathology, and laboratory diagnosis; military and
tropical medicines; military hygiene; Medical Department admin-
istration; sanitary tactics; roentgenology'; orthopedic surgery; sani-
tary chemistry; ophthalmology; French.
1256 report of the surgeon general of the army.
6. Report on Wassermann Tests.
The Wassermann reaction has been performed continuouslj^ as a
diagnostic test for syphilis. During the year ended June 30, 1919,
the total number of Wassernumn tests in the laboratory was 17,652,
of which 761 were reexaminations; 15,365 were made in accordance
with existing orders calling for a Wassermann reaction on appli-
cants for commission, enlisted candidates for various service schools,
recruits, etc.: and 1,492 examinations of new cases. Of the latter,
930 were of syphilis or suspected syphilis, and 593 were from cases
suffering with diseases other than syphilis. In addition there were
179 tests made for gonococcus fixation, 108 spinal fluids in three
dilutions.
7. Property Department.
During this period a considerable amount of business has been
handled by this department. The large classes of enlisted men re-
ceiving instruction in X-ray technique, chemistry, and bacteriological
methods, with the extra sessions for student officers, the preparation
of vaccines for the Army and Navy, and the requirements of the
orthopedic section, necessitated the procuring of large amounts of
supplies and apparatus of every description.
Much of this material was purchased through this office by reason
of the fact that it was not carried in stock at the medical supply de-
pots, and is therefore not placed on requisition, thus relieving tire
depots of this detail.
This office also handles the shipments of vaccines and other labor-
atory supplies shipped from this school to the various Army posts,
camps, and cantonments by express and parcel post. An average of
75 bills of lading were issued each month.
8. Civilian Personnel.
At the beginning of the past fiscal year there were on duty at the
Army Medical School nine civilian clerks other than the chief clerk.
Five of these clerks have since resigned, and an additional clerk
appointed to one of the vacancies.
Five women technicians were on the civilian rolls during the'
greater part of the year, and performed their duties in the labora-
tories with entire satisfaction. The increase in the number of branch
telephone stations throughout the Army Medical School, the opera-
tion of four trunk lines with the main telephone exchange, and four
tie lines with the War Department switchboard, necessitated the
employment of two telephone operators during the first six months
of the fiscal year. But one of these operators is on duty at the close
of the year, the other having resigned.
9. Graduation.
Each of the two classes were closed without formal graduation
exercises.
Of the third section, twenty-second session, there were no honor
graduates.
SCHOOL AND LIBRARY. 1257
10. Remarks and Recommendations.
The signing of the armistice in November, 1918, with the conse-
quent reduction in the strength of the Army, has lessened many of
the activities of the school, particularly in the matter of vaccine pro-
duction and surgical instruction.
The orthopedic classes had grown to great numbers, and on Jan-
uary 1, 1919, there were nearly 200 enlisted men on this duty. This
work and that in roentgenology has been continued in less degree and
the training courses in these subjects are still underwa}', for small
classes.
Valuable work is being done in the pathological laboratories, par-
ticularly along the line of study in the etiology and epidemiology
of respiratory disease.
It is hoped that the school and its laboratories may be housed at
the Walter Reed Hospital during the coming year. The funds for
the purchase of the necessary land, to take permanent buildings
there, are now in hand, and it seems to me that when the quota of
patients falls, it would be well to occupy, for school purposes, some
of the temporary buildings available at the moment, and pending
the construction of new accommodations.
It is proposed to extend the course to eight months beginning Oc-
tober 1, 1919. Due to failure of temporary officers to evince an}^
great desire to enter the permanent corps the class for candidates
promises to be small, but the course of instruction can be very ap-
propriately given to a number of officers already in the Permanent
Establishment, but who have not had the course by reason of the war
conditions.
It is contemplated that 80 officers shall be under instruction at the
next session.
X. LIBRARY OF THE SURGEON GENERAL'S OFFICE.
During the fiscal year of 1918-19, 2,656 books and 8,923 pamphlets
were added to the library collections, with portraits of physicians.
The library now contains 198,900 bound volumes, 35,092 unbound
volumes, and 361,455 pamphlets, in all a total of 595,417 volumes
and pamphlets, with 5.631 portraits of physicians, 136 medical en-
gravings and prints, and 316 medical caricatures. This last, now in-
cludes the unique collection of medical portraits, caricatures, di-
plomas, and autograph letters of physicians recently acquired from
the estate of the late Dr. Mortimer Frank, of Chicago, numbering
44 portraits, 43 caricatures, and 82 miscellaneous items. Exclusive
of transactions of societies, the number of current medical periodi-
cals now received in the library is 1,568. Of these, 1,480 are kept
on the open shelves in the reading room. Through the opening
channels of communication with Germany and Austria, most of
the medical periodicals of the countries, covering the years 1915-1918,
have now been received, and those of the current year are coming in.
It is expected that our invoices of French and German medical books,
theses, and serial publications of the war period will arrive later.
The first volume of the third series of the Index Catalogue of
the library, officially transmitted to the Surgeon General on July
1258 REPORT OF THE SURGEON GENERAL OF THE ARMY.
1, 1918, is now in type, and will soon be ready for distribution.
Delays in presswork and binding have been unavoidable, under the
more immediate necessities of public printing for carrying on the
work of the Government in war time. This volume contains 3,137
author titles, and 34.139 subject titles, of which 29,602 are articles
indexed in medical periodicals. The appropriations just made by
Congress will enable the library to meet all expenses incurred in
the purchase of foreign literature which (ould not be transmitted
overseas during the war period. Through the acquisition of the
large room underneath the library hall, the erection of temporary
bookstacks therein, and the shifting of some of the literature in
the main bookstacks on the second floor, it will be possible to make
room for this huge backwash of Avar-time medical literature, when
bound, and for more recent accessions. The new bookstacks are.
devoted mainly to the storage of public documents. The space in
front will be converted into an additional reading room for the visit-
mg public. Cubicles and private tables in the library hall proper
are set apart for visiting research workers, who require space and
quietude.
The number of printed books of the fifteenth century (medical
incunabula) in the library is now 255. A number of additional
items in this class will be acquired shortly, as also facsimile repro-
ductions of incunabula in the library of the College of Physicians
of Philadelphia, which are not in this collection. It is hoped that
the valuable collection of medical manuscripts on the third floor
of the bookstacks may be overhauled and rearranged during the
coming year. Reproductions of mediaeval manuscripts in the Bod-
leian and other English libraries will be acquired, if it is possible
to obtain them.
XI. PBOVIDENCE HOSPITAL.
The act approved July 1, 1918, having appropriated $19,000 for
support and medical treatment of destitute patients in the city of
Washington, D. C, under a contract to be made with Providence
Hospital by the Surgeon General of the Army, for relief afforded
was as follows:
Patients in liospital July 1, 1918 ^^^
Admitted during the year
Total number treated g^
Average number admitted per month^. . ^^
Xumbcr remaining in hospital June 30, 1919 98 Sfi9
Total number of days' treatment afforded -°-°^-r
Average number of days' treatment per patient -
Average number of patients treated per day ^^^
Longest term of treatment (days ) ^
Shortest term of treatment (days ) ■ -,
Number of patients in hospital durnig the whole year
XII. PORT OF EMBARKATION, HOBOKEN, N. J.
Introduction. — At the close of the fiscal year 1917-18 the real
problem of embarkation has been successfully solved, as may be seen
from a study of the report of that year. A machine had been created
for the medical supervision of all port activities. How well this
machine functioned may be judged from the fact that during the
PORT OF EMBARKATION. 1259
first month it received its maximum load. In July, 1918, 268.116
troops were sent overseas through the ports of embarkation under
the jurisdiction of these headquarters. The machine creaked and
groaned, but it did not break.
Epidemic of infuevza. — During the rest of what may be called
the embarkation period, there remained but one more big problem
for solution — the epidemic of influenza. The period from September
to December, 1918, were dark days for the American Army, both at
home and abroad: but nowhere was the situation more trying than
at the ports of embarkation. When one considered the demoralizing
cifect on a military operation of quarantine and other sanitary meas-
ures necessary during an epidemic, one can not escape the conclusion
that the menace will be most felt at the points of greatest concen-
tration. The port might well be compared to the small end of a
funnel, through which more than 2.000,000 men had to converge
for embarkation to Europe. Overcrowding had alwaj^s been believed
to be a tremendous factor in spreading communicable disease, and
overcrowding did exist at embarkation camps and on transports, but
the situation abroad Avas such that the flow of troops could not be
arrested. It was reduced, of course, and probably no one will ever
know just what reduction was brought about by the influenza, be-
cause factors other than sanitary were affecting the flow; it was
seriously hampered, but it never stopped. Perhaps at no time in
the history of American arms have the military and sanitary situa-
tions been so carefully weighed as at Hoboken during this period.
On the 24th day of September, after a conference with several officers
of the surgeon's office, a letter was addressed to the commanding
general of the port, calling attention to the influenza epidemic that
was prevalent more or less throughout the country. At that time
it had hardly become epidemic in either one of the embarkation
camps. It was stated that pneumonia seemed prone to complicate
the influenza, and a warning was made that through that complica-
tion there might be disaster in case of epidemic on board ship. It
was recommended that the crowding on the transports be reduced
by 30 per cent and that the hospital accommodations be extended 100
per cent. The commanding general, after conferring with the sur-
geon, concluded to support the recommendation for the extension
of the hospital facilities, but approved a reduction of only 10 per
cent in total carrying capacity. This, he said, was his view of the
military situation, and was not meant to discredit the estimate of the
sanitary situation. This recommendation he communicated to the
War Department by telephone, and his view prevailed. On Septem-
ber 26 the surgeon succumbed to an attack of influenza, and was
absent from his office for about 10 days. Upon his return, a cable
message reporting 100 deaths on the Olympic^ which had just ar-
rived in a British port, was referred to him for remark and recom-
mendation. His recommendation was that a 30 per cent reduction
be put into immediate effect, and that still further reduction be made
until the troops arriving in Europe were in such condition that they
proved to be assets rather than liabilities to the American Expedi-
tionary Forces. The reduction, through one process or another,
eventually reached about TO per cent.
Preventati\-<e measures. — The following is a brief summary of the
general measures employed to prevent the spread of the epidemic.
1260 REPORT OF THE SURGEON GENERAL OF THE ARMY.
When a body of troops reached camp, it was placed immediately in
quarantine. A daily examination was made and in case one was
found with influcnza^ he Mas immediately sent to the hospital and all
immediate contacts treated likewise and sent to the detention camp.
The men in detention were examined and air passages sprayed daily
Avitli an antiseptic spray. The physical examination of all troops in-
cluded a daily take of temperature and any man found with a tem-
perature above normal was sent to the hospital. Upon receipt of
orders for embarkation, no troops were allowed to proceed among
whom there was an increasing incidence of influenza, or any marked
prevalence of the disease. Upon arrival at the piers, the men were
paraded preparatory to moving to the ship, a continuous examina-
tion was made of the men while standing, a medical officer going
from one end of the line of troops to the other. Any one found who
was suspiciously sick, or who even appeared fatigued, was taken out
ajid sent to the hospital. This examination continued daily until the
transport sailed from the port. In the event of the appearance of a
case of influenza, it was removed after being masked, sent to the hos-
pital, and all innnediate contacts masked and sent to the detention
camps. After the transport pulled away from the dock, harbor
boats under the control of the Medical Department were kept within
call until the transport passed out of the bay, so that in case a man
was taken ill i^atient and contacts could be immediately removed.
'transport service^ types of ships. — A lesser difficulty encountered
during the embarkation period was in the Atlantic transport service.
Troops Vvcre transported on the following classes of vessels: Naval
transports, commercial transports, and a few United States Army
chartered transports. Commercial transports were obtained from a
variety of sources and consisted of those having a regular run be-
tween this port and European ports, those having a regular run be-
tween other American ports and European ports, those having a
regular run between Canadian ports and European ports, and those
having a regular run between poits located in foreign countries and
temporarily diverted to this service (as between Europe and the Ori-
ent, Australia, or South America). Difficulties were encountered
because some of these commercial liners were well equipped for the
work while the great majority were either cargo or modified cargo
A^essels transformed for the emergency into troop transports and
fitted up as such.
Accommodations and equi'pnient. — There was no uniformity in
troop quarters nor in sanitary equipment. In some, bunks were used
while in others the sleeping accommodations consisted of hammocks.
The American troops had a dislike for the latter form of accommoda-
tion, but troop transports fitted up in that manner were by far the
most sanitary, especially as regards vermin and the incidence of dis-
ease. In the matter of messing and the preparation of food, differ-
ent systems were used, depending upon the type of vessel and the
country from which it sailed. There was far less complaint concern-
ing food where the troops were enabled to sit while messing than
under the cafeteria system where they had to eat from shelves built
along the sides of the vessel.
Medical personnel. — The medical personnel and hospital equip-
ment was different on each of the above classes of vessels. Naval
transports were equipped with hospitals and naval medical per-
PORT or EMBARKATION. 126
sonnel, \\'hich personnel was supplemented by the Army medical
personnel assigned to the troops abroad. On the commercial trans-
ports the hospital space was not as a rule as capacious as the Ameri-
can troops desired, and hospital equipment, such as instruments,
was not available for the needs of the troops except on those vessels'
on which the civilian ship surgeon was acting in the capacity' of con-
tract surgeon. United States Army, the contract being renewed ea: h
voyage. Commercial transports wliose regular run was betv^-een
American and Canadian and European ports had a permanent medi-
cal personnel and hospital and medical equipment that was available
for troops aboard. Manj^ other transports were without medical
personnel or definite hospital equij)ment. It became necessary, there-
fore, to assign to each transport an adequate medical personnel and
adequate medical supplies, and to have space set aside for hospital
purposes. Whenever possible the shipping companies made the ar-
rangements, otherwise the matter was attended to by the port au-
thorities. Frequently on a commercial troopship a United States
Army medical officer was assigned as transport surgeon, and the hos-
pital was equipped throughout with Army medical supplies. These
supplies were furnished as a standardized unit based on the needs of
1,000 men. The transport surgeon in such cases performed the
duties of ship surgeon and furnished medical attendance to the ship's
crew. In all cases there was a difference of opinion between the
port authorities and the transport people as to what constituted a
proper Army medical personnel, and in practically no case was it
possible to obtain a satisfactory adjustment as to the status and num-
ber of this personnel. Correspondence on this subject was initiated
shortly after the oversea movement of troops began and ceased but
a few weeks ago, without ever having arrived at a satisfactory solu-
tion. During the return movement of sick and wounded many medi-
cal officers were assigned, by orders from these headquarters, to com-
mercial vessels, only to be removed therefrom on reaching the
European port and returned as casuals on another vessel, though
these vessels were in need of their services returning from various
ports in England and France.
Recommendations. — It is considered that there should be on each
troopship an Army medical personnel which should remain with the
vessel as long as it serves in the transportation of troops. This per-
sonnel should consist of such numbers as are necessary for the super-
vision of the care of all sick and wounded requiring hospital treat-
ment. It should be so appointed as to permit of expansion or con-
version, if necessary, enough to form a large floating hospital. Per-
sonnel suitable for this work should be especially selected with a view
to their administrative ability, knowledge of sanitation, and kin-
dred subject, and, above all, tact, especially when assigned to com-
mercial vessels, for their work brings them into contact with the
shipowners, the ministry of shipping of other countries, the medical
officers with troops, line officers, and the staff officers of the ports of
embarkation and debarkation, all of whom have different ideas as to
the status of medical personnel. In all cases they should receive
thorough training as well as practical instruction as regards their
work. When once assigned to a vessel, they should not be changed
except when necessary for the best interests of the service. Medical
1262 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
personnel should have entire jurisdiction over all matters medical
and sanitary, in so far as the troops are concerned. Rank should be
appropriate with the duties involved. In the past, lack of sufficient
rank has worked a great deal of injustice to all concerned, and lack
■ of definite status, especially in relation to the commanding officer
and senior medical officer of troops, has resulted in needless friction
while at sea. While it may not be practicable to install such an or-
ganization on each troopship, every effort should be made to ap-
proach this ideal, but in all cases, at least one trained medical officer
should be permanently assigned to each vessel.
A satisfactory arrangement. — The most satisfactory arrangement
was effected whereby the ship surgeon in the employ of the shipping
company, acting in advisory capacity to the United States Army
transport surgeon, rendered services to the Army medical personnel
assigned to duty with the troops on board, which made possible the
use by the Army of all hospital facilities on board the ship. This
arrangement was effected when authority was obtained for compen-
sating the ship surgeon for his work, payment being made after each
trip.
Lesson learned. — The lesson learned from the problems presented
by the transport service is that a thoroughly satisfactory medical
organization can not be established on any vessel which is not wholly
under the control of the Arm}'. That any personnel assigned for
this service should be permanently assigned and thoroughly trained
for this special work.
Reorganization for deharl-ation. — After the signing of the armi-
stice the port of embarkation became a port of debarkation. The re-
versal of machinery entailed by this change was probably the most
momentous administrative event in the history of the port. For the
Medical Department it meant revolution in almost every phase of
activity. Hospitals had to be obtained and men trained to run them.
Extensive sanitary measures had to be put in force for the protection
of the American people from infections and infestations brought
home by the returning soldiers. An evacuation system had to be
created for the transportation of the wounded to the interior hos-
pitals. The various welfare organizations, animated by the sight of
returning wounded, redoubled their efforts, and the Medical Depart-
ment had of necessity' to keep pace with these organizations and to
direct their efforts along proper channels. These are but a few of the
more important changes which were necessary to prepare for the
reception of the returning sick and wounded.
Difficulties of ^procurement. — The debarkation period presented no
problem for solution more difficult than that of procuring adequate
personnel. It was only after the most urgent appeals over a period
covering several months that the War Department became convinced
that what was asked for was needed. The officers and enlisted men,
when they arrived, were untrained in the work. Many of the en-
listed men were in the limited-service class, malingerers, unhealthy
in body and mind, lacking in desire as well as training. Wlien the
proper personnel was finally obtained it had to be trained, and after
training, discharges were ordered by the War Department in com-
pliance with various circulars issued, which interfered materially
by withdrawing from each organization some of the best and most
PORT OF EMBARKATION. 1263
thoroughly trained of its men. The lessons learned from the per-
sonnel problems are so obvious as to require no further discussion.
Hospitals. — Second in importance to the personnel problem was
that of hospitalization. The War Department was slow in being
convinced of the needs for this phase of the work, and between the
date of the approval for more hospitals and the time when these
hosj^itals were actually needed for use a sufficient time had not
elapsed for the construction work rec|uired to put the buildings in
order for occupancy. It was therefore necessary, in the emergency,
to place patients in hospitals before the facilities for proper care
could bo completed. In one hospital, in particular, the messing ar-
rangement and applian< es were in su' h a state of incompletion that
it was very difficult to get enough food cooked and served for the
wants of the men. A study of the inclosures will furnish an ac-
curate idea of what was accomplished along this line.
Evacuation of sick and wounded, estimated rate. — Closely asso-
ciated with the problem of hospitalization was that of evacuating
the sick and woundect. Obviousl}', any estimate as to the number of
beds needed at the port of embarkation for returning wounded would
have to be based in part on the rapiditj^ of evacuation. Cabled in-
formation had been received from Gen. Pershing that patients would
be returned during a period of four months at a rate not to exceed
10,000 each month, and it was estimated that it would be possible to
turn these over in the debarkation hospitals every seven da3'S. The
plans for hospitalization and evacuation were predicated upon these
two factors. The advices received from the American Expeditionary
Forces proved imreliable. the estimate of 10,000 monthly being fre-
quently exceeded, and during the month of March these figures
were nearly doubled. After the system became well organized, how-
ever, the estimate of the " seven-day turnover " proved to be ac-
curate, and these two phases of the work were so coordinated that
in spite of inaccurate information evacuation proceeded without in-
terruption, and at no time was the port seriously embarrassed by
the bed situation.
Inaccurate w foi-mat ion.— The difficulty experienced at the port by
reason of inaccurate information from the expeditionary forces was
a very real one. Time and again carefully laid plans had at the
last moment to be changed, and, until the medical organization
learned to adapt itself to such an extent that it could be prepared
for the unexpected, much confusion resulted.
N onunifoi'mity in rate of returning sick and ivoiinded. — Another
source of confusion and one which has required the surgeon to
maintain his organization constantly on the alert was the lack of
uniformit.v with which sick and wounded were returned. Hardh^
a month passed that did not have one or more periods during which,
within two or three days, sick would be received in such large num-
bers as to threaten the port bed capacity, followed by periods of
relative inactivit}'.
Other ports of embo.rlrition under the jurisdiction of these head-
quarters.— The following additional ports of embarkation were
operated under the jurisdiction of these headquarters: Baltimore.
Philadelphia. Xevr York. Boston. Portland (Me.), Halifax, Quebec,
and IVIontreal. A surgeon and a permanent medical personnel were
1264 REPOKT OF THE SURGEON GENERAL OF THE ARMY.
assiofiied at Halifax. Montreal, and Quebec and the work carried
on under the direction of the surgeon at these ports in a manner
similar in all respe;ts to the system in use at Hoboken. The em-
barkation Avork at Baltimore, Philadelphia, Boston, and Portland
was handled by details of medical officers sent from Hoboken for
each embarkation. These officers conducted preembarkation inspec-
tions of troops, removed and disposed of sick before vessels were
alloAved to sail, and placed aboard medical supplies. During the
debarkation period Boston was removed from the control of the
commanding general, port of embarkation, Hoboken. and made
an independent port. The only other port under the jurisdiction
of these heaaquarters during the debarkation period was Phila-
delphia, and here the situation was handled by details sent from
Hoboken. as was done during embarkation.
Resume. — What has the Medical Department at the port accom-
plished during the fiscal year ending June 30. 1919?
It has, in general, protected from serious outbreak of infectious
disease in, and cared for the sick of, an army of 913.544 men em-
barking for oversea service at the ports of Hoboken. Xew York,
Baltimore. Philadelphia. Boston, Portland, Halifax. Quebec, and
Montreal, and has immunized a considerable percentage to typhoid,
paratyphoid, and smallpox: it has returned 894.593 to their homes
free from infection and cleanly in person and equipment; it has
equipped for oversea service, immunized, and cared for approxi-
mately 8.000 female nurses and returned theu.i to their homes: it
has received, cared for, and evacuated to interior hospitals, con-
valescent centers, and demobilization camps 117,780 sick and
wounded from the American Expeditionary Forces.
What lessons has it learned?
1. That the port of embarkation is a distinctive and highly spe-
cialized branch of the military organization: that the Medical De-
partment commissioned and enlisted personnel should be trained
for their duties at the outbreak of a war: that it is a grave mistake
to wait until war is on before beginning the training of 95 per cent
of the medical personnel that must take part in it : that indiscrimi-
nate transfers of niedical personnel between the port and other
stations are not in the best interests of the service.
2. That a satisfactory medical service can not be established or
maintained on a transport not wholly under the control of the
Army.
3. That preparation for returning sick and wounded must in-
clude the timely and adequate procurement of debarkation hos-
pitals, manned and organized for maximum efficiency prior to the
beginning of the debarkation period.
4. That the colossal undertaking of the Medical Department
could not have been brought to a successful conclusion without the
unstinted support of the commanding general and his staff and the
wholehearted cooperation and zeal of every member of the port
medical personnel.
The surgeon desires to take this opportunity to express his appre-
ciation for the genuine assistance rendered by the American Red
Cross and other welfare organizations. Supplemental at first, this
PORT OF EMBARKATION. 1265
work grew to be an essential service, the administration of which
would otherwise have fallen directly upon the ^Medical Department.
For a more complete description of the methods employed, and
results obtained, reference should be made to the reports of the
various divisions, hospitals, and separate organizations and to the
statistical tables and charts appended.
Personnel division. — In June, 1917, the first convoy of troops was
sent to France, which necessitated assignment of certain medical
personnel, both commissioned and enlisted, for duty on transports.
These, in addition to the personnel on duty in the office of the medical
superintendent. Army transport service, formed the nucleus of the
present organization, known as the office of the surgeon, port of
embarkation. Being directly under the control of the War Depart-
ment, it was necessary for this office to assume the duties of a depart-
ment surgeon. To that and the duties relating to personnel were
divided into two sections, i. e., those relating to personnel assigned
for duty called the permanent personnel division, and those passing
casually through the port known as casual personnel division. Each
of these was under the direction of a noncommissioned officer, while
the two divisions were under the control of a noncommissioned of-
ficer. From a nucleus of 1 officer and 2 enlisted men. the duties of
this division increased to such an extent that on June 30, 1918.
it required 7 officers and 10 enlisted men to satisfactorily perform
the various duties of the division.
Sanitary inspector's division., organization prearmistice . — This di-
vision was established for the purpose of making the various sani-
tary inspections at the port of embarkation which are required by
War Department orders and other regulations.
Due to the increase in the personnel of the port and the large
amount of troops embarking for overseas, the transport division
could not possibly perform its allotted duties. It was necessary,
therefore, to assign some of them to another division. The Sanitary
Inspector's Division being already established, it was decided to
delegate all sanitary inspection duties except those concerning the
ph^'sical inspection of troops at embarkation, to this division.
Duties prearmistice. — As originally organized and with its added
duties, the functions of the Sanitary Inspector's Division are as fol-
lows : Sanitary inspections of all buildings, camps, piers, transports,
etc., under control of these headquarters: fumigation; delousing;
sanitary inspections of transportation.
Hospital division., functions. — The hospital division was created
on June 1, 1918, by verbal orders of the surgeon. (This should not
be confused with the hospital division hereinafter mentioned, which
had for its purpose the procurement of buildings suitable for hos-
pital and other medical purposes.)
In brief, the func tions of the b.ospitnl division have been the super-
vision of all hospital activities and coordination of the efforts of the
directors of the various professional services.
Division of domiciVunnj hof<pitals. — Many offers of houses for con-
valescent soldiers having been made to the Surgeon General of the
Army, and the surgeon, port of embarkation, it was decided to make
use of these offers as far as possible. To that end it was derided to
establish a division of this office for the purpose of organizing and
supervising a system wliereby these places could be used. At the be-
1266 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
ginning^ of the hscal 3'ear there were 6 places with a capacity for
18G patients; 14 other homes, with a capacit}^ for 1.498 patients, had
been otfered. but not as yet accepted for use.
In the fall of 1918, most of these homes or domiciliary hospitals
were closed for several reasons, principally because there was no
further need for them ; also because they were isolated and scattered
over too wide a territory to be administered efficiently. With the
(lose of these homes or hospitals further need of a domiciliary hos-
pital division was not apparent, so it was discontinued.
Hospital division. — This division was organized in May, 1918, for
the purpose of procuring suitable buildings in this vicinity for hos-
pital purposes. On May 23. 1918, a representative body of real
estate men. all members of the real estate board of New York, met
and organized for the purpose of lending their aid, and as a result
there was formed an advisory committee for this division. Alto-
gether more than 12,000,000 square feet of floor space were surveyed,
of which some 7,000,000 were recommended or occurred, and the
balance classified as not available, or unsuitable. The work of the
division, as far as concerns the provision of suitable bed space at the
port, was completed on April 23, 1919, when it was consolidated with
the finance division of this office.
Sick and wounded division., organization. — In October, 1917, this
division was established for the purpose of checking and forwarding
sick and wounded reports of the various organizations under the con-
trol of these headquarters. This work was placed in charge of a non-
commissioned officer under the supervision of the chief clerk.
Anticipating the growth of the port of embarkation and the prob-
able return of large numbers of sick and wounded from overseas, the
division w^as reorganized in December, 1917, and placed in charge of
a commissioned officer.
Genitourinary section. — The duty of the chief of this section was
the supervision of the treatment of the genitourinary diseases in the
various hospitals under the control of these headquarters.
Psychiatric section. — The duty of this section was supervision of
treatment of mental diseases in the various hospitals.
Transport division., organization. — This division was the office of
the medical supreintendent. Army Transport Service, and embraced
the duties as laid down in transport regulations. It had been known
under various names, first, as office of the medical superintendent,
Army Transport Service; second, sanitary division; third, transport
division. Primarily, the duties of the medical superintendent were
those of sanitary inspector for the port of embarkation, supervision
of medical department, activities on board transports, making and
causing to be made the required embarkation physical inspections,
providing for the reception and care of military persons unable to
travel, providing necessary supplies and equipment for the trans-
port hospitals, furnishing sufficient medical personnel for the proper
care of sick on board, and procurement of the necessary information
relative to movement of troops and transports.
Transport supply division. — This division was organized in Feb-
ruary, 1918, to arrange for a systematic supply of transportation.
Prior to that time transportations were supplied through the trans-
portation and property divisions. Owing to the small number of
ships engaged in the transportation of troops, almost no attention
PORT OF EMBARKATION. 1267
at all was required to properly siipplyincr them, but as the number
of ships increased it became necessary to have an efficient organiza-
tion for this purpose.
When the division was organized and assumed control of the
medical supplies of transports, no system of supply being in effect,
some time and study was allotted to standardizing the amount and
variety of supplies and equipment according to the number of troops
carried. This plan as accepted, and later modified by the proceed-
ings of a board, has been in operation since February, 1918, and had
proved satisfactory.
Transportation division., organization. — This office has performed
the function of transporting ever increasing numbers or sick and
wounded. It was first known as the ambulance division, and was
controlled largely by noncommissioned officers under the direct
supervision of the surgeon, port of embarkation. In addition to
ambulance service, local transportation on street cars, subways, fer-
ries, etc., was provided in the form of tickets, which were requisi-
tioned and issued as required. As the pressure of this office in-
creased, it was found expedient to expand in personnel and equip-
ment. An officer was placed in charge, and it was called the " Trans-
portation division." The officer in charge of this unit was given
entire charge of transportation of men, patients, and supplies for
the Medical Department. At the close of the fiscal year this office
was performing the following functions: Transportation of sick and
wounded; transportation of medical supplies, baggage, etc.; trans-
portation of officers engaged in the transaction of official business;
issuance of tickets on local transportation lines for transaction of
official business.
There were in service at this time 24 ambulances, 2 trucks, Hos-
pital Trains Nos. 1 and 4, and hospital boats Gardner., Gosnold.,
Bronx., Islehoro., Princess., and Lexington. The motor cars and am-
bulances of the following organizations were also controlled by this
division : Red Cross, Women's Motor Corps of America, and the
motor division, National League for Woman's Service.
On August 9, 1918, an office was created under the direction of the
surgeon for transportation of sick and wounded. This office was
placed in charge of an officer of the Quartermaster. Department who
assumed control of all water, rail, and ambulance transportation per-
taining to the Medical Department. The medical officer in charge of
the original transportation division then became medical director of
transportation, which office he held until December 25, 1918, when
the evacuation division was established.
Evacuation division., introduction. — One of the most important
and difficult problems arising during the war was the change to be
effected at the port of embarkation from a port of delivery of soldiers
for shipment overseas to a receiving port for their return home.
The problem of evacuating the sick and wounded for debarkation
hospitals in which they were entered upon return from overseas to
hospitals in the interior was successfully solved by thoroughly
organizing and building up a system sufficiently elastic to meet the
most exacting and unexpected requirement, for it may be readily
understood that any system to be successful must be prepared to
evacuate patients as rapidly as they are received from overseas.
142367— Ifl^-voT. 2 19
1268 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Port hcd capacity. — The bed capacity at the port of embarkation.
New York, during the most active period of the return of sick and
wounded soldiers was 17,000, and this was not too large, for on several
occasions the margin of safety was reduced to 2,500 beds. The ar-
rival of several of the larger transports carrying patients at these
times might have easily filled our hospitals to their full capacity. In
accordance with a cabled estimate from Gen. Pershing the evacua-
tion division was organized to handle a maximum of 10,000 patients
a month, but a study of the chart appended will show that this esti-
mate was exceeded in the months of December, January. February.
March, April, and May and that in the month of March it was nearly
doubled.
Fwidamcnfal 'purpose, — Fundamentally the purpose of the evacua-
tion division is to keep the sick and wounded moving through the
port to interior hospitals at the same rate they are received from over-
seas. In order to perform this function it was necessary to provide
rolling stock — that is, hospital trains and hospital unit cars suitable
for the transportation of both ambulant and litter patients and to
train medical personnel in the correct conditions governing the safety,
rare, and subsistence of those patients while en route.
Initial steps. — The initial movement took place on December 23.
1917. at which time Hospital Train No. 1 was ordered to proceed to
the port of embarkation, New York. During the period of embarka-
tion this train was sufficient for all needs, but as the number of re-
turning sick and wounded increased it became apparent that addi-
tional facilities must be provided and new equipment was asked for.
In reply to this request Hospital Train No. 2 and Hospital Train
No. 4 were sent to the port. No. 4 was ordered to the port on June
29, 1918, and on October 11. 1918. Train No. 2 followed.
Post-armistice preparation. — After the signing of the armistice,
preparation was begim for the transportation of 10,000 patients each
month in accordance with cabled advices from the American Expe-
ditionary Forces, and on October 25, 1918, authority was granted for
the construction of 20 hospital unit cars. These cars were built at
the Pullman shops, and on January 21, 1919, 10 of them were sent
to this port. Each car was built to accommodate approximately 28
litter patients, and the beds were of such type as might be used for
any kind of medical or surgical case. By a simple adjustment they
could be converted into several positions, depending upon the type
of accommodation desired. At one end of each car a kitchen was
installed with a capacity for feeding approximately 250 persons.
The plan proposed was to use each of these cars as a nucleus upon
Avhich to assemble a hospital train : thus standard Pullman or tourist
cars could be attached to the unit car up to the feeding capacity
of the kitchen. The unit car carries the administrative personnel
and the more seriously sick and wounded. When it became apparent
that even this amount of equipment would not be sufficient an ar-
rangement was made with the Pullman Co. whereby 10 more cars,
tourist, kitclien, hotel, and private car types, were leased to the Gov-
ernment for the purpose of transporting sick and wounded. This
brought the total equipment up to 3 hospital trains and 20 unit cars,
and with this number it was found possible to evacuate 20,000 pa-
tients a month to interior hospitals and feed most of them to
destination.
POET OF EMBARKATION'. 1269
Hospital trains and unit cars. — Each hospital train carries a per-
sonnel of 3 officers and 25 enlisted men and functions as an inde-
pendent organization. Its personnel is quartered and rationed on
the train at all times. ^Mien, as rarely happened, it became neces-
sary to increase the personnel, an additional escort was drawn from
the escort detachment. On January 26, 1919. the unit cars were
placed in a separate organization known as Hospital Unit Car Group
Xo. 1. Each car carried a personnel of 1 officer, 2 cooks, and 2
privates, or j^rivates first class, and 1 noncommissioned officer.
\\ hen this car is extended into a hospital train by the addition of
tourist or standard Pullman cars the necessary increase in the com-
plement of commissioned and enlisted personnel required for a trip
is drawn from the escort detachment. At the conclusion of a trip
the escort personnel returns to the mother organization in the Chiett
Building, New York. All hospital trains and unit cars of this port
are located at the Pennsylvania Eailroad yards, Waldo Avenue.
Jersey City, X. J., and are under the direct control of the director
of hospital trains. This officer has general supervision of the equip-
ment and personnel, and he is held responsible for these units being
kept in a state of efficiency and readiness for service at all times.
The director of hospital trains also super\4ses the work of the
entrainment officers who are six in number and have charge of the
entrainment of patients at the various railroads in the city of New
York and vicinity.
Difficulties encountered — Feeding. — The problem of feeding pa-
tients on hospital trains has been by far the most difficult one that
this division has had to solve. The reasons for this are that experi-
enced enlisted cooks are extremely hard to get, ranges and other
kitchen paraphernalia on kitchen cars and hospital trains, and many
difficulties to the uninitiated which would not be met with in a hor>-
pital kitchen. It is obvious that individuals traveling on trains,
whether ih^y are sick or well, require an attractive and appetizing
diet, owing to the monotony of travel, lack of exercise, and a ten-
dency to car sickness. Before the Red Cross canteen service had
l)erfected its splendid organization many well-meaning but mis-
guided citizens were a bit overzealous in proffering all sorts of deli-
cacies, fruits, etc., at unseasonable hours without respect to the time
of regular meals. A soldier fed indiscriminately naturally does not
relish the wholesome food served by the medical department at regu-
lar hours. Feeding difficidties were largeh* overcome through the
efforts of the port nutrition officer, who made special investigations
for a period covering approximately six weeks and whose written re-
port on this problem is appended. The first step was to standardize
the menus so that even mediocre cooks could learn to prepare well
a few simple diets. Somewhat later, at the request of the Surgeon
General, the commutation rate for ]5atients traveling on hospital
trains was increased to $1 per diem for each patient. On January
19, 1919, 10 colored cooks were obtained from the Pullman Co. and
employed on hospital trains as an experiment. The experiment
worked out so Avell that subsequently all enlisted cooks were re-
placed by colored Pullman cooks, most of whom were men with many
years of experience in cooking on railroad trains and Pullman
kitchen cars.
1270 REPOKT OF THE SURGEON GENERAL OF THE ARMY.
Su/mmai^y. — An accurate idea of the actual work accomplished by
the Evacuation Division may be obtained from a study of the at-
tached charts, tables, and separate reports of the various subsections,
the salient features of which may be briefly summarized as follows:
The work has been so closelj' applied to the debarkation hospitals
that at no time has there been any embarrassment of the port hos-
pital bed situation.
Xo patient has ever been sent out of this port without competent
iiiedical attendance, with the exception of officer-patients able to
travel alone.
Every patient transferred has been provided either with food or
with funds for its purchase.
Xo litter case has ever been transported b}' rail except in a tourist
or Pullman berth or in a hospital bed.
Xo patient, whether litter or ambulatory, has been transferred by
rail except in a berth or bed, provided the journey was of five hours
or of longer duration.
During the fiscal year ending June 30, 1919, a total of 108,790
transfers have been accomplished. Of this number, 102,355 have
been transferred from 13 debarkation hospitals at the port of
Xew York to approximately 84 interior hospitals widely distributed
over the entire United States, have been provided with subsistence
and medical attendance en route, and that with onh^ two serious ac-
cidents, and two deaths en route from natural causes.
Finance Division — Organization. — This division was established
when the office of the surgeon was first organized. The principal
duty was the purchase of supplies.
Later it was incorporated with the property division, and when
the growth of the office demanded it was again instituted as a sepa-
rate division under the control of the executive officer. The corre-
spondence and files divisions were in this division at that time for
purposes of administration.
In December, 1917, the finance division was separated from the
correspondence and files divisions and entirely reorganized. The
duties at the end of the last fiscal year were substantially as fol-
lows :
Checking and modification or approval of requisitions for medical,
dental, and veterinary supplies for organizations under control of
these headquarters.
Checking of all money papers for the Medical Department — i. e..
vouchers for supplies purchased, services rendered, pay rolls of
nurses and civilian employees, and all papers pertaining to the hire
discharge, resignation, etc., of civilian employees of the Medical
Department. The medical supply depots at Camp Merritt and
Camp Mills were organized under the direction of this division and
were under its control for purposes of administration.
Approximately $175,000 was disbursed monthly under approval
of this office and at the end of the fiscal year about 3,000 requisitions
had been approved for issue or forwarded to the Surgeon General
for action.
On June 30^ 1918, there were two commissioned officers and one en-
listed man on duty in the division. This does not include the men
on duty at the supply depots at Merritt and Mills.
PORT OF EMBARKATION. 1271
Reorganization. — During the fiscal year past the duties of the di-
v'ision remained the same. On Xovember 20, 1918. the division known
as the transport supply division of this office was consolidated with
the finance division, all personnel on duty in that division being as-
signed to the finance division. On January 1, 1919. pursuant to War
Department orders, all matters pertaining to requisitions, supplies, and
medical supply depots were removed from the jurisdiction of the
Medical Department, and on April 23, 1919, the division Ivnown as
the hospital division, office of the surgeon, was transferred to the
finance division. The hospital division as then organized was con-
cerned with real estate, leases, surveys of buildings and other mat-
ters connected with the provision of suitable bed space for the re-
ception of sick and wounded, etc., and is not to be confused with the
recently organized hospital division which is concerned only with
the treatment of sick and wounded.
Property division — Duties. — This division, one of the pioneer
organizations, was formed in August, 1917. Its duties are to pro-
cure for the office of the surgeon and clependent organizations, medi-
cal supplies, including drugs, vaccines, and office equipment. It
verified and receipted for medical, quartermaster, and ordnance
property, and prepared and forwarded the prescribed returns for
them ; maintained in proper mechanical condition the wheel trans-
portation of the Medical Department at this port, and prepared and
shipped medical supplies to the various other embarkation points
under the jurisdiction of the port, namely, Montreal, Halifax, Port-
land, Boston, Baltimore, ancl Philadelphia.
Attending surgeon's division — Organization. — Shortly after the
port of embarkation was established a place for the medical and
surgical treatment of military persons on duty here was needed.
A clispensary was established at 200 River Street and an attending
surgeon was appointed and placed in charge thereof. Increase in
the personnel on duty at the port of embarkation necessitated the
assignment of additional personnel, and for administrative pur-
poses the office of the attending surgeon was absorbed by the office
of the surgeon, port of embarkation, and made a separate division
of that office.
Function. — The principal function of this office has been to- fur-
nish medical and surgical attendance to officers, field clerks. Army
nurses, enlisted men on duty at this port, and their immediate
families. First-aid and phj^sical examinations have been provided
for civilian employees who are entitled thereto.
Director of dental service — Organization. — On July 1. 1918, the
dental service for the port of embarkation was instituted when the
surgeon designated a dental officer then on duty in the office of the
surgeon as director of dental service. The duties of the officer were
to direct, organize, ancl supervise all dental work at hospitals, camps,
or other organizations, under the jurisdiction of the commanding
general, to cooperate with the personnel officer, office of the surgeon,
by recommending the assignment of dental officers as their need
became apparent.
Liaison Officers. — Prior to March, 1918, it was difficult for the dif-
ferent divisions to obtain the information regarding movement of
troops and transports necessary to perform their duties. Relief
1272 REPORT OF THE SURGEON GENERAL, Oi' TJIE ARAIY.
was imperative and to that end a commissioned officer was appointed
to maintain liaison between this office and the different departments
at these headquarters. Satisfactory results are being obtained. At
present there is on duty in this division, one commissioned officer.
Embarkation Hospital No. i, Hohoken, N. J. — Prior to the begin-
ning of the fiscal year of 1918-19, the hospital known as St. Mary's
Hospital, Hoboken, was used by the military as an embarkation
hospital. It was under the control of the Sisters of St. Francis and
the militar}^ patients were admitted and cared for at a rate of $2
per diem. The mess was controlled entirely by the hospital man-
agement which also furnished medical supplies and nurses. Medi-
cal officers and enlisted men were furnished by the Army but this
arrangement proved so unsatisfactory that negotiations were started
to place the hospital entirely under military control. The War De-
partment leased the building and all equipment and on July 1, 1918,
the hospital was established as a strictly military institution, and
has been operated as such up until the present date.
United States Army Embarkation Hos^ntal No. 2,SecauGus,N. J. —
This hospital occupies part of the buildings of Hudson County insti-
tutions located on Laurel Hill, overlooking the Secaucus Station of
the Lackawanna Railroad. The location is high and well drained.
It is used as a communicable disease hospital for the port of em-
barkation. All cases of communicable disease arriving on transports
or developing in hospitals in or about the port of embarkation, as
well as contacts, are sent here for treatment.
Embarkation Hospital No. 3, Hoffman Island, New York Harbm' —
Location. — Embarkation Hospital No. 3 is located on Hoffman Island,
a low-lying " made " body of land, situated in New York Harbor, in
that part commonly laiown as the lower bay. Accessible only by boat,
it was an admirable location for the treatment of veneral disease.
The island itself and the buildings on it are the property of the State
of New York, and were formerly used as a place of detention by the
quarantine officer of New York,
Embarkation Hospital No. If.. — This hospital was taken over by
the Medical Department, United States Army, October 20, 1918,
from the New York Polyclinic ^Medical School and Hosjpital. From
that date until December 18, 1918, the building was cleaned, and
preparations were made for the reception of patients. During much
of this period the main hospital building was used as quarters for
nurses who were being mobilized for duty overseas. There were a
few patients in the hospital, casuals from command, nurses from
overseas, etc., but on December 18, 1918, the hospital was formally
opened b}' the entrance of 176 overseas patients who arrived on the
transport Celtic. The hospital functioned principally as a debarka-
tion hospital, and these cases were evacuated as rapidly as possible.
History of Debarkation Hospital No. 1 — Geographical location. —
This hospital is located on Ellis Island, in New York Harbor, about
1^ miles from the city of New York.
Terrain. — Ellis Island is made up of three parts, laiown respec-
tively as island No. 1, No. 2, and No. 3. Two of the islands have
been made, and in consequence the buildings have been constructed
on piling. There is very little ground space surrounding the build-
ings, and this is either lawn or cinders. The climate is that of New
PORT OF EMBAKKATI02S'. 1273
York Cit}'. The island location insures an abundance of light and
air. There are no roads or streets. To the north and west of the
hospital, the piers and railroad tracks of the Central Railroad of
Xew Jersey cover the nearest portion of land at a distance of about
one-third of a mile from the hospital.
United States Debarkation Hospital No. 2, Statcn Island, N. Y. —
Geogra'phical location. — The hospital is located on Staten Island, in
the Borough of Eichmond, city of New York. From Manhattan
proper the distance is 5 miles by water.
Debarkation Hospital No. 3 — Lease. — On June 1, 1918, the United
States Government leased the then vacant Greenhut Building, for
the purpose of converting it into a debarkation hospital to receive
sick and wounded soldiers returned from overseas. Some adverse
criticism of this action was met with through the local press. It
was thought by many that due to the location and close proximity of
the building to the Sixth Avenue elevated trains that this would not
be a desirable site. However, the proposed plans for remodeling
the building for hospital purposes were rushed and the good judg-
ment of those who selected the site was soon proven.
Deharkatian Hospital No. 4 — Description. — During the early part
of the fiscal year negotiations were under way for additional hospi-
tal space in the vicinity of New York. Among other plans under
consideration was the procurement of Nassau Hotel, Long Beach,
Long Island, N. Y. This is a fireproof building, seven stories high,
with annex of hollow tile, steel, und brick construction, steam
heated and electrically lighted throughout, and containing its own
heating and lighting system, ice machine, bakery, kitchen, etc.
It had been operated as a hotel, and except for the fact that it
was somewhat isolated was admirably suited for hospital purposes.
After considerable correspondence with the office of the Surgeon
General, necessary steps were taken for the acquisition of this
property.
Debarkation Hospital No. 5, Grand Central Palace., New York —
Designation. — On September 16, 1918, the building formerly known
as the Grand Central Palace was designated Debarkation 'Hospital
No. 5, under General Order No. Ill, Headquarters Port of Embar-
kation, Hoboken, N. J. However, a lease bearing date September
1, 1918, was taken bj' the Government on September 3, 1918, at a
time when the floors were still in use by tenants. The building
being of the loft type of architecture and otherwise adapted, it
was taken over by the authorities at this earlier time.
United States Army General Hospital No. i, Columbia War Hos-
pital, Nexo York City — Function. — This institution serves as a gen-
eral hospital for medical, surgical, and mental cases whose homes
are in the vicinity of New York City, and for such other patients
as maj' be referred for observation an^ treatment from other de-
partments of the Army.
United States Army base hospital, Camp Mernti, N. J. — Intro-
duction.— The United States Army base hospital at Camp Merritt,
N. J., was opened January 9, 1918. On the first day 46 patients
were admitted; within three days 105 patients were admitted.
Thirty-one thousand four hundred and fifty patients were admitted
to the base hospital from its opening day to November 1. 1918,
1274 REPORT OF THE SURGEON GENERAL OF THE ASMY.
there being an average stay of 12 days in the hospital for each
patient. Of this total of patients 10,942 were returned to duty,
15,916 were transferred to other hospitals, 546 died, 782 were dis-
charged on surgeon's certificate of disability, and 451 retained for
domestic service only. Also within this same period of less than
nine months the hospital personnel consisting, on the day of open-
ing, of 20 commissioned officers, 11 nurses, and 97 enlisted men,
with a total bed .capacity of 41G, had increased on November 1,
1918, to 90 commissioned officers, 300 nurses, and 800 enlisted men,
and the bed capacity to 2.500, further increased to 3,800 as an
emergency capacity during the influenza epidemic.
The gradual increasing of the movement of troops overseas, to-
gether with the influenza epidemic, called for the greatest ingenuity
and the liighest administrative ability to meet the changing condi-
tion and enlarge the hospital sufficiently to meet the emergency.
This construction and enlargement Avas so arranged that if there
should have been occasion to have again increased the size of the
hospital, by the addition of other buildings, it would have found
the hospital capable of adding another 100 per cent to its capacity
without inconvenience.
XIII. HEALTH AND SANITARY CONDITIONS OF DEPARTMENTS.
CENTRAL DEPARTMENT.
The larger number of admissions was for diseases of the respira-
tory organs, which totaled 4,227, distributed as follows:
Bronoliitis 433
Influpnza 2,836
riuMiinoiiiii 142
Tonsillitis 1— 816
A severe epidemic of influenza viritcd many pests, the greatest
number of cases (1.627) being at Fort Leavenworth, Kans. There
were 499 cases at Fort Brady, Mich.; 686 at Fort Riley, Kans.; 11 at
Fort Meade, S. Dak. ; 13 at Fort Robinson, Nebr.
Tonsillitis was epidemic at Fort Leavenworth and Fort Riley,
Kans ; 632 and 146 cases, re pectively. There were 32 cases at Fort
Brady, M'ch., and 6 cases at Fort Robinson, Nebr.
Diphtheria was prevalent at Fort Leavenworth (47 cases) and
Fort Riley (12 cases).
At Fort Leavenworth there were 170 cases of mumps; Fort Riley,
131 ; Fort Brady, 32.
Bronchitis was severe at the following places: 260 cases at Fort
Leavenworth, 148 at Fort Brady, 23 at Fort Riley, 2 at Fort Rob-
inson.
Fort Leavenworth had 140 cases of gonorrhoea and sequelae. Fort
Riley, 51 cares; Fort Robinson, 26 cases; Fort Brady, 23 cases.
There Avere 313 cases of venereal diseases and 6 cases of alcoholism.
The total number of cases in which typhoid prophylaxis was ad-
ministered between January 1 and December 31, 1918, was 4,988, di-
vided respectively as follows :
Fort Brady, Mich 196
Fort Leavenworth, Kans 1 3,804
Fort Riley, Kans 952
Fort Meade. S. Dak - 4
Fort Robiusou Nebr 32
BEPAETMliNTS — U. S. 1275
EASTERN DEPARTMENT.
Camj) Crane^ AUentown, Pa. — New drainage system was installed
during the year, as the old system was not adequate to carry off the
surface water fast enough during heavy storms, therefore causing
flooding of some jilaces.
^£d Infantry^ East Potomac Parh^ D. C. — A complete system of
drainage is being installed.
Fishermans Island. — A new water system has recently been in-
stalled. Wooden bunks in company barracks removed and iron cots
substituted therefor. Owing to the difficulty of destroying bedbugs
and roaches, the old type of sleeping accommodations were con-
demned.
Fort Howard. — The use of stoves in heating cantonment buildings
is reported to have been conducive to rhinitis, tonsilitis, and bron-
chitis among the men housed there, due to the rapid changes in tem-
perature.
• Fort Hunt. — Prophylaxis against mosquitoes was carried out by
means of draining low-lying swampy places, keeping the weeds and
grass well cut, and the frequent application of crude oil, with the
result that there was not a single case of malaria. The grounds and
buildings have been well policed and the post kept in excellent sani-
tary condition.
Fort Jay., N . Y . — The surgeon reports that the United States Dis-
ciplinary Barracks has been constantly overcrowded during the year.
This fact contributed to the greater prevalence of respiratory diseases
among these men. During the early fall an incinerator was estab-
lished, which takes care of all the wastes efficiently. The water supply
of the island has been materially increased, facilitating to a large
degree the ordinary measures of cleanliness.
Fort Mott., N. J. — Ditches running through the rifle range were
drained during the year and all weeds burnecl.
Fort Myer., Va. — Sanitary condition of the post is excellent.
Water supply is taken from the District of Columbia supply and
direct from the Potomac- River. The water from the river is filtered
and mixed with the District water and then chlorinated.
Fort Niagara. — The drainage of the post is poor on account of the
clay subsoil, whi( h is very compact, making it difficult for the water
to seep away. This fault could be overcome by laying a system of tile
drains leading to either the river or the lake. The prevailing winds
are northwest, causing the water to become muddy, which has been
responsible for some acute diarrhea but no tj'phoid. Two new
chlorinating machines were installed in the water plant during No-
vember of 1918.
Fort Story. — Sanitary conditions at the post, in the main, are
good. The clrinking water is supplied from very shallow wells and
is never allowed to be drunk without previous boiling. There is no
incinerator for the kitchen; all garbage and scraps that can not be
properly burned, together with slops and dishwater, are buried and
well covered with sand. The surgeon states there are a number of
flies, propagated from a kind of seaweed, dead fish, and mollusks that
are constantly being thrown upon the beach from the ocean which is
but a few yards from outbuildings, and as there is not a sufficient
1276 REPORT OF THE SURGEON GENERAL OF THE ARMY.
force in the entire garrison to constanth' destroy this decomposing
matter, the complete eradication of the fly is an impossibility.
Fort Tet'ry. — Sanitary conditions at the post have been uniformly
good. The water supply during the month of August was so re-
duced that it was necessary to diminish the amount used for bathing
j)urposes in the different barracks, but this deficiency was overcome
by sea bathing.
' Camp Alfred Vail. — In March the surgeon recommended that an
area 600 by 1,900 feet within the camp limits be drained, cleared of
brush and undergrowth, and resurfaced, because of the presence of
stagnant water and the fact that it might afford an ideal breeding
place for mosquitoes. This area has been cleared and is now in ex-
cellent condition. During the warm weather, hedges and other
places where mosquitoes were likely to gather were regularly sprayed
with kerosene. Practically all the tents and the windows and doors
of barracks were closely screened. With the close cooperation of all
the organizations in camp it has been possible to maintain a high
standard of sanitation.
Fort H. G. Wnght.) N. J. — A summer campaign was instituted to
discover and treat mosquito breeding places, which abound in the
near-by lowlands adjacent to the shore line.
Fori Washington. — Antimalarial work embraced thorough drain-
age and oiling of swampy places. Two sanitary soldiers and two
enlisted men of the line were kept on this work from April to Oc-
tober. A herd of goats has been kept for the purpose of keeping
down the undergrowth. Xo larvae of mosquitoes were found on the
reservation. The barracks are more than ample for the number of
men stationed here.
NORTHEASTERN DEPARTMENT.
Sickness and moHality of troops. — There was one case of typhoid
fever at Fort Revere which made an uneventful recovery.
There were 14 cases of diphtheria reported : 1 at Fort Andrews, 7
at Fort Banks, 1 at Fort Ethan Allen, 1 at Fort Standish, 1 at Fort
Strong, 1 at Fort Warren, and 1 at Newton Technical High School.
No deaths resulted from this disease.
There were 27 cases of scarlet fever reported: 1 at Foit Adams,
10 at Fort Banks, 2 at Fort Gerrv, 1 at Fort Greble, 1 at Fort Mc-
Kinley, 1 at Fort Preble. 7 at Fort Eevere, 1 at Fort Wetherill,
and 3'at Fort Williams.
In September an epidemic of influenza occurred w^hich visited all
posts and vocational units at schools and colleges in this department.
There were 2,777 cases reported, 340 of which were complicated with
pneumonia. One hundred and fifty nine (159) deaths resulted —
6 from influenza and 153 from pneumonia. A few sporadic cases of
influenza remained at the close of the calendar year.
SOUTHERN DEPARTMENT.
Influenza. — On the appearance and reports of the epidemic of in-
fluenza that began in the East, the department surgeon. Fort Sam
Houston, sent telegrams to all post, camp, and base hospitals of this
department to prepare to accommodate at least 10 per cent of their
DEPARTMENTS U. S. 1277
commands that would very probably be infected with influenza and
the subsequent complications.
The post, camp, and base hospitals of this department were
quickly equipped for the anticipated 10 per cent increase of the
command. All hospitals of this department were quickly filled with
patients suifering from influenza and its complications. Additional
medical officei's, nurses, and corpsmen were dispatched throughout
the department wherever the}' were needed most. However, the
hospitals were found to be not sufficient to accommodate all of the
sick, and barrack buildings were taken over and used in many in-
stances throughout the department.
Reports from districts, posts, and stations were received at these
headquarters for the first time September 26, 1918.
All surgeons of districts, posts, and stations were ordered to close
their reports promptly at 12 noon each day, reporting at once by
wire to this office the number of new cases of influenza, pneumonia
develoi)ing, and deaths from same.
These reports were then consolidated in this office and telegraphed
to the Surgeon General daily.
During the following months the total number of influenza cases
were:
September 543
October 13,766
November 1,809
December 825
Total influenza 16. 943
The number of pneumonia cases developing were :
September 15
October 1, 808
November . 424
December . 246
Total pneumonia 2,493
The number of deaths resulting from pneumonia were:
October 460
November 129
December 84
Total deaths 673
During October the epidemic reached its height ; on the yth 1,088
cases of influenza being reported. The greatest number of pneu-
monia developing was reported on the 13th, 222 cases occurring.
On October 11 and 12 the greatest number of deaths occurred,
83 being reported on each day.
The daily averages are as follows:
September :
Influenza 108. 6
Pneumonia 3
Deaths, pneumonia 0
October :
Influenza 444. 0b4
Pneumonia 58. 82
Deaths, pneumonia 14.83
1278 REPORT OF THE SURGEON GENERAL OF THE ARMY.
November :
Influenza ^ 60.8
Pneiunouia 14. 13
Deaths, pneumonia 4.3
December :
Influenza i 26.61
Pnemmonia 7.93
Deaths, pneumonia 2.79
CENTRAL DEPARTMENT.
Fort Leavenworth. — An epidemic of influenza at this post ran
from September 26. 1918, to November 2, 1918. During that period
there were about 1.230 cases of influenza and 164 cases of pneumonia;
with approximately 64 deaths from pneumonia. As shown by the
report there was a total of 1.627 cases of influenza at this post during
the entire year.
Fort Rohinson. — In a recent epidemic of influenza 13 cases devel-
oped, all moderate except on which developed broncho-pneumonia
resulting in death, the only death during the j'ear. All influenza
cases were well isolated.
EASTERN DEPARTMENT.
During the year there were 15,557 cases of influenza and 1,403 of
pneumonia. With 633 deaths from pneumonia and 7 from influenza.
In almost all of the pneumonia cases the primary disease was in-
fluenza. Of the total number of pneumonia cases there were 633
deaths, a percentage of approximately 45 per cent of deaths com-
pared with the number of cases, which shows the virulence of the
disease during the epidemic.
With reference to epidemic di-^eases, the following extracts from
reports of posts and stations in this department may be of interest:
Attending surgeon''s o-jjice^ Neio York City.
During the epidemic of the fall of 1918, our office, as with all medical sta-
tions, became seriously involved in handling influenza patients. Our records
show that of these 17 died from the disease and its complications. In this
connection it is gratifying to commend the efficient, faithful service of my
staff in their dealings with this unusual and dangerous epidemic. Careful
instructions were given my officers to follow such methods as would appear
to be protective against infection from contact with the sick and it is a mat-
ter of satisfaction that none of my officers and men were attacked by the
disease. As a matter of exiieriment, though with considerable doubt as to
its efficiency, this office instituted a control list of volunteers, who sub-
mitted to vaccination with a watery solution of bacilli of inffuenza prepared
by Dr. Parke of the city health department. Sixty-eight subjects were vac-
cinated and up to the present date, so far as we can determine, none of
these contracted the disease. It is true that, at the time this vaccination
was undertaken, the disease was somewhat on the wane, so that it may be a
matter of coincidence that all have escaped. A careful study of the im-
mediate effects of vaccination has been unable to prove by the subjective
symptoms that this vaccination produced a resistance which would protect
against the organism causative of the epidemic. No symptoms following the
vaccination wiiich was given at intervals of 48 hours in three injections
could be selected as common to all who submitted to the treatment. Per-
haps the most common subjective symptom, was a sense of malaise, mental
and physical depression, and a weight in the limbs. Some of the subjects
reported nausea, vomiting, and diarrhea. The great majority, however, com-
plained of few symptoms which would indicate a marked reaction on the
DEPABTMENTS U. S. 1279
part of the 5?ystem. The local reaction was slight in a great majority of the
cases, fairly luarketl in a few. In view of the diverse theories as to the true
organism responsible for the epidemic, it is problematical whether this vac-
cination was responsible for its nonappearance in oiir test list of 68 subjects.
In this connection, while the majority of observers in this city and else-
where have been unable to identify the bacillii of influenza as the organism
per sf responsible for this epidemic, it may be of interest to state that one
of the parhologists on duty at Mineola, First Lieut. Harold Smith, Medi-
cal Corps, United States Army, has been able by a method of his own
to identify the bacilli of Pfeiffer in over 80 per cent of all cases at that
station. It would seem that, from his observation and from the conception
of other bacteriologists who have struggled with the question, this unusually
fatal epidemic was the result of a symbiotic process in which possible the
bacilli of influenza played the most important part, for, as is well known,
the pneumococcus of the various types, the streptococcus haemolyticus, the
l)acillus catarrhalis, and other nonpathogenic organisms had been found in
the secretions of those suffering from the disease and it is not unreasonable
to assume that the toxic products of all these organisms thrown out into
the system in one vast volume might account for the severity and fatality of
the disea.se. In the fatal cases which come under our immediate observation
the profound stupor, high temperature, great prostration, all were suggestive
of an intense toxemia, in many respects very much in contrast with our usual
understanding of a true influenza.
Ca7n'p Crane^ Allentown, Pa. — There ^ve^e two epidemics of
measles; the first 162 cases and the second 46 cases. Three hundred
and forty-eight cases of influenza are reported from this camp. The
following quotation from the report of the commanding officer is
submitted :
Because of the small size of the command at the beginning of the epidemic
the men were so distributed that 100 square feet of floor space were allowed
for each man. The cubicle was not used. Instead the heads of the cots were
placed in the same direction and the shelter halves so hung that the protecting
effects of the cubicle were obtained without interfering to the same extent
with ventilation. In the mess hall the men sat on one side of the tables only.
The mess kits were washed in two changes of water ; they were first dipped in
a trough containing hot soapsuds and then rinsed in water, flowing from
spigots, the temperature averaging about 140° F. The cooks, bakers, and
kitchen police reported at the infirmary each morning at 9.30 for examina-
tion and the application of an antiseptic spray to the nose and throat. Men
with symptoms of respiratory infection or with temperature above normal were
placed in isolation. In the beginning of the epidemic medical officers arriving
at the camp were sent to the surgeon for examination and cultures from the
nose and throat. Awaiting the culture returns, they were isolated. Later,
owing to the difficulty of recovering the influenza bacillus by culture in known
cases of influenza, only those showing symptoms of respiratory infection or
having temperatures above normal were isolated.
Percentages of influenzas, pneumonias, empyemas. ;ind deaths as follows: (a)
Mean strength of command during epidemic, 2,171; (b) total influenzas, 348.
or 16 per cent of ccmunand ; (c) total pneumonias, 51, or 14.6 per cent of in-
fluenzas; (d) total deaths, 12, or 23 per cent of pneumonias; (e) total empye-
mas, 3. or 6 per cent of pneumonias.
Fort Du Pant {Coast Defenses of the Delaware). — Mumps and
measles were preA'alent in the roast defenses of the Delaware during
the spring of 1918. Four deaths from influenza were reported.
East Potomac Park. Washington. D. C. — Surgeon reports that in-
fluenza was well controlled by moving one-half command into tents
and using shelter tents to form cubicles.
Fo7't IJamilton. N. Y. — Surgeon reports that 412 cases of in-
fluenza developed during September and October, of which 62 were
complicated by pneumonia. There were 29 deaths during the epi-
demic.
1280 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Fort Hancock, N. J. — Surgeon reports that the prevailing com-
inimicable diseases from January to May, inchisive, "were measles and
mumps. In January there were 11 cases of measles, 41 cases of
mumps, and 7 cases of epidemic conjunctivitis; the epidemic of in-
Hnenza commenced about September 28, 1918, and increased rapidly,
tlic fir^t death from pneumonia occuring October 8, 1918; the largest
number of deaths in one day was 3. On account of the large num-
ber of civilian employees not living on the reservation, a rigid
<iuarantine could not be enforced. During the epidemic, the hospital
and all verandas were overcrowded and only emergency surgical
work could be done during the prevalence of the disease.
Camp HoJahird, Baltimore, Md. — It was reported that an epidemic
of influenza commenced on September 20, 1918, and soon assumed
such proportion that the men had to be cared for in improvised hos-
pital barracks : all sick men as soon as detected were isolated, and the
sick men and attendants wore masks; on the last two days of con-
valescence the noses and throats were sprayed with a solution com-
posed of boric acid, menthol, camphor, phenol sodium chloride, and
water; the throats of all patients were swabbed once daily with
iodine, K. I., and glycerin; all meeting places were closed, including
the post exchange, Y. M. C. A., etc. ; the quarantine was lifted during
the last week of October.
Fort Howard, Md. — The surgeon reports that there was a mild
epidemic of measles during the early months of the year, and a mod-
erately severe epidemic of Spanish influenza during the months of
October and Xovember; two cases of epidemic cerebrospinal menin-
gitis with one death occurred in April. Eight deaths were reported
due to the " complications of influenza."
Fort Hunt, Va. — It was reported that in September and October
there was an epidemic of influenza amongst a detachment of drafted
men from Camp Meade; some of the men were sick when thev ar-
I'ived at the post, two of these being followed by a fatal pneumonia.
Fort Jay. Governors Island, N. Y. — During the year there were
two epidemics of influenza — one from about March 2 to 23,
and another from about September 15 to November 15. The epi-
demic of March was mild in character and not general among the
troops on Governors Island, confined mainly to the troops of the
casual camp. The epidemic of September, October, and November
was widespread, attacking all organizations. Throughout the latter
four months of the year a mild epidemic of mumps was present
among the troops of the 424th Keserve Labor Battalion, Quarter-
master Corps.
Fort Monroe, Va. — The surgeon reports the following cases of epi-
demic disease:
Cases.
Influenza 2,574
Measles •_ 256
Mumps 183
Pneumonia (38 deaths) 61
Meningitis (4 rleaths) 24
Scarlet fever 23
Fort Mott, N. J. — It was reported that 98 cases of Spanish influenza
occurred during the months of September. October, and November;
6 died.
DEPAKTMENTS U. S. 1281
Fort Myei\ Va. — This post divides the prevalence of influenza into
two periods; first, from January 1, 1918, to Au^ist 31, 1918, and
second, from September 1, 1918: the strength of command for the
first period ^Yas 19,160 ; number admitted to hospital, 1,641, the rate
per thousand being 80 ; the strength of command for the second period
was 5,261; number admitted to'hospital 484, the rate per thousand
being 90. During the first period there were 9 deaths — 7 from pneu-
monia, 1 meningitis, and 1 valvular heart disease : during the second
period there were 20 deaths, 19 from pneumonia and 1 from acute
nephritis, the rate per thousand for the first period being 0.5 and the
rate for the second period being 4.
Fort Niagara, N. Y. — At this post, during the period from Septem-
ber 26 to October 17. there w ere 598 cases of influenza, with 63 deaths.
Provost guard, Pearl and Park Streets, New York City. — During
October and November, this camp developed a considerable num-
ber of cases of influenza, which presented approximately 5 per cent
of pulmonary complications, but was without serious sequels; all
cases of this disease were immediately masked and transferred in
ambulances to General Hospital No. 1, New York City, for treat-
ment. Because of the disease, all energetic measures were taken
relative to ventilation — airing of bedding, washing of floors with
corrosive sublimate, phenol or cresol; disinfection of latrines and
urine troughs, etc. ; the entire cantonment was placed under partial
quarantine : all mess kits and dishes were thoroughly scalded and dis-
infected. There were 67 cases of this disease, of which one man died
at General Hospital No. 1, New York City, from pulmonary com-
plications.
Foi't Story, Va. — The surgeon reports that in January there were
4 cases of influenza ; and in October, November, and December there
were 9 cases of this disease; 3 deaths from pneumonia and compli-
cations following measles were also reported.
Fort Tei^y, N. Y. — During the month of April there was a short
epidemic of pneumonia, and a few cases of mumps, measles, scarlet
fever, and diphtheria ; and 12 cases of influenza occurred during the
months of October and November.
F&rt Totten. N. Y. — There were 240 cases of influenza at this post
and 31 of pneimionia, 63 of mumps, 6 scarlet fever, 8 of diphtheria.
52 of measles: during the epidemic of influenza, starting in Septem-
ber and continuing through until about November 15, nightly in-
spections were made by medical officers, starting at 11.30 p. m. and
finishing about 3 a. m. ; all windows in barracks and cantonments
were kept pulled down all the way from the top, weather permitting:
each man was allowed at least 600 cubic feet of air space; all cots
were lined up with heads and feet alternating; the tents when occu-
pied were kept open and not more than five men permitted to sleep
in any one tent at any time.
Camp Alfred Vail, Little Silver, N. ./.—The surgeon reports that
on September 23 influenza first made its appearance— 15 cases being
reported ; two organizations to which the men belonged were placed
in quarantine, and the quarantine was gradually extended as the
epidemic progressed until September 30. when the entire camp was
placed in strict quarantine ; the wearing apparel of the patients and
the bed clothing were thoroughly disinfected, and the dishes and
the mess kits in camp were washed in boiling water; 267 cases were
1282 REPOKT or THE SURGEON GENERAL, OF THE ARMY.
treated between the dates of September 23 and October 24 ; a number
of these developed pneumonia.
Fort W adsicorth^ N. Y. — There was a mild epidemic of influenza
at this post during the months of March and April. During the
month of October influenza was again prevalent, one case developing
into pneumonia, resulting fatally.
Fort Washington, Md. — The surgeon reports that a number of
cases of pneumonia occurred in the spring of 1918 among the drafted
men, and an epidemic of influenza during the autumn months, sev-
eral cases being followed by pneumonia.
Fort H. G. Wright, A\ Y. — During the fall months, the epidemic
of influenza was severe in New London; the surgeon assumed the
functions of health officer of the village and the civilian portion of
Fishers Island outside the post, and established a quarantine on in-
fected houses, closed schools and churches, and treated all cases; an
early and efficient quarantine was established on the post, so that no
individual, either military or civilian, could enter the post without
going into quarantine barracks for five days; the influenza was
limited to a few scattered cases, being introduced into the post by the
crew of a naval patrol boat on duty at the fort, who were subsequently
isolated on board their vessel.
UNITED STATES GUAKDS.
Detachment 10th Battalion, Submarine Boat Corps, Port Neioarh,
N. J. — From September 11 to 30 there was an epidemic of influenza
at this station, and in other companies of the 10th Battalion, United
States Guards, on duty at the P'oundation Ship Co., Kearney
Meadows, X. J., and the Federal Ship Co., Kearney Meadows, N. J'.
Upon the first symptoms of the disease all men were transferred to
the hospital at port of embarkation, Hoboken, N. J., 77 cases being
thus transferred.
Detachment Company C, 15th Battalion, Newhurgh, N. Y. — In
October, there was an epidemic of influenza at this post — on October
5 two cases developed ; October 7, one case ; October 20, one case ; and
during the night of October 25, 24 cases; four cases of bronchial
pneumonia developed, resulting in two deaths.
Detachment Company B, loth Battalion, South Amhoy, N. J. —
There w-as an epidemic of influenza and pneumonia during the fall
months; one death occurred from influenza complicated by pneu-
monia.
SOUTHEASTERN DEPARTMENT.
Influeiiza among Porto Rican laborers. — On November 14, 1918,
the commanding officer. Fort Caswell, N. C, pursuant to authority
from these headquarters, caused to be removed from the transport
City of Savannah, engaged in transporting laborers to different ports
on the Atlantic seaboard, 134 Porto Rican laborers, who were placed
in the post hospital suffering from influenza and broncho-pneumonia.
Early in the morning of November 15 all Porto Ricans who were
able to leave the ship were taken under guard to the Government res-
ervation, Southport, the remaining sick being removed to the hos-
pital at Fort Caswell. These laborers were badly nourished and
lacked vitality, due to prevalence among them of hookworm. Of
DEPAKTMENTS — U. S. 1283
the total cared for in the post hospital, 29 died of broncho-pneumonia.
The ship was thoroughly cleaned and disinfected, and the command-
ing ofR( er, after a personal inspection of the vessel and consultation
with the post surgeon, decided to place aboard those Porto Ricans
who had been taken to Southport and sail for Porto Rico. It was
thought best by the commanding officer to get these laborers to a
warmer climate as soon as possible in view of their lowered power of
resistance and lack of accommodations at Southport. The over-
crowded condition of the post hospital was also considered in mak-
ing a decision to proceed to Porto Rico. In view of the impossibility
of getting in touch with department headquarters, the post com-
mander reports that he detailed two lieutenants of the Medical Corps
and two sergeants, Medical Department, from the post personnel, to
accompany the transport to Porto Ri^o and assist the one medical
officer assigned to the transport as surgeon. In paragraph 4 of his
report to the commanding general, Southeastern Department, the
post commander reports that —
At the request of the trarsport commander, about 2.000 new Army blankets
were invoiced to the quarterm.-'sTer of tlie transport, so as to give every Porto
Rican a b'anket for the return journey. I regret to state that these natives
were put aboard this transport (at Torto Rico), many of them barefooted and
all of them insufficiently clad in .scanty garments and without a single blanket
or a single nfattress. or any rea.sonnble preparation made for tbeir protection
on the journey to the United States. The conditions on board this vessel
when I inspected it on its arrival at Southport (post office for Fort Caswell)
from Wilmington, N. C, could not have been worse.
No special report is submitted with reference to the influenza
epidemic in view of special reports mailed to the Surgeon General
of the Army from each post, pursuant to directions from that office.
WESTERN DEPARTMENT.
Long before the invasion in tl^e department of the influenza epi-
demic its presence was known throughout the eastern part of the
United States.
Upon the recommendation of the d'^partment surgeon, the de-
partment commander sent to all po^ts and camps an ep'tome of
existing instructions relative to irfluenza, which had been received
from the Surgeon General of the Army on the subject per'^aining to
quarantine, housing facilities, personal precaution, ventilation, care
of bedding, recognition of the disease, detection among troops, hos-
pital accommodations, hospital personnel, isolation of the sick,
isolation of contacts, management of influenza wards and disinfec-
tion.
The proper preparation for the influenza epidemic was enjoined
upon all medical officers. On October 22 the for.owing telegraphic
order was issued by the department co'^imander to all the posts in
the department relative to the use of influenza masks:
Members of this command at stations where influenza exi.sts in epidemic
form will wear suitably constructed gauze masks while in close contact with
comrades or other persons. Organization commands will see that each member
of his conunand is provided with three masks and that they are kept in proper
sanitary condition. The existence of influenza in epidemic form and the
termination of such epidemic are ti be determined by local commanding
officers in consultation with medical officer.s.
142367— 19— VOL 2 20
1284 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The mask was worn at all of the posts during the presence of the
disease and was not discarded until its use was considered no longer
necessary by the local medical officers.
The means of preventing the spread of influenza which have been
employed with the best degree of success are, first, restriction to
the minimum of intermingling of men with comrades and civil
population; second, allowance of at least 50 feet floor space to each
man in barracks; third, early isolation of the sick and suspects, and
treatment in cubicles; and, fourth, wearing of gauze masks. -
SpraA'ing of throat and nostrils twice daily of the men was prac-
ticed at a number of the posts, and it is believed with great success.
In compliance with instructions from the Surgeon General's OflSce,
medical officers at all of the posts in the department were called
upon to submit a special report of their epidemics, which has been
done, and which reports have l)ecn forwarded to the Surgeon Gen-
eral of the Army.
It is not the intention of this office to discuss the various reports
submitted by the different medical officers or their methods, because
the task would be too great. However, many interesting facts have
been brought out in regard to the character of the disease at the
various posts — its severity or lightness, and the character of the
pleural and pneumonic symptoms.
Fort Mac Arthur^ Calif.
The night of October 26-27, between 10.30 p. m. and 3 a. m., 780 drafted men
arrived from northern Colorado, Wyoming, and Oregon. Of these 42 were taken
directly to the hospital suffering from influenza or pneumonia. Twenty-nine
were received the following day. * * * By November 3, 122 of these drafted
men were admitted to the hospital on account of influenza. * * * Fifty-
seven developed broncho-pneumonia within from one to five days after admis-
sion. So virulent was the infection that 11 died within 24 hours of the first
symptoms of the pneumonia, and 8 others within 48 hours, making 19 who died
witliin 48 liours of the first recognized symptoms of pneumonia. The appear-
ance of these patients was from the first that of extreme gravity ; prostra-
tion was marked, and an unusual degree of anxiety was evident ; aching of
the back and limbs was complained of but distinct chill was rare. The tem-
perature in the most severe cases reached 103° to 106° within two to six
hours after onset of the disease. The pulse rarely reached 100 until dissolu-
tion was imminent ; the range was generally 68 to 88, and of good quality.
Fort Rosecrans, Calif.
The epidemic at Fort Rosecrans was extensive and malignant in proportion
to the strength of the command. Total number attacked with the disease, 731,
being 47.46 per cent of the command. Deaths, 53 or 7.25 per cent of men con-
tracting the malady. Percentage of cases of pneumonia to total cases, 14.22
per cent. Percentage of deaths by pneumonia to total cases of pneumonia,
50.90 per cent. All deaths were due to pneumonia. Very few of the cases
could be termed true lobar pneumonia. In these, the infection was secondar\
in what might be called the beginning of convalescence from the influenza.
This " lobar pneumonia " was atypical in most instances. Epistaxis was
common and often profuse and it was noted that this was a favorable symp-
tom as to prognosis.
Fort Stevens, Oreg.
The date of the appearance of the epidemic coincided with that of the arrival
of 1,634 men from Camp Lewis, Wash., the men arriving during the night
after a trip of about 16 hours.
The personnel of this contingent was composed of class A men
who had been examined, vaccinated, and inoculated, and selected for
DKPARTMENTS U. S, 1285
a specific purpose, large mimbers of enlisted specialists being
included.
This fact is mentioned as it bears on the matter of lack of immu-
nity in those who are ordinarily considered healthy in all respects.
A tabulated report kept at this time showed that the segregation
plan was responsible for the confinement of the disease to certain
organizations, one company succeeding in going through without a
case developing in their quarters.
Fort Worden^ Wash.
Until October 16, 1918, no actual cases of influenza had developed with the
command. On that date a detachment of some 315 men from eastern Wash-
ington arrived at the post for duty, coming from a section where the epidemic
had already gained a strong foothold and bringing the disease to this fort.
Immediately upon their entry into the fort they were carefully examined and
;ill men found to be ill were at once sent to an emergency hospital established
prior to their arrival. As admission to the emergency hospital continued in a
daily increasing scale, it became necessary to request from the fort com-
mander larger accommodations. Accordingly, on October 17, an emergency
hospital of larger capacity was established on one of the pervmanent barracks
huilding.s. As the epidemic progressed other barracks buildings were occupied,
until four were in use. In accordance with telegraphic authority, Adjutant
Oeneral's Office, dated September 26, 1918, enlisted men from line organizations
(Coast Artillery) were requisitioned to assist the overtaxed medical personnel
during the emergency ; also a commissioned line officer to act as mess officer
was designated by the commanding officer in order that medical officers
might not be burdened with other than medical work.
The policy of sending inducted men from infected areas to posts
free from the disease resulted in serious local epidemics at the posts
in question, with a correspondingly large mortality.
HEADQUARTERS PHILIPPINE DEPARTMENT.
The conditions of the health of this command have been satisfac-
tory during the past year, with the exception of a severe epidemic of
influenza which occurred during the later months.
The troops have been in service in close proximity to a civilian
population which, during the larger part of the year, has been
affected with a mild epidemic of cholera and a somewhat severer
epidemic of smallpox. This situation has resulted in the occurrence
of several cases of cholera among the Scout soldiers, and also rather
more than the usual number of smallpox cases in both white and
Scout soldiers.
With the concentration of the Scout soldiers into larger posts
nearer the centers of population, the danger from surrounding epi-
demic diseases has increased. This is partly due to the fact that a
great many Scout soldiers are married and live with their families
outside the limits of the military reservation.
This undesirable situation is being remedied as fast as possible by
the construction of Scout "barrios" at each station, but as there is no
appropriation made for the housing of married enlisted men, and as
these barrios have to be constructed partly from native material and
partly from materials left over from torn-down military structures,
this process is necessarily slow, but it is expected that within a year
or so all the authorized families of enlisted men will be under the
sanitary control of the military authorities.
1286
KEPORT OF THE SURGEON GENERAL OF THE ARMY.
There have been two epidemics of influenza ; the first in June was
a comparatively mild epidemic, the second epidemic in November
being much more severe, causing a greater number of deaths, but was
equally short in its duration.
China expedition, Tientsin, China.
There have been no grave sanitary defects at this post. Minor defects con-
(•<>rning disposal of garbage, etc., have been promptly remedied. Drainage of
componnd is rather unsatisfactory, but by constant supervision this defect is
overcome. Ventilation in all buildings occupied by soldiers is very poor and
all barracks crowded when command approaches full strength.
Measures have been taken to perfect disposal of garbage. Septic tanks have
been installed in the Compound by the Real Estate Co. that are quite satis-
factory. Drainage ditches ai'ound compound are constantly watched and
cleaned daily when necessary. The isolation hospital has recently been turned
over to the hospital proper, and all cases of contagious diseases are properly
isolated.
The present sanitary condition is very good and improved generally over
that of a year ago, due to improvements completed during the past year.
The troops are stationed in 10 posts and one subpost. No new posts
have been established. Three stations have been abandoned during
the year, namely, Augur Barracks, Camp Keithley, and Camp Over-
ton. Camp McGrath is in course of being dismantled.
There has been an increase in the admission rate and constantly
noneffective rate due to respiratory disease and tuberculosis.
Part of the increase is due to tne taking of a tubercular survey of
Scouts in this department, and part results from the two epidemics
of influenza, which occurred in May, June, and November. This sur-
vey showed that about 3.5 per cent of the Scouts were suffering from
active or inactive tuberculosis. All these cases have been discharged
on surgeon's certificate of disability.
The comparative admission rates for the posts in the department
for the year 1917 and 1918 are given below :
Posts.
Admission rates
per 1,000.
Camp Eldridge
Camp John Hay
Camp McG rath
Camp Stotsenburg
China Expeiition
Cuarte' de E spana
Fort Santiago
Fort Mi'ls
Fort WUIiam MoKinley
Pettit Barracks
Camp Stotsenburg. — Both the admission rate and constantly non-
effective rate per 1,000 show a slight decrease over those for the pre-
vious year, due largely to disciplinary measures relative to passes
and places visited by soldiers, causing a considerable drop in venereal
rates. The malarial situation shows a decided improvement, the ad-
mission rate per 1,000 being 113.3 against 143,9 in 1917.
China expedition, Tientsin, China. — Both the admission rate and
constantly noneffective rate per 1,000 show a slight increase over
those for the previous year, due largel}^ to the influenza epidemics
that occurred in June and November, 1918. The admission rate for
oepabtments — u. s. 1287
venereal disease shows a slight improvement, being 307.9 per 1,000
against 355.6 in 1917.
Fort Mills.
Dengue, malaria, and iuflueuza have been the only diseases attaining any
marked force. The last, while acute in its incidence, never became extensive
in character, being limited in epidemic form to two companies of Philippine
Scouts. Trachoma among the Bilibid prisoners required considerable attention.
In addition to the physical inspections of soldiers, all civilian employees of the
various departments such as the quartermaster shops, engineering forces, post
exchange, and all servants, together with shopkeepers and similar dwellers in the
native barrio, are inspected monthly. This has resulted in the deportation of
•A number of venereal, trachoma, and other cases.
The present condition of all the hospital buildings in the depart-
ment is very good. During the year the extensive repairs to the
hospital at Camp Stotsenburg were completed, and this is now a
fairly satisfactory structure which will meet the requirements of this
station for a considerable number of years, or at least until the
permanency of this station is decided.
During the year the following improvements were made :
1. The storeroom was removed from building No. 21 to building
No. 11. The compartment system of storekeeping was inaugurted
and a filing system as used for criminals by police departments was
established, both a decided improvement on former methods in vogue
here.
2. The office of the attending surgeon of Manila was removed
from Estado Maj^or and established at the hospital. This has also
proved advantageous.
3. The administration building was remodeled and a second story
added thereto. This was a decided improvement, giving on its first
floor pleasant, air}^ offices for the record force, sergeant major, and
commanding officer, and also a large, roomy library. On the second
floor a very pleasant 12-bed ward and the offices of the attending
surgeon of Manila and a room with bath for the officer of the day.
Much new construction is imcler development for this coming
year such as {a) new officers' ward, (b) new kitchen, (c) new non-
commissioned officers' quarters, {d) new operating and X-ray pa-
vilion, (e) new wards for buildings No. 21 and No. 26, all of which
will tend toward greater efficiency and comfort to all and give to
the department hospital, Philippine Department, a better status.
The plans as approved are to two-story all buildings. The equip-
ment of the institution is also being modernized so that another year
ought to bring forth the best and most modern results.
Two or three efforts have been made to improve the standing of
the sanitary privates detailed by the different Scout organizations.
These sanitary Scouts at present are detailed on the same princi-
ples as medical attendants were detailed for duty at hospitals many
years ago, and with similar results.
It would be very desirable and at the same time a matter of great
economy' to the Government if these sanitary soldiers could be de-
tailed permanently and be given the same opportunities for non-
commissioned rank that the other Scout soldiers have. It is believed
after some investigation that if we could get a desirable class of
sanitary soldiers transferred to the Medical Department for duty
with the Scouts, and they be given a commensurate rank, that the
number of white enlisted personnel at present needed to take care
1288 REPORT or THB SXJBQEON GENERAL, OE TSE ASMiY.
of the sick Scouts could be very largely reduced. Recommendations
along this line have been made to the department commander several
times during the past year but without results up to the present
time.
Malarial fevers. — The malarial situation continues to show great
improvement, the admission rate per 1,000 being 33 against 51.7 in
1917 ; 51.8 in 1916 ; 65.6 in 1915 ; 93.9 in 1914 ; and 125.4 in 1913. The
rate per 1,000 in 1918 was the lowest since American occupation.
Caiiif Stotsenburg. — Although the admission rate for this disease
continued excessively high for the year, a comparison of the figures
shows a gi-eat improvement over 1917. except for the month of
March, 1918.
All cases of malaria, new or old, are treated as soon as discovered and treat-
ment is continued until these patients can no longer be considered as car-
riers of the infections.
Quarters of all soldiers sleeping in the post are screened and each soldier's
bed is provided with a mosquito bar which he is required to keep repaired and
clean and sleep under each night.
Nightly inspections are made by the noncommissioned officer in charge of
quarters to see that this is done.
All mosquito breeding areas in or near the post are liept clear and clean ;
streams are kept running and pools that can not be drained are well oiled. A
" sanitary squad " of 27 men in charge of a sergeant. Medical Department, Is
constantly on duty in the accomplishment of the above.
China expedition.^ Tientsin, China.
There is very little malaria at this post, and no special measures have been
adopted for its prevention. Control of venereal disease here is a serious prob-
lem. For a few months some of the prostitutes were examined every 10 days,
but this was found impracticable as such a small proportion could be inspected,
due to lack of control of conditions in the various concessions. Effort is ex-
ercised to instruct men on the importance of prophylaxis and prompt treatment.
Fort Mills.
No malaria-bearing mosquitoes are found on Fort INIills despite the fact that
the Mariveles is an epidemic focus of malaria. The extramural treatment fol-
lowing a month's hospitalization seems to have relegated recurrences to .an
appropriate minimum.
Smallpox. — There were 32 cases admitted during the year — 10
American and 22 Philippine Scouts, with 3 deaths, of which 2 were
Americans and 1 a Philippine Scout. The admission rate for this
disease was 2 per 1,000; the increase was largely due to the fact that
the disease was epidemic practically during the whole year among
the native (civil) population of the islands.
Typhoid aiul paratyphoid. — No cases reported during the year
for typhoid. No cases reported during the year for paratyphoid.
Dysentery. — The total admission for this class of diseases in the
department for 1918 were 82 as against 93 in 1917, although, con-
sidering the strength of the command, this disease shows a slight in-
crease. The admission rate per 1,000 Avas 5.2 as against 5 in 1917.
Beriberi. — Three cases were admitted at Fort William McKinley,
all Philippine Scouts.
Cholera. — Three cases were reported during the year with two
deaths. Fort William McKinley. one case, died: Camp McGrath,
two cases, one died.
Camp Stotsenburg.
Influenza occurred in two epidemics, the flrst in June and the second In
November. Number of cases, first epidemic, treated in hospital and quarters,
UiCPABTMENTS V. S. 1289
500. All cases In second epidemic, to the number of 161, were treated In hos-
pital. All cases seemed to be of the respiratory type — about 10 per cent of
troops at this station developed broncho-pneumonia as a complication, and as
a result of which one death occurred during second epidemic. Filipinos
slightly more frequently affected than Americans, due to the fact, it is believed,
that they were more frequently exposed. Strict quarantine and isolation of all
cases assisted greatly in mitigating the extent of the second epidemic.
Dental sanitation. — The systemmatic eradication of dental disease
among officers and enlisted men has proceeded during the past year
with excellent results, considering the circumstances of changing
personnel and clientele. The records kept in this office show that all
the troops in this department, with the exception of those of two
or three outlying posts, have been put in a condition of good dental
sanitation. In an experiment that was made with the troops in
China it has been found that it takes three dental surgeons with
their assistants about six months to accomplish the results in dental
sanitation desired. It is probable that it would be a much smaller
project if a second dental survey was made of this command. Xearly
all the dental surgeons in this department have been enthusiastic in
this work.
PANAMA CANAL DEPARTMENT.
Mdlaina fevers. — The most serious danger to troops in Panama
during the past year, as always, has been that of malaria fever,
which has been particularly hard to hold under control with the
large number of men exposed at night on guard over bridges, Canal
Zone locks, secondary stations for Artillery, and river guards. This
has been controlled hy construction of mosquito-proof houses and
employment of mosquito catchers (a system that is too often over-
looked in the control of malaria fever, although carefully described
by Gen. Gorgas in his Sanitation in Panama) ; by education of offi-
cers and soldiers in the elementary knowledge as to how malaria
is spread; prophylactic use of quinine; the recognition and habits
of the Anophedes mosquito, ect. : and the unremitting search for
and destruction of the mosquito breeding and harbor places.
The care with which this work has been pursued is shown by the
report of the comparative rates per thousand for this year and the
year before, which are as follows:
1917
Noneflective rate per 1,000 1.92 2. 53
Admission rate 66.037 109. 00
Death rate 017 .025
Influenza. — Probably the first influenza of the so-called Spanish
influenza type to make its appearance in the American Army, was
that which occurred on the Canal Zone among the Porto Rican troops
shortly after arrival and which spread through the command like
wildfire, but at that time with little serious consequences; when
some months later it made its reappearance at the post of Amador,
and then sporadically from post to post, where it raged furiously,
and efforts for its control were almost without avail.
Probably because of the open-air life of the Tropics there have
been but few cases of this disease complicated with pneumonia and
otherwise, as prevailed generally elsewhere.
AMERICAN EXPEDITIONARY FORCES AND SPECIAL ACTIVITIES.
CHIEF SURGEON'S OFFICE.
1. Personnel Division,
a. organization.
In describing the activities of the Personnel Division it is neces-
sary to consider the offices of the chief surgeon, American Expe-
ditionary Forces, the chief surgeon, L. O. C, liaison officer in Eng-
land, and the special services.
The medical personnel of all American units in France, England,
and Italy was under the supervision of the chief surgeon, Ameri-
can Expeditionary Forces. On INIarch 21, 1918, the chief surgeon's
office moved from Chaumont to Tours and from that time on func-
tioned in Tours as a part of headquarters, Services of Supply.
Orders were issued from headquarters Services of Supply covering
medical personnel under the jurisdiction of the Services of Supply,
and from general headquarters for personnel not under the juris-
diction of the Services of Supply; that is, all personnel belong-
ing to armies, corps, divisions, and the Army Ambulance Service.
Rej^lacements were handled entirely through the Services of Sup-
ply, the Medical Casual Depot being at Blois until July, 1918,
when it was transferred to the First Depot Division at St. Aignan.
This transfer was made with a view to establishing a short course
of training in field work at the First Depot Division, but it was
never possible to carry out this plan because of the constant short-
age of Medical Department enlisted personnel which necessitated
using all available men at all times, the longest stay in the depot
being not more than two weeks. The transfer was a disadvantage
in that it caused some delay in getting officers and men shipped to
points where they were needed at once. The delay was mainly due
to lack of transportation.
The main feature of the work of the Personal Division was an
effort to keep activities of the Medical Department up to par, with
a constantly increasing shortage of medical personnel. This short-
age, while large, was not critical until June, 1918, when the activi-
ties of the American Army at the front increased so tremendously.
The Paris group had hardly been organized when it became ap-
parent that the fears of the Medical Department, as to the short-
age of personnel, had been justified, and in an official investiga-
tion of wounded from the Paris group, the Inspector General recom-
mended that " further provisions be made for emergency reserve
surgical teams and that steps be taken to secure an increase of sani-
tary personnel, both commissioned and enlisted." The chief sur-
geon, in a memorandum of July 30, 1918, to G-4 on this matter,
brought out clearly the situation in reference to the shortage of
1290
A. S. F.— PEBSONNEL. 1291
personnel. " The present surgical teams are obtained bv stripping
the base hospitals of a considerable extent of their surgical staffs
at the very time when their services are needed at the hospitals
because of the active evacuation of wounded from the front." From
June until November, 1918, while replacements came in increasing
numbers, the demand for personnel was such that we were always
falling behind in filling requisitions. The situation at times was
desperate, and in the early days of November it appeared that the
armistice was the onl}- thing that could save the Medical Depart-
ment from breaking under the strain. On November 11 the Medi-
cal Corps was short approximately 250 officers on the division
requisitions alone. This shortage was especially serious, as the allow-
ance of medical officers per division is not very liberal.
The one factor which saved the Medical Department from collapse
was the self-sacrificing spirit of all personnel at the front and rear
in hospitals and in the field. Officers, nurses, and men worked to
the limit of physical endurance, and many instances have been re-
ported where stretcher bearers became so exhausted that they were
unable to lift their hands above their heads. Operating surgeons
were on duty sometimes as long as 72 hours at a stretch, without op-
portunity to sleep more than a few minutes at a time, and the work
done by the nurses was beyond anything which could have been
expected of them. Some base hospitals, organized on the basis of
500 patients, were forced to take as many as 2,100, with very few
enlisted men added to their original personnel and practically all
base hospitals cared for at least 1,500, and some of them as high as
3,000 or more. One hospital with a total nursing staff of 110 cared
for 4,500 patients. This shortage of personnel undoubtedly caused
many nurses to overwork to the point where their health was per-
manently injured.
There is no doubt that the shortage in officers and nurses particu-
larly, contributed to the death of several patients in hospital, as it
was necessary in some base hospitals for the bacteriologists, ophthal-
mologists, oto-laryngologists, commanding officers, and adjutants
to assist in performing operations, and in many cases these special-
ists or officers, comparatively untrained in major surgery, had to per-
form major operations in order to do what they could to prevent loss
of life. Instances were reported where patients died of secondary
hemorrhage in base hospitals when no trained attendant was present
or available.
B. PRIORITY.
Requests for priority of personnel were at first handled entirely
by the office of the chief surgeon. American Expeditionary Forces.
The first estimate on the needs of the Medical Department was made
on the basis of a million men. It called for 10,615 officers, including
the Dental and Veterinary Corps. 22,430 nurses, and 85,477 enlisted
men, exclusive of medical personnel of divisions. This amounted to
about 14 per cent of the total personnel of the American Expedi-
tionary Forces, and was considered by the chief surgeon as a con-
servative statement of our needs ; but on the priority schedule which
was finally adopted, the Medical Department was allowed only a
total of 7.65 per cent, and, as a matter of fact, it was not until Oc-
1292 REPORT OF THE SURGEON GENERAL. OIT THE ARMY.
tober, 1918, and then only after a most urgent representation on the
part of the chief surgeon, that this percentage was reached.
The percentage on which estimates submitted by the Medical De-
partment were based were, in the spring of 1918, as follows:
Officers : Per cent.
Medical Corps 0.8
Dental Corps -1
Veterinary Corps .05
Sanitary Corps .05
1.0
Nurses • 8
Soldiers, Medical Department 9.8
11.6
The grand total of 11.6 per cent was exclusive of the personnel
of the Medical Department. This was believed to be a just estimate
of the number which would insure that the Medical Department
would not fail, and it is certain that if the figures could have been
reached, we could have faced most any emergency with confidence
in our ability to fulfill the demands on us. However, it was never
possible to obtain approval of the shipment of that percentage of
personnel and there was great difficulty in getting even the small
percentage authorized by the priority schedule.
On May 22, 1918, an analysis of the strength of the Medical
Department priority made bj^ the Medical Department representa-
tive with G-1 and General Headquarters showed a total personnel
!5hortage of 13,671, while the total Medical Department strength
was only 48,768. The Medical Department was therefore 30 per
cent below even the low percentage of the priority schedule. In
units, the shortage o"n approved priority included the following:
Base hospitals 25
Hospital trains 4
Evacuation hospitals 8
Venereal hospitals 2
Evacuation ambulance companies 1
Sanitary trains 1
In cases, the shortages of approved priority were much larger,
and a cable sent on August 10 called for a total Medical Department
personnel of 21,700 to be given priority in so far as possible over
divisional units. In this persomiel were the following units:
Base hospitals 53
Evacuation hospitals 39
Evacuation ambulance companies 37
Other Medical Department organizations 27
On September 30 the total shortage of approved priority was
26,497, including:
Base hospitals 26
Evacuation hospitals 31
Convalescent camps 1
Evacuation ambulance companies ^ 32
Hospital trains 3
Mobile laboratories ; 12
Medical supply depots 1
A. £. y.— P£E80NK1UL,
1293
The personnel expected in October amounted to 34,868, while
approximately 18,000 arrived. On November 11, the shortage of
approved priority was:
Officers 3, 604
Nurses 6, 925
Soldiers 28, 023
The following tabulation covering Medical Department personnel
shows the bimonthly totals from June 1 to November 30, 1918. These
totals in some cases are only approximate, as reports of arrivals of
personnel were often delayed in the mail.
Officers.
Nurses.
Soldiers.
Junel
5,198
9,601
14,483
17,487
2,539
4,735
7,522
8,951
30,574
67,140
Aug. 1
Oct. 1
104, 557
Nov. 30
137,403
The highest number of officers, nurses, and men reported in the
American Expeditionary Forces at any time are as follows:
Officers 18, 146
Nurses 10, 081
Men 145, 815
C. PROMOTIONS.
Very few promotions were made during the first 10 months
of the existence of the American Expeditionary Forces. Those ap-
proved by the chief surgeon were as a rule disapproved on the
ground that a definite and methociical scheme of promotion which
would as nearly as possible do justice to all should be presented be-
fore the commander in chief would be willing to make promotion ex-
cept in very exceptional cases. Such a scheme was finally worked
out and presentee! to the commanding general, Service of Supply,
May 17, 1918, bj' whom it was approved May 19, with the following
indorsements :
Heretofore I have generally disapproved recommendations for promotions
in the Medical Corps because they come as isolated cases and presented no
facts hy which a reasonable judgment could be formed as to the relative merit"
of the particular case in comparison with the entire body of medical officers.
As this paper presents a plan which appears to me to be comprehensive, legaJ,
and reasonable, I approve it and recommend that it be adopted as the basis for
promotions of officers in this corps serving witli the American Expeditionary
Forces in Europe.
This plan consisted in giving a numerical valuation to each of
certain more important qualifications of the individual, which, taken
together, determine his efficiency, and then bringing these valuations
together upon a roster. This places the comparison on a mathe-
matical basis and permits its application to the whole body of in-
dividuals, however numerous. It is an entirely practicable and just
method of applying the principle of selection, provided the values
given to the different elements which make up the efficiency figure
are judiciously apportioned. Special professional accomplishments
or unusual administrative ability, energy, and zeal can be given their
proper weight by a special service factor, determined in each case by
1294 EEPOHT uF THB SURGEON GENERAL OF THE ABM¥.
the recommendation of superiors under whom the individual has
served, and the advancement of officers of unusual merit can be thus
secured. The factors which were used in this roster and which
added together made the roster number were:
1. Age. which represents, in a general way, professional experi-
ence.
2. Length of active military service, which represents military ex-
perience.
3. Character of service and special qualifications, which were given
a numerical valve based upon a special report which the immediate
superior medical officer was expected to give in the case of each officer.
This scheme Avas approved in principle bj' the commander in chief
on May 31, 1918, and received a formal approval on June 27, 1918.
This plan worked well in spite of many most disheartening diffi-
culties and obstructions. Medical commanding officers, under the
pressure of war conditions, were slow in preparing and forwarding
their reports of character of service and qualifications upon which
the system was based, and on account of the confusion existing in the
mail service many of these were lost. There were also great delays
at general headquarters, due to the fact that there was an indispo-
sition to grant promotions in the Medical Department until other
staff departments had developed satisfactory systems of promotion.
Finally the medical lists had to be forwarded across the ocean to
Washington and had to undergo long delays at the War Department
before action could be taken upon them. This delay was in the case
of lieutenants increased by the fact that their names were not sent
to Washington by cable, but by mail. Thus the entire summer
passed without any promotions being received by medical reserve
officers, except one small group on June 8. One entire list of 54
captains recommended August 21 for promotion to major was lost
either at headquarters or in the cable office, and these officers, or such
of them as remained in the service, were finally promoted in Feb-
ruar3\ 1919.
On September 4, 1918, the chief surgeon's office was informed that
no more lists would be forwarded to Washington, because a new
order was received authorizing promotions by the commander in
chief. The hope that this rational procedure would greatly simplify
and expedite promotions, was, however, disappointed, because ques-
tions were raised as to its applicability to the Medical Department,
which after much correspondence and many unfortunate delays
were only finally removed on November 7. Four days later the
armistice was signed and all temporary promotions were stopped.
The best use was made of this short period of the open door to
secure 680 promotions; but there remained about 6,500 vacancies
for men who were entitled to promotion by law and by the admirable
character of their service. More than half of these vancancies were
filled by a list forwarded January 15. 1919, and published in orders
on February 17. 1919. Xo regular officers were promoted on this
list, but those recommended on it afterwards received their pro-
motion, about May 1, 1919. Another list of 1.171 names received
favorable action on May 2, 1919, but several hundred deserving
officers whose active service dated from 1917 remained unpromoted
when the chief surgeon was notified that no further list should be
A. E. F. — PEKSONNEL. 1295
forwarded. In most of these instances the recommendations had
not been forwarded at an earlier date because the medical officers
whose duty it was to forward the reports of character of service and
qualifications had failed to give the necessary data upon which the
scheme of promotion was based, such as the length of active service,
age, and date of last promotion.
Personnel Division, offico of chief surgeon, lines of communica-
tion.— The first di\dsion of the office of the chief surgeon, lines of
communication, into personnel, supply, and sanitation divisions was
made during September, 1917. The Personnel Division handled all
medical personnel of lines of communication directly until January.
1918, when the control of personnel was decentralized and the sec-
tions handled all personnel in the sections except that of base
hospitals. A medical replacement camp at Blois was planned and
was practicallv organized when it was taken up as a casual officer's
depot; but still handled Medical Department causuals.
The situation as regards personnel was always trying, even in the
earliest days, berause of the lack of casual officers and men, and it
was not until September 30. 1917, that any fairly large number of
medical rasuals arrived in France. On September 30. 1917. about
650 men landed. Due to the lack of a replacement camp, it was neces-
sary to assign these soldiers in groups to various base hospitals which
had already arrived and had barrack space to ac^-ommodate them.
Another casual detachment of 250 men arrived in November. 1917.
This was the last detachment of any size which arrived for several
months, and it was only after urgent appeals had been sent to the
Adjutant General that casuals began to arrive in the latter part of
February and March, 1918.
The greatest diffirulty during January and February and 1918 was
in tracing Medical Department men who arrived in France, and it
was estimated that practically a thousand men badly needed by the
Medical Department succeeded in transferring to the line while
passing through the 41st Division, which at that time was acting as
a depot division. Another factor which led to a great need of Medi-
cal Department soldiers was lack of labor troops which could be used
in the construction of base hospitals. This necessitated the use of the
Medical Department soldier^^ attached to base hospitals in hastening
the construction of the buildings and there were complaints from all
sides of the lark of sufficient labor to handle the construction as well
as the routine work about buildings already constructed.
The situation on the arrival of Base Hospital Xo. 34, Der-ember 27,
1917, was such that this hospital for a time practically ceased to exist
as a unit, the personnel being scattered in camps located in many
different parts of France. At one time this hospital had personnel in
11 different stations.
The growth of the expeditionary forces constantly led to an in-
crease in the number of camps and camp hospitals. The poli-^y of
general headquarters was that no permanent personnel should be sup-
plied camp hospitals. This led to the use of the medical personnel
attached to units in training at the camps, and when these units left
the medical personnel naturally had to accompany them, and it was
therefore necessarv that a certain percentage of permanent personnel
be assigned to each camp hospital. The policy mentioned above was
later changed and estimates made for permanent personnel for all
1296 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
camp hospitals. This subject was presented very forcibly by major
general in his letter to the commander in chief under date of Feb-
ruary 8, 1918. In this letter he made the following statement :
I may say that no organization arrived in France witliout a large distribution
of measles, mumps, meningitis, and scarlet fever. It required personnel to
decently care for those unfortunates, and I am sure that they are not at this
moment getting the care they might have wei'e the personnel available.
This undoubtedly was the only solution to the difficulties arising
through the use of personnel passing through camps, in handling
sick in camp hospitals, as their interest in the camp hospitals was not.
great, and the interference in their training for field work was a
marked handicap to them upon their departure for the front. Also
when an organization left camp it naturally desired to take its medi-
cal personnel with it. But this could not be done with an abandon-
ment of the sick remaining in camp hospitals.
Activities between Novemher 11^ 1918, and May 31, 1919 — Imme-
diately after the armistice, a large number of Medical Department
units and casuals was shipped from the United States, approximately
900 officers and 9,000 men and 1,500 nurses being sent. This per-
sonnel, with the decrease in work in France, led to a slight surplus
in Medical Department personnel for the whole American Expedi-
tionary Forces, but this surplus was soon disposed of through the re-
turn of officers and men to the United States. The work of the Per-
sonnel Division increased tremendously during December because of
the large number of applications for immediate return to the United
States for discharge. The first application for discharge reached
this office two hours after the armistice went into effect, and was in
the shape of a telegram. The applications for discharge have not
been counted, but are estimated at about 6,000. It is estimated that
over 70 per cent were from officers who arrived after September 1,
1918. A large number of casual officers were released shortly after
the armistice, mainly for the purpose of return to the United States
for discharge because of teaching affiliations, and because of these re-
leases it became necessary to hold many officers who also desired im-
mediate return, but by the middle of January the weekly net loss of
officers had reached 400 and varied between 100 and 600 each week
after that date. On April 26, the total personnel remaining in France
was:
Officers 12, 544
Nurses 6, 238
Men 121, 351
Civilians 847
On May 31, one officer remained on duty with the British Expedi-
tionary Forces, while on November 16 there were on duty with the
British Expeditionary Forces 944 officers, 656 nurses, and 1,314 men.
The whole United States Army Ambulance Service on duty with the
Italian forces was returned to the United States about the 1st of
April.
Because of the large number of base hospitals released for return
to the United States within a few weeks after the armistice, it was
necessary to remove a certain number of junior officers from each
unit in order to supply demands of personnel for the army of occu-
pation and in the various base sections and also to replace some of-
A. E. F. PERSONNEL. 129T
fleers of long service in the American Expeditionary Forces who had
urgent reasons for return to the United States. This action naturally
ledto some feeling on the part of those who were detached from their
units as they felt that they were being discriminated against.
(d) difficulties.
One of the greatest difficulties encountered was the keeping of rec-
ords of stations of offirers, nurses, and men. due to delay or loss in
the mail, carelessness of rendering reports, etc. Perhaps the greatest
factor in causing this difficulty was the fact that under general orders,
American Expeditionary Forces daily change reports were rendered
direct to the central records office and many officers thought that these
records were forwarded to the chief surgeon. It was only after the
armistice when services became somewhat more settled that it was
possible to straighten out our records, and even at the best, there has
always been uncertainty as to the actual location of many officers,
nurses, and men. During the summer of 1918 orders were issued that
all personnel records would be kept by the central records office and
that no staff department would retain any personnel records. This
order was the result of the belief that centralization of records was
the only efficient method and it undoubtedly would have prevented
duplications of records, but it was believed then, and is still, that such
action would have utterly disrupted the Medical Service. Fortu-
nately, the order never was carried into effect, and the personnel
records were retained in this office to the end of the war.
Conclusioiw. — It is believed that the working of the Personnel
Department would have been much smoother if we had had a per-
sonnel officer at British general headquarters in France, whose du-
ties would have been to keep the personnel office informed as to the
stations, duties, abilities, etc., of all medical officers on duty with
the British Expeditionary Forces.
Personnel of special qualifications should have been handled
through one office.
At least one regular officer of experience, and preferably several,
should have been assigned to duty as traveling representatives for
this office to visit all Medical Department units and to keep the
office better informed as to the actual duties, abilities, etc., of all
medical officers. This function was performed by the consultants,
but as the headquarters of the special services were separated from
the office of the chief surgeon and the method of communications
slow and uncertain, a great deal of the information never reached
the chief surgeon's office.
A large reserve of officers, nurses, and men for surgical teams and
other emergencies should have been available at all times. It is esti-
mated that at the time of the armistice surgical teams actually needed
would have absorbed 2,000 officers, 4.000 nurses, and 4.000 men.
2. Nursing Department.
On January 1, 1918, there were 1,503 nurses in the American Ex-
peditionary Forces, about 600 of whom were on duty with the Brit-
ish Expeditionary Forces. On January 1, 1918, there were 10,057
1298 REPORT OF THE SURGEON GENERAL OF THE ARMY.
nurses in the American Expeditionary Forces, including approxi-
mateh' 650 with the British Expeditionary' Forces. When the Ger-
man spring offensive began on March 28, 1918, the commander
in chief phiced all the American Expeditionary Forces at the com-
mand of Marshal Foch. At that time there were 500,000 troops
in France, and with the plan for 300,000 to come in June, 300,000
in July, and 200,000 each month until January 1, 1919, it can readily
be seen that the necessity of increasing the medical personnel was
great.
On March 30, 1918, the estimated existing shortage of medical
personnel included 400 nurses. At this time there were only 2,088
nurses in France, approximately 700 of whom were with the Brit-
ish. About the middle of April the shortage of medical personnel
was most acute, in( hiding a shortage of nurses which was esti-
mated at 1.121. At this time the statement was made that a " break-
down in Medical Service was threatened," and on May 3, 1918, a
cable was sent asking for the immediate dispatch of 555 nurses.
A report on July 27 was that the " recent fighting has been so
severe that the resources of the Medical Department have been prac-
tically exhausted in so far as personnel is concerned." On August
10, 1918, a cable was sent from General Headquarters requesting
absolute priority for medical organization including 2,312 nurses.
A thousand nurses arrived in August, but a little later the situation
as regards medical personnel was described in the War Diary ot
September 7 as follows : " Base hospitals have been stripped of every
available officer and nurse for the purpose of forming surgical teams,
and in the event of extreme activity of our troops at the front there
undoubtedly will be the greatest difficulty in taking care of the
patients sent back to the base hospital in the Services of Supply.
" The situation was saved only by the self-sacrificing spirit of
officers, nurses, and men. During the period from July 18 to Novem-
ber 11, the amount of work done was such that no praise would be
great enough. It was not at all uncommon for nurses to work 14 to
18 hours a day for weeks at a time, and some hospitals with only
70 or 80 nurses rared for patients up to the number of 2,100." One
hospital had 5,000 patients at one time with 70 nurses to take care
of them. There were many other hospitals with equally dispropor-
tionate figures. " Officers, nurses, and men worked themselves to
the limit of ph3^sical endurane, and that limit was beyond any
which might be expected of human beings." The next two months
brought very nearly 3.000 more nurses, and when the armistice was
signed there was a total of 8,587 nurses. At this time there were ap-
proximately 6,925 nurses short of actual needs, (p. 59, Rep. M. D.)
On that date there were 184.421 American soldiers occupying hos-
pital beds in 153 base hospitals, 66 camp hospitals, and 12 conval-
escent hospitals
It may be of interest to show how many nurses were on duty in
the centers where the largest number of patients were grouped at
this time. At Mesves center on November 16, the center's " peak "
day, there were 20,186 patients in the 10 hospitals, cared for by 394
nurses. At Allerey on the 17th, in their 6 hospitals there were 17,140
patients, cared for by 360 nurses. Mars, on the 16th in 6 hospitals
had 14,302 patients, cared for by 493 nurses. And at Toul on the
A. E. r. — PERSONNEL. 1299
28th of November in 7 hospitals there were 10,963 patients cared
for by 320 nurses. The maximum number of nurses at these centers
at one time was : Mesves, 650, on January 4 ; Mars, 612, on December
4; Toul, 439, on February 1.
It is to be noted that the failure of nurses to arrive in France was
not due to the fact that nurses were not available and read3\ but
was due entirely to lack of transportation for them. The need of
brinofing over combat troops put all other needs in the background.
The shortage of nurses during the summer and early fall was great.
Those already in France were pushed to their limit, but no com-
plaints were made and each woman devoted her efforts to finding out
how she could do the work of two nurses or even three instead of
one.
Between the signing of the armistice and the time of our greatest
number of nurses, on January 25. 1919. nearly 1,500 nurses arrived,
more than came over in all of 1917.
The plan of appointing center chief nurses was first put into prac-
tice in an informal way in November, 1918. This was a natural
development of the plan of grouping hospitals into hospital centers
which came about when the need of changing the capacity of a
standard base hospital from 500 beds to 1,000, to be doubled in time
of emergency, made the grouping necessary in order to use personnel
to the greatest advantage. The scheme of using a center chief nurse
developed in every place in which it was tried, with possibly one
or two exceptions, where the failure was due to the fact that the
chief nurses appointed were unable to obtain cooperation.
The health of the nurses of the American Expeditionary Forces
during this year has been on the whole very good. Following the
periods of heaviest work, it was natural that periods of increase sick-
ness should occur. The influenza epidemic of the fall did an amount
of damage to the Nurse Corps which corresponded to that done to the
men of tlie Army. The deaths of nurses by months during this year
are as follows: Januar}^, 3; February, 1; March, none; April, none;
May, 1; June, 3; July, 2; August, 1; September, 8; October, 41;
November, 12; December, 4; total, 76.
From the time the first nurses landed in France in May, 191 <, to
January 1, 1918, there was only one death among them and by Sep-
tember 1 there had been only 12. By this time there were 5,700
nurses in the American Expeditionary Forces. Pneumonia was the
greatest cause of death and meningitis the second. Only two nurses
have been wounded at all seriously by enemy action. A third had
her clothes torn to pieces and was slightly scratched, but no nurses
have been killed by enemy action.
The Army supplied no equipment for nurses' uniform supplies until
the end of December. In July requests for equipment for nurses
were sent from the office of the chief nurse through the chief quarter-
master of the American Expeditionary Forces, but no articles were
ready for delivery until late in December. Previous to this time
the replacement of clothing and shoes was made through the Ameri-
can Red Cross in Paris without whose assistance great discomfort
and actual hardships would have resulted. The nurses of 11 mobile
hospitals Avere completely outfitted with all the needed equipment
for life at the front and hundreds of nurses in evacuation hospitals
142367— 1&— VOL 2 21
1300 REPORT OF THE SURGEOIST GENERAL. OF THE ARMY.
and on hospital trains were also ^iven many extra supplies. The
thousands of nurses in the bases all over France received not only
replenishment of the regular uniform equipment, but additional
articles which added greatl}^ to their welfare and comfort.
No units of nurses were returned to the United States from
France before January, 1919, but one group left England the last
week in December.
3. Dental Service.
The dental service of the American Expeditionary Forces has been
highl}^ satisfactory. It has materially assisted in maintaining a con-
dition of health and physical efficiency with the troops, whereby a
large percentage of effectives were kept available for front-line
duty. This service comprised a total personnel (conmiissioned and
jnlisted) of approximately 4,000, more than 2.000 of whom were
graduate dentists, with a total of 1,876 commissioned officers. The
remainder were enlisted dental mechanics and dental assistants,
largely di-awn from undergraduates in dentistry. The activity of
the Dental Corps in this campaign has maintained the reputation and
traditions of American dentistry, and represents the world's record
for dento-military organization and achievement.
A. ORGANIZATION.
The requirements of our large Army, on active campaign, made
it necessary to organize the Dental Corps in conformity with
established military precedents and customs. This was made
possible for the first time through legislation passed October
(3, 1917. By this organization, each division was allowed 30 dental
officers, under direction of a senior officer, the division dental sur-
geon. Division dental surgeons functioned under the general direc-
tion of division surgeons and were charged with the responsibility
of coordinating, supervising, directing, and inspecting the dental
service of the divisions. Thirty dental officers to a division made an
excess of officers to the prescribed rating of one dental officer to 1,000
men, but this was necessary on account of the several units of a
division with less than 1,000 men, operating as separate organization,
i. e., field signal battalions, machine gun battalions, etc. With units
of command of sufficient size to require more than one dental officer,
the ranking dental officer was designated regimental dental surgeon
and charged with the responsibility of conducting the dental service
thereof. After complete organization of the American forces and
the creation of Army corps, it became necessar}^ to appoint corps
dental surgeons, who functioned under general direction of the corps
surgeon. These administrative officers were charged with the co-
ordination and direction of all the dental service of their respective
corps, which included the inspection, supervision, and instruction of
the several division dental surgeons, and supervision and control
of all dental officers assigned to duty with corps troops. After the
organization of field armies, experienced dental officers were assigned
to duty as chief dental surgeons thereof, under general direction of
the Chief Surgeons of the armies. They were charged with the
resDonsibility of coordinating the dental service of the entire com-
A. E. F. PEKSONKEL. 1301
mand. Their administrative activities were carried on generally
with corps and division dental surgeons, who rendered reports and
returns, through medical channels, to them, and their reports and
returns were made to the chief dental surgeon, in the office of the
chief surgeon. American Expeditionary Forces. The Services of
Supply was organized with a supervising dental surgeon in charge
of each section thereof, who was charged with the responsibility of
coordinating and conducting the service under general direction of
the surgeon, making his reports and returns, through medical chan-
nels, to the chief surgeon. American Expeditionary Forces. Hospital
centers, replacement depots, and later, embarkation areas, were
organized with local dental super\'isors, usually selected from among
the ranking dental officers of those commands. Their duties, in ad-
dition to regular professional service, were to centralize and co-
ordinate the professional service and the supply situation in their
respective commands under general direction of the commanding
officer, or surgeon, through whom their reports and returns were
rendered to the chief surgeon, American Expeditionary Forces.
B. PERSOXXEL,
The full quota of commissioned personnel at the rate of 1 to
1,000 was never complete in the American Expeditionary Forces,
there being a shortage of over 300 dental officers at the time of sign-
ing the armistice. This was largely due to the fact that many com-
mands were organized in France, the phenomenal growth in strength
of certain commands sent overseas (one regiment of Engineers
increased to over 20,000), and the necessity for giving approxi-
mately three additional dental officers to each combat division over
and above pro rata requirements. However, a general scheme for
equalization was carried out whereby each separate command was
assured of having dental service. The full quota was eventually
reached by absorption and reassignment of about two-thirds of the
dental personnel from each division released, a skeletonized dental
service only being authorized to return with those divisions for the
purpose of rendering professional services during the voyage. This
embargo was removed in April. 1919, when the full complement of
dental officers of each division was authorized to accompany the or-
ganization to the United States. Of the large number of dental offi-
cers serving in the expedition, 79 belonged to the Dental Corps,
United States Army (Regular) ; 12 to the Dental Corps, United
States Navy: about 225 to National Guard organizations; and the
remainder to the Dental Reserve Corps. The services rendered by
the Xavy dental officers was of the highest professional type and
characterized by a splendid esprit de corps and devotion to duty.
The services of National Guard officers was of that experienced type
of military and professional duty usually expected of them. That
rendered by the large number of reserve officers has been marked
by close application to duty, willingness to meet any and all re-
quirements of the service, and by a degi'ee of loyalty and deA'otion
to their country that is highly commendable. !Many of these officers
have been men of outstanding professional and educational quali-
fications in civil life. Their special services, rendered in the
1302 REPORT OF THE SURGEON GENERAL OF THE ARMY.
higher professional and educational positions in the American Ex-
peditionary Forces, have redounded grcatl}- to their credit and to the
distinction of the American dental service. A majority of the
higher offices of administration were filled by selection from the
older and more experienced officers of the Eegular Dental Corps.
While the greater number of dental officers served with the Army
in France, a large number arriving with organizations in England
were detained there temporarily for duty at the several hospitals,
aviation camps, and instruction centers of the American Army, then
being trained under British direction. Several dental officers were
detailed for duty with organizations serving in Italy and northern
Russia, and in March, 1919, 20 dental officers, with enlisted assist-
ants and full portable outfits, were sent to the United States mili-
tary mission, Berlin, Germany, for special duty in the Russian mili-
tary prison camps.
C. EQUIPMENT AND SUPPLIES.
Each dental officer leaving the United States for overseas duty
was supposed to be fulh' equipped for field service with portable
dental outfit, carried as baggage. Through exigencies of transporta-
tion these plans often miscarried and officers arrived in France with-
out their equipment and in many instances were never able to locate
it. This condition can be understood when consideration is given to
the vast number of men, munitions, and rations that Avere rushed to
France during the summer months of 1918, which taxed to the utmost
the transportation facilities and rendered it almost impossible to
find small units of equipment hurriedlv unloaded and stored in the
warehouses at congested ports. The problem of supplying such
officers with dental outfits proved to be one of considerable magni-
tude. An adequate stock of dental equipment and supplies for field
service had been provided by timely requisitions, but delays in the
shipment and receipt of these supplies seriouslj' hindered our serv-
ice in many instances. An automatic monthly dental supply, based
upon the embarkation of everj^ 25,000 men for overseas duty be-
came effective early in 1918, but owing to accidents in shipment,
due to enemy interference, to congestion in handling supplies at base
ports, to lack of facilities for early rail movement to destination in
France, and to other causes, it became necessary to make emergency
purchases of dental equipment and supplies in France. This was
carried out through the medical member of the general purchasing
board, and proceeded to such an extent as to seriously embarrass
the local market, the French authorities placing an embargo on the
further purchase of dental supplies by the American Army. The
resources of dental supply were investigated in England and a large
amount of dental laboratory equipment and supply was purchased in
London and ordered shipped to the supply depots in France. A re-
.striction was also placed on the further purchase of dental material
in England by the British war office. This particular purchase of
much-needed equipment never reached our depots, as the ship carry-
ing it was sunk by enemy submarines in crossing the Channel. Sev-
eral tons of equipment sent from the United States was also lost by
the sinking of one of our transports off the Irish coast. During a
period of several months it became necessary to strain to the utmost
A. E. F. — PERSONNEL. 1303
our supply resources and to modify field equipment accordingly.
Actual field experience in combat divisions demonstrated the fact
that our portable dental outfits were not practicable for field service,
owing to the bulk and weight of the several containers. Dental
equipment was accordingly modified and reclassified into camp equip-
ment; full portable outfit, for such detached organizations in the
Services of Supply as could furnish transportation for same; modi-
fied portable outfits for combat divisions, consisting of the essential
equipment and supply in three chests for carrying on field den-
tistry; campaign equipment for divisions in battle areas, consisting
of the dental engine chest and contents, plus the contents of an
emergency dental kit, containing cloth instrument rolls for a few
essential instruments and medicines, and a small amount of supplies
contained in hospital corps pouches, carried slung over the shoulders.
Instructions were issued in August, 1918, that each dental officer in
combat divisions would carry with him at all times one of these
emergency kits and thus be available to render first aid dentistry
for the relief of pain and for minor oral surgical or dental opera-
tions. These modifications of dental equipment solved many of the
transportation problems of the dental service in combat divisions.
For the purjDOse of making the dental service of divisions a complete
entity, capable of remed^ang any dental defect that might be pre-
sented, a portable dental laboratory, containing, in one chest, all
the essential equipment for prosthetic service, was provided. A
specially qualified dental mechanic was assigned to duty therewith
as an assistant to the dental officer in charge. The dental laboratory
was usually located with one of the division field hospitals.
The transportation of dental equipment and supplies has ever
been a source of irritation to division commanders, transportation
officers, and division surgeons. This was largeh' due to the failure
of Tables of Organization in not making provision for either dental
personnel or dental equipment of a division. Much loss of equip-
ment and consequent loss of dental service in several di\dsions has
resulted thereb3^ The First Division, moving into combat area in
May, 1918, was forced to abandon their entire dental equipment
through lack of transportation facilities. This was afterwards found
and salvaged. At that time it required the entire resources of our
Medical Supply Depot No. 3 to resupply emergency equipment for
this division after its arrival in the new area. It is recommended
that provision be made in Tables of Organization for dental per-
sonnel, dental equipment, and transportation facilities for each.
Plans for the development and operation of dental sections of med-
ical supply depots were proposed, whereby this branch of the supply
business would be carried on at each of the issue supply depots,
storage warehouse, and the receiving depots at base ports, under
direction of dental officers and an enlisted force acquainted with
dental merchandise. The plan was never put into operation. In
order to take advantage of the vast fund of experience gained during
this campaign a board of three experienced -dental officers was se-
lected for consideration of modifying dental equipment and sup-
plies to meet actual field conditions. The report of this board has
been forwarded to the medical equipment board. Their recom-
mendations will greatly modify dental equipment and reduce to
1304 REPORT OF THE SURGEON GENERAL OF THE ARMY.
a minimum the size and number of containers for the articles
deemed necessary. The need for dental ambulances — mobile dental
offices — has been indicated many times during the campaign. All
efforts prior to the cessation of hostilities to obtain tonnage priority
for their transportation to France has met with failure. The use
of dental ambulances with outlying commands or detachments with-
in divisional training areas, in the rear of combat sectors, or with
the Air Service, would have proven of great value, inasmuch as these
mobile units could proceed to the various locations with little loss
of tune, either in actual transport or in the unpacking and repacking
of equipment ordinarily required of dental officers on itinerary
service. Only two dental ambulances have been utilized in the
American Expeditionar}^ Forces. Both were presented to the serv-
ice— one through individual donation and the other through the
American Red Cross. Dental Ambulance No. 1 has been functioning
with mobile motor transport organizations in the zone of the armies,
and Dental Ambulance Xo. 2 has been operating with various air
squadrons and aviation groups in the advance section. During the
months of February and March, 1919, large amounts of delayed
base equipment and supplies arrived. While this was too late to
meet the originally projected requirements of the service, it has
been utilized to the fullest extent in carrying on a more thorough
and complete practice of dentistry at the large dental infirmaries at
base ports. Owing to the gradual disintegration of the service, the
return of combat divisions, the release and abandonment of hospitals
and of hospital centers, a large proportion of this base equipment
will not be used. Every effort is being.made to keep this expensive
material in original containers and to have it reshipped to the
United States for retention and utilization in the service. The
following special appliances have been developed in the American
Expeditionary Forces to meet the requirements of the ser^ace :
Ariiex denture. — ^A denture cast in aluminum of one piece, wherein
the base plate and the teeth themselves are reproduced in this light
inexpensive metal. This process of plate construction lends itself
admirably to the military service, inasmuch as more than 98 per
cent of the dentures required are for only partial loss of teeth. For
full dentures, well-matched porcelain incisors and cuspids are at-
tached thereto, solely for esthetic purposes. This appliance ma-
terially reduces the expense of dentures, supply stock, and necessary
equipment.
Emergency kits. — This equipment was developed solely for the
purpose of making it possible for a dental officer and his enlisted
assistant to carry with them at all times the necessary dental instru-
ments and medicines for emergency treatment.
Folding trench chair. — This article was developed for the purpose
of supplying a seat with stabilized headrest for convenience in
rendering dental service in trenches and dugouts. It is made of
aluminum, reinforced by steel, and can be folded and carried in a
musette bag with the two pouches of the emergency kit, weight 4^
pounds.
Amex casque. — A surgical appliance for face and jaw reconstruc-
tions, an evolution of a similar article used in the surgical service
of the British and French Armies. It consists of an adjustable steel
band, fitting aroimd the circumference of the head, with adjustable
A. E. F. PERSOXXEL.
1305
cranial bands and an adjustable perpendicular rod and horizontal
face bow. Its use in facial and jaw reconstruction permits of ab-
solute fixation for either soft parts or osseous fragments, and is in-
^ tiluable in this class of highly specialized surgery.
D. CHARACTER OF DENTAL SERVICE RENDERED.
During the period when divisions were in trainmg areas, it was pos-
sible to conduct a high-class tooth conservation service with a view of
maintaining dental fitness and military efficiency. Primary endeavor
was made to inspect the mouths and teeth of the entire personnel of or-
ganizations for the purpose of first rendering oral prophylaxis, i. e.,
extracting all broken-down teeth, putrescent roots, evacuating ab-
scesses, and removing rough calcareous deposits, this to be followed
by such filling operations as were deemed practical for tooth con-
servation and masticatory function. During combat activities, when
dental officers were equipped either with modified outfits or with emer-
gency kits only, it was impossible to give more than emergency
treatment for the relief of pain. This service comprised free ex-
tractions, minor surgical operations, medicinal applications, and a
few plastic fillings, merely sufficient to return a soldier to the front-
line without appreciable loss of time.
After the armistice was signed and troops returned to rest and bil-
leting areas, the character of dental service changed again to the
careful consideration of tooth conservation, masticatory restoration,
and prosthetic construction. Large dental infirmaries were organ-
ized in base sections of the Services of Supply and embarkation
areas, where base dental equipment and complete laboratories were
installed. Here a modern practice of dentistry was carried on to
the fullest extent. Reports of dental operations for the last few
months show satisfactory evidence of the high character of dental
service rendered and the vast number of officers and men served. Our
records for March, 1919, as compared with September, 1918, show an
approximate gain of 300 per cent in dental activities between periods
of active field operations and rest. The consolidated report for Feb-
ruary, 1919, shows 245,524 persons treated. 443,788 operations per-
formed, including 376,655 fillmgs and 67,133 teeth extracted, and
the following prosthetic operations : 1,370 crown and bridge con-
structions and repairs; 833 denture constructions and repairs. At-
tention is invited to the following summary report for the six-month
period up to and including March, 1919 :
E. SUMMARY REPORT OF DENTAL WORK FROM OCT. 1, 1918, 'tO MAR. 31,
1919.
Persons
treated.
Teeth
treated.
Fillings.
Minor.
Teeth
ex-
tracted.
Crowns.
October | 87, 956
November 10^, 868
December 113, 979
January . . ; 145, 140
February i 245, 524
March 115, 433
812,900
24,567 !
28,490 .
36,046
53,269
53, 172
39, 145
234,689
97,883
98, 527
104, 255
155, 78:}
376,655
147,349
980,452
1,853
2,500
2,283
3,250
4,467
2,312
16,665
33,444
32,760
31,665
4,453
67, 133
23,924
193,379
279
411
413
628
841
742
1306 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
E. SUIVIMARY REPORT OF DENTAL WORK, ETC. Continued.
Crowns
repaired.
Crowns
and
bridges
reset.
Build-
ings.
Build-
ings
regis-
tered.
Den-
tures.
Den-
tures
repaired.
October
201
231
222
282
380
242
3,040
3,852
4,442
5,422
7,990
3,705
76
85
32
98
132
139
211
239
274
270
479
247
1,131
1,504
628
686
861
618
344
309
269
Januarv
314
Febriiarv
486
March
215
1,558
28,451 562
1,720
5,428
1,937
A group of 40 specialists in general surgery and dental surgery
for special maxillo-facial surgical service arrived in France during
May, 1918. The dental personnel of this group came under the acl-
ministrative control of the dental division, chief surgeon's office.
Maxillo-facial teams composed of one surgeon and one dental sur-
geon were assigned to the important hospitals or hospital centers,
and several specially qualified officers were assigned to the Vichy
Hospital center, where Base Hospital No. 115 was designated the
head hospital. These specialists came over under direction of a
well-known oral surgeon, who upon arrival was designated the chief
consultant in maxillo-facial surgery. The following summarized re-
port is compiled from the records received at this office. It is under-
stood some of the special reports were forwarded through error
to Washington, or otherwise disposed of with hospital records:
Cases :
Gunshot wounds (battle) 878
Other causes 124
Total 1,002
Gross classification :
Injuries to bones • 976
Injuries to soft tissues only 26
Total 1.002
Fractures :
Mandible 596
Mandible, with appreciable loss of substance 126
Maxilla 199
Other bones of face 55
Total 976
Operations :
Bone wirings 22
Debridements 131
Drainage 160
Fragments removed (teeth and bone) 196
Foreign bodies removed 104
Plastic operations 129
Blood transfusions 2
Tracheotomy 5
Ligation of arteries 22
Total 771
A. E. F. — PERSONNEL. 1307
Splints and appliances :
Interdental splints (1 jaw) 538
Intermaxilliary splints (both jaws) 225
Intermaxillary wiring 300
Prosthetic restorations 40
Total 1,134
Splint classification :
Emer,£rency 63
Cast metal 369
Swedged metal 137
Band and wire 178
Vulcanite 47
Total ^ 794
X rays reported 369
Deaths reported 8
The term "interdental splints" was selected to represent any splint
made for one jaw, either upper or lower. The "intermaxillary splint"
was the term used where splints were made for both upper and
lower jaws and connected by some mechanical method for pui*pose
of fixation. All the intermaxillary splints shown in the above table
were connected either by the pin-and-tube method or by inter-
maxillary wiring. Thirty-eight of the above listed splints were of
the open-bite model, 20 had inclined planes, 9 had jackscrew attach-
ments for traction or expansion of fragments, and 47 had extra oral
attachments for the application of counter pressure.
r. SCHOOLS.
Division schools for the instruction of the recently joined in-
experienced dental reserve officers were established in the early
fall of 1917. It was recognized that however well qualified pro-
fessionalh', these officers were unacquainted with methods of con-
ducting a military dental practice, customs of the service, system of
obtaining supplies, militarj' correspondence, and the making and for-
warding of reports and returns. This plan for division instruction
was changed in Xovember, 1917, by the organization of the dental
section, Army sanitary school. The first session of this school
opened on December 3, 1917, at headquarters. Army schools area.
The term covered two weeks' intensive instruction and application.
This was conducted under direction of an experienced dental officer,
termed " director," assisted by a corps of specially qiuilified in-
structors. The course embraced all the subjects laid down for di-
vision schools and in addition taught approved methods of practice
in war dentistry and a practical knowledge of face and jaw surgery.
In addition thereto instructions were given in the fundamental
duties of medical officers, special stress being laid on minor surgery,
bandaging, splinting, first-aid for woundecl and gassed, transpor-
tation of wounded, duties in advance dressing and triage stations,
special drill instructions, administration of antitetanic serum, and
in general anesthesia. The splendid services rendered by dental
officers as auxiliary medial officers during the stress of battle activi-
ties have proven the wisdom of this course of instruction. A
special school for instruction of enlisted men in the duties of dental
1308 REPORT OF THE SURGEON GENERAL OF THE ARMY.
assistants was organized at headquarters, first depot division, St.
Aignan; and two schools for special instruction in dental mechanics
were organized, one at central dental laboratory headquarters, first
depot division, for course in ordinary dental laboratory work, and a
second at American Red Cross Military Hospital Xo. 1. for ad-
vanced instruction in swedged and cast metal splints and other frac-
tured-jaw appliances required in maxillo-facial surgery. After the
armistice, a school for the instruction of dental assistanst in dental
prophylaxis was organized at headquarters. Base Section Xo. 2,
Bordeaux. During February, 1919, the American Expeditionarj'
Forces university was organized at Beaune, through the instigation
of an educational bureau composed of prominent American educa-
tors. On March 12 the classes of the dental section of the medical
college of this university were organized and began functioning,
being the first college of the university to open its doors and begin
actual operation. Eighty-five students were enrolled. The curric-
ulum was based upon predental instruction, undergraduate instruc-
tion, and postgraduate study. The dental section was placed in
charge of a competent dental officer as director and a corps of speci-
ally qualified instructors. The facilities for teaching clinical dent-
istry were carried on m the large infirmary, which was equipped
with 18 complete sets of modern base dental equipment and an ade-
quate laboratory with modern equipment and electrical appliances.
A special course of instruction in dental and maxillo-facial pros-
thesis was conducted by the senior consultant in prosthetic dentistry,
who made A'isits to each hospital center and the important bas^.*
hospitals, for the purpose of teaching both the dental officers and
enlisted assistants thereat in the highlv specialized technique of ad-
vanced maxillo-facial prosthesis. In addition to the above, general
instruction was carried on by correspondence from the chief sur-
geon's office in subjects of general military administration, technical
dentistr}', and official.
G. ARMY DENTAL BOARDS.
Army dental boards for the examination of candidates for ap-
pointment and commission in the Dental Corps (temporary com-
mission) have been appointed from time to time as required. The
candidates for these examinations were of two classes of profes-
sional men : American dental surgeons who were engaged in the
practice of dentistry in Europe and desired to enter the Ameri-
can service, and graduate practitioners of dentistry from among
the enlisted men in the American Expeditionary Forces who had
been drafted into the service. One hundred and twenty-eight
candidates were successful in these examinations. The last class
finished shorth^ after the signing of the armistice, but were not
approved for appointment and connnission on account of the policy
established and instructions received, per cable, prohibiting further
appointments in view of the cessation of hostilities.
H. CASUALTIES.
Seven dental officers in combat divisions have been killed on the
field of honor, and eight dental officers have died of disease in the
American Expeditionary Forces, having made the supreme sacrifice
A. E. F. — SAXITATI017. 1309
in the service of their country. The following officers constitute our
roll of honor, namely :
OFFICEKS KLLLEU IN ACTIOX.
Lieut. Weeden E. Osborne, United States Navy, 2d Division.
First Lieut. Walter P. Desmond. 3d Division.
Capt. Melvin Augustein, 79tli Division.
Fir.^t Lieut. Joseph H. Parsons. SOth Division.
First Lieut. Lester H. Stone. 26th Division.
First Lieut. Howard H. Morrissey, 90th Division.
First Lieut. Lisle P. Ambelang, 32d Division.
OFFICEKS DIED OF DISEASE.
Capt. :Max Xeal, Base Hospital No. 27.
Capt. Earl P. Jones, 16th Engineers.
First Lieut. Alexander D. Baris, 317th Labor Battalion.
First Lieut. Alexander H. Jones. Field Artillery Training School, Saumur.
First Lieut. Frank S. Leonard. American Red Cross Military Hospital No. 1,
Paris.
First Lieut. George W. Mattox, 122d Infantry, 31st Division.
First Lieut. Delmar H. Stocker, Camp Hospital No. 21.
First Lieut. George E. Wilcos, 332d Machine Gun Batalion. 86th Division.
The following enlisted assistants were killed in action :
Pvt. Oscar Schroeder, 79th Division.
Pvt. Harry P. Morrison. 29th Division.
•Pvt. P. J.'O'Connell, 4th Division.
Pvt. H. E. Williams, S2d Division.
Pvt. Lingon Brush, S2d Division.
Pvt. Anthony Bayarski, 82d Division.
Dental assistant to First Lieut. L. C. Whitlock, 42d Division.
Thirty-six officers and four enlisted dental assistants were wounded
in battle activities. Most of the officers were killed while perform-
ing the duties of auxiliary medical officers. Commendation and cita-
tion in orders, and .special reports of division commanders and divi-
sion surgeons have been forwarded for a number of dental officers in
the American Expeditionary Forces, several of whom have been
awarded the distinguished service cross and the croix de guerre, two
being posthumous awards.
4. Saxitatiox.
The health of the officers and men in the American Expeditionary
Forces has in the main been good and the noneffective rate from
disease, that is, the number of men in proportion to the strength of
troops incapacitated from duty from other causes than battle casu-
alties and injuries from accidents, etc., has been low. As has been
the case with our Allies, the number of beds occupied in our hos-
pitals by men incapacitated by battle casualties has not at any time
equalled the number occupied by the sick and injured. From August
1 until the last of Xovember, 1918. when the battle casualties and the
accidental injuries requiring hospital care were at the highest, the
percentage of hospital beds occupied by these cases varied between
41 per cent and 47 per cent of the total hospital beds occupied. For
the period prior to the sharing of American troops in active military
operations, accidental injuries and all the A^arious external causes
which incapacitated men for active duty represented from 5 per cent
to 10 per cent of all hospitalized patients. In other wards, disease
1310 REPOET OF THE SURGEON" GENERAL OF THE ARMY.
caused from 53 per cent to 90 per cent of the noneffectiveness in the
American Expeditionary Forces according to the participation of
our troops in offensive operations and the presence of the various
epidemics of disease.
Only two diseases developed in a sufficiently generalized way to
effect the entire American Expeditionary Forces and cause serious
difficulties, and temporarily excessive sick rates, epidemic diarrhea
and influenza, and only the latter as the result of the secondary
pneumonia developed a serious rise in the death rate.
Against neither disease is there any known specific protection.
Both diseases were prevalent in the armies of our allies and of the
enemy at the same time, as well as in the civilian population.
It is doubtful if there are any sanitary measures which could have
been applied under the existing conditions which would have pre-
vented either of these two extensive epidemics among our troops,
although the coincident crises in the military situation throughout
this period (Jul}' 15-Nov. 1) demanded such priority in service,
transportation, and material that many precautions, practicable under
ordinary field conditions, were inevitably neglected.
Epidemic diarrhea with a considerable amount of dysentery and
probably some unrecognized tj^phoid and paratyphoid fevers de-
veloped in various parts of France late in June, appearing first in
the more southern areas occupied by our troops, and wherever insan-
itar}' disposal of human wastes, fly breeding, and insufficient precau-
tions in the preparation and serving of food prevailed. Imme-
diately after the Chateau-Thierry offensive the troops suffered quite
generally from diarrheal diseases, probably as many as TO per cent
having been so affected. This was inevitable under the conditions of
a hard-fought and prolonged battle which made even the elementary
principles of sanitation impracticable of application. Inadequate
and ill-prepared food chilling of the body at night, polluted water
sources, and the plague of flies, which bred and fed upon human ex-
creta everywhere exposed and upon the dead bodies of men and draft
animals upon the battle fields, combined to produce a widely spread
epidemic of diarrhea among which was a certain proportion of true
dysenter}^ and typhoid-paratyphoid infections. Most of the cases
never reached a hospital or obtained medical treatment. Spontaneous
recovery in a few days was the rule. The enthusiasm of the vic-
torious forward movement of the troops carried many men out of
reach of hospitalization, and a true measure of noneffectiveness from
that epidemic can only be guessed. A small number of serious and
persistent infections found their way through the evacuation hos-
pitals to the base hospitals, and of these the great majority examined
early in the course of their disease were found to be suffering from
true dj'sentery caused by well-recognized strains of bacilli. Fortu-
nately the type of the infection was mild and very few deaths re-
sulted from the entire epidemic. The disease prevailed during the
warm weather while the fly-breeding season continued. In a few
favored places, where after medical care was combined with adequate
physical equipment to avoid fecal exposure and pollution of food and
water, only an occasional cases of diarrhea developed and entire or-
ganizations escaped infection, but in the main the disease prevailed
throughout the American Expeditionary Forces from July 1 to the
middle of September.
A. E. F. — SANITATION. 1311
Following this period a few cases of typhoid and parat3'phoid
fever developed each week, often in commands which had partici-
pated or were still in the areas of recent active operations. In De-
cember, 1918, and January. 1919, the greatest number of cases oc-
curred, the incidence declining sharply in February, to rise again in
March with an outbreak of 70 cases at Marseille clue to infection in a
large mess kitchen by an unrecognized acute typhoid among the
kitchen help, the cases again falling to inconsiderable numbers in
April. During the entire period after November 11. 1918. the infec-
tion in great majority of the cases reported was found on careful
study to be attributable to the use of polluted and unauthorized
water supplies or to carriers in the organizations in which the cases
developed. In many instances the carriers were found among the
cooks and kitchen police on duty. There is good reason to believe
that the carriers and early undetected cases of these diseases had ac-
quired their infection during the period of extensive incidence of in-
testinal disease in the summer months.
The other epidemic and one which was much more serious as a
cause of noneffectiveness, and as the case of the greatest mortality
in the American Exj^jeditionary Forces was that of influenza, which
was and continued to be part of a pandemic of the disease which has
within the past 3'ear affected all parts of the world. The disease in a
mild form prevailed from the middle of April until the middle of
July without interfering materially with the activities of the Ameri-
can Expeditionar}' Forces. There was much increase in noneffective-
ness for a week or so while the disease swept through a command, but
the recoveries were prompt, complications rarely occurred, and there
were very few deaths from the primary infection or from complica-
tions.
In September the disease returned at the time when large ship-
ments of troops were arriving from the United States when every re-
source of men and material was being strained to prepare for or take
part in the Meuse-Argonne offensive. The weather was unfavorable,
the type of disease was more severe, the means of evacuation and the
hospitals were strained to their capacity in caring for the wounded.
Troop movements were extensive and urgent, military necessity de-
manded every sacrifice for offensive operations. These conditions
combined to make adequate preventive measures and early and suffi-
cient hospital care well nigh impossible.
Heavily infected and exhausted hj the strain of the voyage, troops
arrived with a loss in some instances of as many as 2 per cent of their
entire strength within three weeks after embarking in the United
States. Long delays and insufficient provision for rest, food, and
medical supervision during train transportation to training areas or
replacement divisions added to the spread of the disease. Crowding
in billets and barracks beyond the limits of safety, unfamiliarity of
officers and men with the precautions needed in this climate, ignorance
of the part which warmth, dry clothing, sufficient rest, and hot food
play in raising bodily resistance to infection, delayed diagnosis and
removal of infected men. and insufficient precautions in hospitals of
all kinds to prevent communication of the disease in the wards, all
contributed to a heavy incidence of pneumonia and high mortality
from this common complication.
1312 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
By the middle or third week of October the epidemic again began
to subside, and by December 1 the incidence of influenza was well
below the usual rate for that month of the year. In the latter part
of January there was a third wave of the disease in a mild form, and.
coming at a time when every precaution could be taken, and when
other factors were favorable, it did not cause a serious loss of life. By
the middle of March this third wave of influenza had subsided and
during April the incidence of all respiratory diseases, including influ-
enza, reached remarkably low figures.
Venereal diseases have been subject to control by policies, medical,
educational, and disciplinary- so different from those applied in any
Army heretofore that only detailed report of these diseases can ade-
quately present the subject. It is not too much to say that the offi-
cial attitude of the Government as expressed in orders from the
War Department and from the commander in chief supported by
a logical medical service for the prevention and treatment of vene-
real diseases have resulted in a smaller loss of man power to the
Army, a lower incidence rate of the diseases, and a smaller number
of permanently disabled and invalided men from these diseases than
has been recorded in any other army up to the present time, or than
has been recorded among the troops in the United States.
These diseases, when treated according to the information avail-
able through medical science, can be controlled, and to a greater
degree than ever before have been controlled, by applying the prin-
ciples of preventive medicine, namely, diminution of contact with
human sources of infection, prophylactic treatment promptly after
exposure, and segregation with intensive treatment for those in the
communicable stages of the diseases.
Supplementary to the application of these fundamental medical
principles have been the forces of education, recreation, discipline,
and appeal to patriotism and moralit}^
Of the less important communicable diseases, mumps hold first
place, and indeecl leads all diseases as a cause of noneffectiveness
in the first year of the American Expeditionary Forces. No meas-
ures applicable under existing conditions appeared to have any defi-
nite effect in controlling this disease. It is to be presumed that
exposure was almost universal and that tliose not already insuscepti-
ble because of a previous attack developed the disease when exposed.
Measles similarly prevailed among immature and susceptible
troops, but where the principles of daily examination and segrega-
tion of all men who showed the least catarrhal symptoms or rise
of temperature, spacing out and separation of men into small units,
and separating old or mature troops from contact with replacement
or new detachments, could be and were carried out intelligently this
disease was quickly stamped out. Measles was alwaj's prevalent at
the base ports among recently arrived troops and appeared to a less
and less degree as the troops were passed through replacement depots
and training camps on their way to the front.
Diphtheria, while occurring to a degree not previously experi-
enced in our Army, occurred only in epidemic form in a few di-
visions and hospital formations, and then only for a brief period
until well-known methods of control could be made effective. The
A. E. F. SANITATION. 1313
successful treatment of diphtheria epidemics demands laboratory
facilities of a very efficient kind for the detection of carriers and
diagnosis of mild cases. In this war these facilities have for the
first time in our Army been furnished to bodies of troops in the
field by means of mobile laboratories which were sent out instantly
on call fi'om the central laboratory at Dijon and constituted an
extension of that institution. Scarlet fever, except on one occasion
in a regiment delayed in its passage across France in December,
1917, never developed into an epidemic of any proportions, although
the American Expeditionary Forces was never wholly free from it.
The incidence of the other communicable or preventable diseases
was not sufficient to justify- mention in a general survey such as this.
Effort syndrome, the " irritable heart of soldiers " well known to
the Arni}^ surgeons of our Civil War occurred as a primar}^ case of -
disability requiring prolonged care in convalescent camps, or as a
complication following " gassing '' or infectious fevers. Owing
chiefly to the short period of our participation in the war and to the
vigor and freshness of our troops, this typically war disability did
not develop into the proportions observed in the English and French
Armies.
In the matter of lousiness and scabies, from which our troops suf-
fered generally throughout France, the avoidance and elimination of
these infestations was a matter at all times dependent chiefly upon
the resourcefulness and conviction of officers that their men should
keep themselves and their clothing clean. All troops became lousy
in the trenches. Lack of bathing facilities, and of fuel and appli-
ances to accomplish disinfestation was almost universal. At times
75 per cent of many commands were heavily infested. The atten-
tion given by officers and men to correct this condition soon after the
armistice accomplished more in two months than had resulted from
the eiForts made in the previous year. The American Expeditionary
Forces never had any such experience with the chronic infections of
the skin, the " pyodermias " or " inflammations of the cutaneous tis-
sues " as the armies of our Allies suffered from in the earlier years of
the war. The regulations insisted upon during the process of prepa-
ration for embarkation have been effective in eliminating vermin
infestation in all l)ut about 1 per cent of the men who reach the em-
barkation camps at the base ports.
Sanitation, or the control of environment for the sake of preven-
tion of disease, was limited narrowly in the American Expeditionary
Forces by the restriction of transportation, the insufficiency of
structural material and of labor to build shelter, and by the difficulty
of getting enough fuel to heat living places and to dry clothing, and
enough water of a pure quality to provide sufficient facilities for
body cleanliness and the washing of clothes.
AMierever, owing to fortunate local conditions, adequate floor space
j)er capita was made available for living purposes, or where the
ingenuity, resourcefulness, and determination of the medical and com-
manding officers to obtain adequate space and facilities was brought
into play the sick rate was always low. In the American Expedi-
tionary Forces as elsewhere attention to the comfort, cleanliness,
1314 EEPOKT OF THE SURGEON GENERAL OF THE ARMY.
food, sleep, exercise, and rest of the men was always accompanied
by a low sick rate.
* Adjustment to environment by green troops under young officers,
with the advice of medical officers wholly unfamiliar with any
aspect of medicine except those of the family or hospital practitioner,
was accompanied by many of the disabilities and losses from sick-
ness which seasoned troops, with each man a trained practical
hygienist and sanitarian, with line officers capable and willing to take
infinite pains to guard the health of their men, and surgeons who
have learned the preventive side of medicine, escape. With every
month the improvement in sanitary discipline and experience be-
came more marked, and at the time of the armistice some organiza-
tions and areas in the armies and in the Services of Supply had
reached a good standard of field sanitation. Since the armistice the
standards of field sanitation have been steadily improved and the
attention given to the hygiene of the men has been sufficient to acconi-
plish a progressive lowering of the noneffectiveness from disease.
During the month of April the total noneffectiv^iess from disease and
injury has been a fraction over 4 per cent, a very satisfactory figure
considering the climate and environment of the men.
5. Division or Laboratories and Infectious Diseases.
AVhen the United States entered the war practicall}' no informa-
tion was at hand relative to the organization and activities of the
laboratory services of the nations engaged. It was not possible,
therefore, at that time, to formulate any definite plan of organization
based on their experience.
The organization, development, and activities of this division may
be divided, for purposes of discussion, into two periods : From June
to November, 1917, and from November, 1917, to November, 1918.
A. SECTION or LABORATORIES, JUNE TO NOVEMBER, 19 IT.
a' . General plan of organization and develoiJinent. — Soon after
the first American troops sailed for France, five commissioned offi-
cers and six enlisted men, designated as Army Laboratory No. 1,
sailed Julj' 26, 1917, arriving at Liverpool August 4, and in France
August 5. It was presumed that general laboratory supplies would
be available in France and this unit brought with it only a few
special items. It was ordered to Neufchateau for station. An emer-
gency equipment was secured from the Pasteur Institute consisting
of one French Army model field laboratory packed in chests. The
laboratory was of necessitj' housed in a building altogether unsuit-
able for the purpose; the necessary alterations were made under
almost insurmountable difficulties and neither gas nor electricity was
available with sufficient constancj" to permit their use. The follow-
ing tentative plan of organization was agreed upon:
Each base hospital coming to France to bring with it trained com-
missioned and enlisted laboratory personnel and its initial labora-
tory equipment.
I
A. E. F. — ^LABOEATORIES. 1315
To meet the requirements of combatant troops the followmg lab-
oratories had to be provided (chief surgeon to Surgeon General,
Aug. 12, 1917) :
One field (mobile) laboratory for each division, 2 officers and
4 enlisted men.
One corps laboratory for each corps; 4 officers and 8 enlisted
men.
One Army laboratory, 8 officers and 16 enlisted men.
None of these units arrived prior to November 1, 1917, though
several base hospitals (Nos. 6, 101, 15, 18, 17, 8, 9, and 27) arrived
and their laboratories began operating.
6'. Personnel. — The personnel for the period consisted of that of
Army Laboratory No. 1 and two commissioned officers and a varying
number of enlisted technicians for each base hospital laboratory.
c'. Equipment and supplies. — The equipment secured from the
Pasteur Institute consisted of very limited material for clinical
pathology and general bacteriology. With the greatest difficulty a
very incomplete equipment for serologic and pathologic work was
got together. A small requisition for supplies had been placed with
the Supply Division before the unit left the United States ; but much
of this material never reached Neufchateau. A requisition was
placed for the limited number of items of laboratory equipment on
the supply tables of the M. M. D. and provision made for supply
of the standard cantonment laboratory equipment to corps labora-
tories and the Army standard field laboratory equipment plus a
poison-detection chest, etc., to field (mobile) laboratory units as they
were ordered oversea. The base hospitals had fairly complete lab-
oratory equipment and supplies, but much of it was useless, since
neither sufficient gas or usable electric current was obtainable.
d\ The technical lahoratory services. — A considerable amount of
routine clinical patliolog^^ was done and an autopsy service of prac-
tical value conducted. The bacteriologic work done during this
period consisted mainly of a study of the organisms concerned in
the prevalent infections of the respiratory tract. The Wassermann
service was begun in September, 1917. The difficulties to be over-
come were many. Little equipment was available, all reagents had
to be prepared and standardized, only with the greatest difficulty
could guniea pigs be secured, only a low-speed hand centrifuge was
available, and it was necessary to use a tin basin heated with an
alcoliol lamp as an inactivating bath. At that time it was planned
that the Wassermann work for the entire American Expeditionary
Forces would be done at Army Laboratory No. 1. This, however,
was not possible because of delays in transmission of specimens and
reports.
B. SECTION OF LABORATORIES X0^^:MBER, 1917, TO X0VE3IBER 11, 1918.
In the latter part of October, 1917, a division, charged with the
supervision of the laboratory service for the American Expedition-
ary Forces, was created as part of the office of the chief surgeon,
142367— 19— VOL 2 ^22
1316 REPORT OF THE SURGEON GEISTERAI^ OF THE ARMY.
American Expeditionary Forces, and a director designated. He re-
ported to the chief surgeon, November 11, 1917, and was directed
to submit plans, inchiding a section of laboratories and a section
infectious diseases. December 28, a final plan for the organization
of the division was submitted and approved. January 1, 1918, head-
quarters of the division were established at Dijon, in which city
the central medical department laboratory of the American Expe-
ditionary Forces was being established. In the development of
this division it eventually became necessary to include two addi-
tional sections, the section of food and nutrition and the section of
water supplies.
In the organization and development of all sections of this division
it was borne in mind that the main activities of its sections — lab-
oratories, infectious diseases, food and nutrition, and water sup-
plies— were primarily concerned with the prevention and control of
epidemic diseases, the maintenance of the physical well-being of the
troops, investigations furthering the prompt return to duty of sick
and wounded, and the inspection at autopsy of a portion of the pro-
fessional services rendered. Hence, it quite naturally became an
integral jDart of the division of sanitation and inspection of this
office.
"VMien the office of this division was established at Dijon, the office
of the chief surgeon was located at Chaumont, and no great diffi-
culties of coordination were anticipated. Later the chief surgeon's
office was transferred to Tours and, not infrequentl3% there was
considerable delay in the transfer of personnel, as all orders for
such transfers emanated either from general headquarters or from
headquarters, Ser\aces of Supply. Such delays were occasioned
b}" unavoidable congestion of telegraph and telephone lines, neces-
sary^ censorship regulations, and irregular mail facilities. The rem-
edy was the delegation to the director of the division of authority
to issue orders to meet emergencies and to fill existing vacancies
from the reserve staff on duty at the central medical department
laboratory. The necessars^ authority was granted and the efficiency
of the serA'ice thereby greatly increased, particularly in the early in-
vestigation of epidemic diseases and in meeting combat emergencies.
A. GENERAL PLAN OF ORGANIZATION AND DEA-ELOPMENT.
The section of laboratories was charged with the following gen-
eral duties: (a) Representative of the chief surgeon in all matters re-
lating to the laboratory service; {!>) organization and general super-
vision of all laboratories and the assignment of special personnel;
(c) adviser to the supply division, chief surgeon's office, in the pur-
chase and distribution of laboratory equipment and supplies; (d)
publication of circulars relating to standardization of technical meth-
ods, collection of specimens and other matters of technical interest
to the laboratory service: (e) collection and distribution of literature
relating to practical and definite advances in laborators'- methods;
(/) collection and compilation of* statistics on routine and special
technical work done in laboratories; ((/) instruction of medical de-
partment personnel in general and special laboratory technic; (h)
distribution and replenishment of transportable laboratory equip-
A. E. Y. — ^LABORATORIES. 1317
ment ; (i) cooperation and coordination Avith the Chemical Warfare
Service, American Expeditionary Forces; (j) supervision of the col-
lection of mnsenm specimens and photographic records of Medical
Department activities.
From time to time circulars of instruction and memoranda cover-
ing matters of information have been prepared in this section. The
policy was adopted of having all circulars of general interest to the
Medical Depaiiment at large issued from the office of the chief sur-
geon. The director of the division was authorized to prepare and
distribute directly special letters and circulars of instruction relating
to the organization and activities of the division.
B. CENTRAL MEDICAL DEPARTMENT LABORATORY.
This laboratory was established at Dijon January 1, 1918, by
officers from Army Laboratory No. 1, Neufchateau. The building
for the purpose was donated by the University of Dijon at a nominal
rent of 1 fi-anc per year. At the time, with the exception of two
laboratories in use by the university, the interior of the building
was unfinislied. Authorization was obtained and early in February
the entire interior was reconstructed into a modern laboratory build-
ing and completely equipped with material brought from the States.
In March, 1918, the staff consisted of 16 officers, 35 enlisted men,
and 12 civilian employees. The buildings then consisted of the large
laboratory building, four barracks donated by the Red Cross which
housed the office of the director of laboratories, a large laboratory
for instruction of student officers, five well-equipped research labor-
atories, an operating room for experimental surgical research on ani-
mals, a complete X-ray installation and photographic darkroom,
space for the art museum section, and a mess and quarters for the
enlisted personnel. Later, four small Abincourt barracks Avere
added as animal house and carpenter shop and four additional bar-
racks erected for enlisted personnel and storage of supplies. The
laboratory and secured 2 buildings for garage space and o])erated
a breeding farm for laboratory animals on funds privately donated
for special research. The entire plant occupied 18 buildings, large
and small.
The average personnel on duty between June and November, 1918,
was 24 officers. 93 enlisted men, and 23 civilian employees. From
November, 1918, to May. 1919, the average personnel remained ap-
proximately the same and a considerable number of special research
problems were taken up by groups of workers. Portions of this work
will be continued in the United States. The important activities of
this laboratory, in contrast to other types, lie in the following fea-
tures: (1) The instruction of laboratory officers for ser\dce else-
where in the American Expeditionary Forces; (2) the standardiza-
tion of bacteriologic methods: (3) the preparation of supplies for
other laboratories; (4) the conduct of research looking toward the
improvement of medical and surgical treatment of cases in the field ;
(5) the organization of trained teams of officers and equipment
which could be sent on short notice to investigate and advise on the
causes and remedy for epidemics. Routine laboratory examinations
were also conducted here, but the great importance of the central
laboratory rests in the development of the above noted phases.
1318 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The activities of this laboratory may be summarized as follows:
1. BacteHology. — Th^ work consisted in the standardization of
technical bacteriologic methods: the investigation of new technical
methods; the preparation of all culture media for stocking trans-
portable laboratory units and mobile laboratories in the zone of the
advance; laboratory studies in the instance of communicable dis-
eases— notably influenza, pneumonia, diphtheria, meningitis, and in-
testinal diseases; the isolation, intensive study, and classification of
the aerobic and anaerobic bacteria concerned in wound infections and
gas gangrene ; experimental and practical tests of the efficacy of anti-
toxic sera in the prophylaxis and therapy of gas gangrene; the
identification of cultures of microorganisms received from other
laboratories; the preparation of bacterial antigens and vaccines; the
propagation and study of lice concerned with the transmission of
trench fever. This was in addition to the ordinary routine bac-
teriologic examinations.
2. Serology. — Standardization of the Wassennann test and manu-
facture and supply of amboceptor and antigen to all laboratories per-
forming the test. The diagnostic sera furnished the laboratories of
the American Expeditionary Forces for the identification of patho-.
genie microorganisms, as well as human sera for typing donors and
recipients for blood transfusion, were prepared in this division. A
considerable volume of routine serologic work, notably Wassermann
tests, was also accomplished.
3. Pathology. — Pathology was concerned with the performance of
all autopsies at Base Hospital No. 17, the gross examination and
histologic study of operative and autopsy tissues, the collection and
preparation of specimens for the Army Medical Museum, and the
review of the proctocols of all autopsies performed in the American
Expeditionary Forces. The latter activity was of value in checking
errors in diagnosis. A collection of photographs, moving-picture
films, paintings, charts, etc., was prepared for the Army Medical
Museum.
4. Chemistry. — The activities of the chemical laboratory covered
routine medical chemistry, the examination of foods for the food
and nutrition section and the Quartermaster Department, toxicologic
examinations, investigations of the chemical properties of mustard
gas, examination of drugs and other supplies furnished the Medical
Department, and sanitary and industrial water analysis. During
battle activities this division manufactured many thousands of liters
of gum-salt solution for intravenous use in the resuscitation of the
seriously wounded. The laboratory also prepared standard solutions
and reagents for transportable laboratories and such other labora-
tories as were not equipped to prepare their own.
5. In the laboratory of surgical research experimental studies on
animals were fruitful in their bearing on the prevention of wastage
from battle casualties. The cause, prevention, and treatment of
surgical shock were approached experimentally here and the results
applied practically at the front during the Chateau-Thierry and
subsequent offensives. Experimental attempts to place wounds of
the chest in the category of those amenable to treatment by " debride-
ment," and studies of the relation of various anesthetics and methods
of anesthesia to the production of shock were also made.
A. E. F. — LABORATORIES. 1319
6. Perhaps the most important work of the laboratory from the
practical j)oint of view was that concerned with the laboratory and
epidemiologic investigation and control of communicable diseases.
Specially trained commissioned and enlisted personnel with mobile
equipment were held in reserve at this laboratorj^ for the prompt
investigation of epidemics or threatened epidemics anywhere in
the American Expeditionary Forces. By bacteriologic detection of
early cases of communicable diseases, mild cases missed clinically,
and carriers, this laboratory did much to prevent the spread of
influenza, pneumonia, diphtheria, meningitis and enteric infections,
and thus decreased the wastage concomitant with outbreaks of these
diseases when not detected early and effectually controlled.
7. The supply division of this laboratory was charged with assem-
bling, equipping, and issuing transportable laboratory equipment to
mobile units ; replenishing expendable items and replacing those that
bad become unserviceable; issuing to mobile units and camp hos-
pitals various culture media and reagents required for bacteriologic
work in the field; and issuing to all Medical Department units in
the geographic region served by the central Medical Department
laboratory the various biologic products used in the diagnosis,
prevention, and treatment of infectious diseases. During the period
of active participation of our troops at the front, the greater por-
tion of these supplies was delivered by courier service, necessitating
the constant operation of numerous camionettes, trucks, and motor
cycles.
8. From its inception this laboratory conducted courses of instruc-
tion in professional subjects. One hundred and fifty-eight student
officers were given two-week courses of instruction in the bacte-
riology of war wounds, while in the laboratory of surgical research
a six-clay course, repeated weekly, was given to prospective members
of shock teams which covered the experimental evidence that had
been gathered as to the cause, prevention, and treatment of surgical
shock, and its practical application to the resuscitation of the seri-
ously wounded. Selected student officers in lesser numbers were
also given special courses in epidemiologic laboratory methods, in
serologic work, and other laboratory procedures.
C. BASE LABOBATORIES (SECTIONS OF THE SERVICES OF STIPPLT).
In the original plan of organization provision was made for one
base laboratory for each section or other subdivision of the Services
of Supply. It was contemplated that the laboratories would be
located, when possible, at the headquarters of each section and under
the direct control of the surgeon of the section. They were to be
housed in permanent buildings and completely equipped for gen-
eral laborator}^ work. It was intended that these units should af-
ford general and special laboratory facilities for troops in their
sections not cared for by local laboratories. Their activities were
to consist of clinical examinations, general and special bacteriology,
general and special serologic work, the distribution of culture media,
laboratory examinations of water supplies, the investigation of
outbreaks of epidemic diseases, and such other activities as the sec-
tion surgeon might deem advisable.
1320 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
The plan outlined above was adhered to: these units were estab-
lished as rapidl}' as the necessity for them arose and personnel and
equipment became available and the general functions outlined for
them were carried into effect. The first laboratory of this type was
established at Neuf chateau (Army Laboratory No. 1), in September.
1917, while the last was established for Base Section No. 4, at Le
Havre in September, 1918. In September, 1918, a laboratory of
the type outlined above was functioning in each section or other
subdivision of the Services of Supply. All of these laboratories
were located at the intermediate section at Tours, the one for the
advance section at Xeuf chateau, and the one for the Base Section
No. 3 at Winchester, Encrland.
In the original plans of organization for these laboratories pro-
vision was made for the necessary transportation to carry out
field surveys of water supplies, to investigate outbreaks of epidemic
diseases, and to dispatch therapeutic sera in emergency. The trans-
portation problem in the American Expeditionary Forces, however,
was unavoidably of such a nature that adequate transportation
was not alwaj's available.
D. BASE LABORATORIES FOR HOSPITAL CENTERS AND HOSPITAL LABORATORIES FOR
HOSPITAL UNITS SERVING IN CENTERS.
In the plans for the organization of the laboratory service, a pri-
mary consideration was the conservation of equipment and sup-
plies to release tonnage, conservation of special personnel, the sup-
ply of which was kno>vn to be inadequate, and conservation in con-
struction. In the development of the large hospital centers these
considerations were put into effect. Each base hospital included in
its personnel two or more commissioned laborator}- officers, a varying
number of enlisted technicians, and presumably a complete labora-
tory equipment. By centralization of the laboratory service the
efficiency could be increased, personnel released, equipment con-
served, and construction cut down. It was therefore planned to
organize in each hospital center one base laboratory for the center
and one small clinical laboratory for each base hospital unit. The
base laboratorj' was to be a part of the headquarters' organization
and its commanding officer the representative of the commanding
officer of the center in all matters relating to the laboratory service.
Its personnel was to consist of selected officers and enlisted tech-
nicians drawn from the hospital units comprising the center, and its
equipment was to be drawn from the same source.
Standard plans for the laboratory buildings for the center and
for smaller clinical laboratory buildings for each unit were drawn
up and turned over to the hospitalization division for inclusion in
the general plans of construction. The original plans provided for
two standard barracks for the base laboratory and one small build-
ing for each hospital unit functioning in the center. The original
plan of two barracks for the base laboratory was later cut to one on
account of scarcity of building materials.
The activities of the base laboratory for the center were to consist
in general of such routine clinical and anatomic pathologic Avork as
might be necessary, all highly technical bacteriological and serologic
work for the center, the preparation and distribution of culture
A. E. F. LABORATORIES. 1321
media and special reagents for the subsidary clinical laboratories.
The clinical laboratories operating in the base hospital units were
to do the clinico-pathologic work for the individual units.
The general plan outlined above was followed in the large hospital
centers of temporary construction. In the large centers in which
the hotels or other buildings converted into hospitals were consider-
able distances apart, it v.as not always possible to centralize the work
so definitely. However, by November, 1918, a laboratory service
conforming in general to the plans outlined above had been estab-
lished in all hospital centers operating with the American Expedi-
tionary Forces.
E. BASE HOSPITAL LABORATOraES FOR BASE HOSPITALS OPERATING INDEPENDENTLY.
The establishment of these units presented no difficulty as, in the
organization of base hospitals, provision was made for laboratory
personnel and equipment. The installation of these laboratories
was a matter of local administration. The activities of these units
have been in general all routine clinical and anatomic pathologic
work and all bacteriologic and serologic work for the hospital.
F. CAMP HOSPITAL LABORATORIES.
In the early stages of development of the American Expeditionary
Forces it was contemplated that camp hospitals would retain only
patients suffering with slight ailments, all others to be evacuated
j)romptly to base hospitals. It was presumed that most of these hos-
pitals would require onh^ a clinical laboratory service. As a matter
of fact, the functions of the camp hospitals varied widely; some
functioned as base hospitals, others were little more than evacuating
infirmaries, and still others varied between these two extremes. An
attempt was made to furnish these hospitals with laboratory service
in accordance with their reciuirements. By Xovember, 1918, there
were 58 camp hospitals operating with the American Expeditionar}'
Forces and of these there is record of laboratory service in 51.
G. EVACUATION AND (h) MOBILE HOSPITAL LABORATORIES.
The original conception of the organization and activities of the
laboratory service for these units was based very largely on the ex-
perience of the Allies after three years of trench and stationar^^ war-
fare. It was anticipated, however, that this type of warfare would
change to one of " movement " and the laboratory equipment for
these units was placed in chests capable of being packed or unpacked
quickly and easily transportable. The equipment provided permitted
the performance of all types of clinical and general bacteriologic
work. As a rule only one laboratory officer and two technicians
were assigned to these units, though it was originally intended that
their quota should be two officers and three or more enlisted
technicians. Officers assigned to these units were given a special
course in the bacteriology of war wounds prior to assignment. It
was planned that these units would do clinical pathology and au-
topsies, general bacteriology and wound bacteriology, and collect and
preserve nuiseum specimens.
1322 REPORT OF THE SURGEON GENERAL OF THE ARMY.
This general type of work was done in evacuation and mobile hos-
pitals partially immoblized and operating in quiet sectors. In ac-
tive sectors, however, and after July, 1918, when a war of " move-
ment *' was begun, the activities of many of these units changed. In
evacuation and mobile hospitals caring for medical cases a consider-
able amount of clinical and anatomic pathology and some general
bacteriology was done ; in others, oaring for only a moderate number
of battle casualties, the work was mainly clinical and anatomic
pathology and wound bacteriology ; in others some technical work
was carried on in connection with outbreaks of epidemic diseases;
while in still others, where large number of battle casualties were
being received and daily and prompt evacuation was mandatory, no
laboratory work was done, the personnel being used for other urgent
duties. The first laboratories attached to evacuation and mobile
hospitals were those assigned to Evacuation Hospital Xo. 1 in
March 1918, and Mobile Hospital Xo. 39 in April, 1918.
I. ARMY LABORATORIES.
In the original plan of organization a laboratory unit for each
army was considered but it was thought best to await further de-
velopments before making definite plans. Until July, 1918, all
laboratory investigations of outbreaks of epidemic diseases in the
advance section and zone of the advance were covered b}' personnel
and motor laboratories from the central Medical Department labor-
atory or Army Laboratory Xo. 1.
During the Chateau-Thierry offensive a motor laboratory car was
attached to the First Corps for the investigation of epidemic dis-
eases, and it was understood by the chief surgeon, First Army, that
this car was available for use anywhere in the First Army. The
work done by this unit in the Chateau-Thierry sector proved to be
of very considerable value, demonstrating that much of the diarrhea
and djsentery occuiiing in that sector was bacillary dysentery, ty-
phoid and paratyphoid.
In August, 1918, it became evident that there should be attached
to each army a laboratory unit equipped to do general bacteriology,
serology, and examinations of water supplies. A transportable labor-
atory equipment for the First Arm}" was assembled and shipped to
Toul just prior to the St. Mihiel offensive. Special personnel was
not immediately available, and the equipment was installed at the
Toul Hospital center where the laboratory operated for the center
and also met the emergency requirements of the First Army.
During the early phases of the Argonne offensive, a motor labor-
atory was attached to the First Corps of the First Arm3^
When the Second Arm}- was formed, a motor laboratorj^ car was
attached to the office of the chief surgeon, functioning under the
sanitary inspector of the Army in the investigation of epidemic dis-
eases. When the Third Army was organized to constitute the Army
of Occupation in Germany a survey of its laboratory requirements
was made by a representative from this office and the necessary
equipment and personnel was supplied.
Two Army laboratories were established, one at Coblenz and one
at Treves (Trier). The organization of the sanitary division of
A. E. F. — LABOKATOEIES. 1323
the office of the chief surgeon, Third Army, inckided supervision of
general sanitation, prevention and control of transmissible diseases,
and the laboratory service, permitting complete decentralization
from this office.
The activities of the central office of this division therefore, so far
as the Third Army vras concerned, were confined mainly to co-
ordination, advisory supervision, inspection, and the supply of per-
sonnel and equipment.
J. DIVISIONAL LABOKATOEIES.
a. Organization. — These units consisted of two officers and four en-
listed technicians, one such unit being attached to each division.
The unit constituted a part of the sanitary staff of the division
surgeon, to be used by the divisional sanitary inspector in the in-
vestigation and control of epidemic diseases and in inspection and
supervision of sterilization of water supplies. The laboratory
equipment furnished these units permitted only the performance of
routine clinical examinations. No equipment for general bacteri-
ology- was issued, the intention being that this would be done
in evacuation and mobile hospitals. It was the intention that
purely laboratory work would constitute only the minor part of the
duties of these divisional units and that their main function would
be epidemiology and supervision of water chlorination. While
some of these imits did admirable work aud were considered as in-
dispensable b}^ some divisional surgeons, a large percentage were
unable to function properly under combat conditions. The prin-
cipal reason for this failure was lack of transportation. In the
original tables of organization for the American Expeditionary
Forces, adopted in August, 1917, it was intended that this unit
should be a divisional one, but no transportation was provided for
at that time. For some reason, unknown to this office, it was in-
corporated in the priority schedule as a mobile laboratory and a
Services of Supply unit. Several efforts were made to secure trans-
portation for it, and the inclusion of the personnel and transporta-
tion as a divisional unit was recommended by this office in the pro-
posed revision of the tables of organization under consideration
during the summer of 1918. This proposed revision had not been
approved on the date of the declaration of the armistice. Had even
a motorcycle been available for these units, there is but little doubt
that water discipline would have been better throughout the di-
visions with a consequent decrease in the prevalence of tj^phoid-
paratyphoid fevers and dysentery-. In January, 1919, on special
request of this office, G. 4, general headquarters, directed that one
motorcycle with side car be issued to the divisional laboratory of each
division still in France. This transportation permitted much closer
and more satisfactory supervision of chlorination of water supplies
in divisional areas.
After the armistice went into effect, in November, 1918, and the
divisions went into rest areas, many divisional laboratory units
requisitioned for and were supplied with additional transportable
chests, thus completing their equipment for general laboratory work,
including general bacteriology.
1324 EEPOKT OF THE SURGEON GENERAL OF THE ARMY.
The divisioiuil laboratory units of all divisions in the Third Army
were supplied with complete eight-chest transportable laboratories,
permitting general bacteriological work as well as clinico-patho-
logical work.
I). Personnel. — (<z) Composition. The personnel of this division
consisted of: Medical officers with special training in laboratory
procedures, sanitation, and epidemiology, and with other special
qualifications; officers of the Sanitary Corps, who were sanitary en-
gineers, who had special knowledge of food and nutritional prob-
lems, who were competent to make field surveys and laboratory
examinations of water supplies, who had general or special quali-
fications in laboratory- procedure, who were artists, photographers,
executives, or with other special qualification; and enlisted men,
many of whom had special technical training.
(h) Source of supply. During the entire period of our participa-
tion in the war there were not more than 12 officers of the Regular
Medical Corps and Sanitary Corps on duty with the division who
had liad any service in the Army prior to the war. Two of these
medical officers and one officer of the Sanitary Corps were on clutj-
in the office of the director and the remainder were assigned to ad-
ministrative positions elsewhere in the American Expeditionary
Forces. The remaining persomiel, consisting of approximately 670
officers, was drawn chiefly from civil laboratories. A large per-
centage of the enlisted personnel consisted of college graduates, un-
dergraduate students, and men with special technical training in
laboratory- work of various kinds. As was the case with the Medical
Department as a whole, there was always a shortage not only of com-
petently trained men, but also in actual numbers.
The personnel to carry on the activities of the division was ac-
quired from various sources, nuiinly the following: (1) Base hospitals
and a considerable number of evacuation hospitals in the organiza-
tion of which pro^nsion was automatically made for the inclusion of
laboratory personnel. (2) Stationary laboratory units consisting of
0 officers and 12 enlisted men of which 5 were sent to France. (3)
Special units sent to France for special highly technical activities.
(4) Divisional (mobile) laboratory units automatically dispatched to
France for service with divisions. (5) Detachments of casuals sent
to France on cable request from general headquarters. (6) The
above-mentioned sources of supply did not furnish adequate per-
sonnel and a considerable number of officers with special training
were withdrawn from the general medical service of the Expedi-
tionary^ Forces and assigned to duty with this division.
(c) Special qualifications. The individual qualification cards of
officers of the Medical Department on file in this office permitted a
board of general classification of qualifications, but for the special
highly technical activities in which the division of laboratories and
infectious diseases was engaged it was necessary to have a much
fuller insight into the special qualifications of each officer. To ac-
complish this a special questionnaire, covering in detail the informa-
tion desired, was filled in by each officer on duty in the division and
filed in the office of the director. A still better conception of the
special qualifications of the individuals was gained b}^ direct ob-
servation of from 300 to 400 of these officers who served on temporary
A. E. F. LABORATORIES. 1325
duty at the central Medical Department laboratoiy either as casuals
or taking special courses of instruction. These officers were inter-
viewed b}' the personnel officer on duty in the office of the director
of the division and special rating of those undergoing instructions
were submitted to him. From these sources of information and from
inspections of the work actually being done in the different labora-
tories, an effort was made to so classify and distribute the personnel
that the necessar}- activities might be more efficiently performed and
incompetents weeded out. The laboratory personnel sent to France
with the earlier base hospitals was made up, as a rule, of very highly'
trained and competent men. This statement also applies to many of
the special units. The special laboratory- training of a considerable
percentage of the officers, however, consisted only of the training
ordinarily acquired in medical schools plus a short course of train-
ing at the Army Medical School, at the Yale Army Medical School.
at the Rockefeller Institute, or a combination of these. Special
courses of instruction in the bacteriology of epidemic diseases and
in the bacteriology of war wounds were given at the Central Medical
Department Laboratory and approximate!}^ 250 officers took one or
the other of these courses.
{d) Distribution. This division was charged with the organiza-
tion of new laboratory units and the distribution of personnel under
its supervision. All requests for laboratory personnel were referred
to it and assignments and changes in station made on recommenda-
tion of the director.
(e) Summary. While in May, 1918, less than 140 commissioned
officers were engaged in activities under the supervision of this di-
vision, by November, 1918, this number had increased to 685.
c. Equij^ment and supplks. — One of the greatest difficulties that
confronted the laboratory service in the early months of the war was
a shortage of equipment and supplies. Before the war many essen-
tial technical items, notably of apparatus, glassware, dyes, and
chemicals, were imported from German3^ American industries that
had entered these fields were still lacking in quantity production in
many essentials. Furthermore, tlie normal peace-time stock of
dealers in scientific apparatus and supplias were just sufficient to
meet the comparative meager demands for the upkeep of established
institutions and the initial equipment of an occasional new one.
Demands such as were made by the Army in the earlier months of
the war were unheard of and they could not be met until American
scientific industries became organized for quantity production. The
situation was further complicated by priority schedules on raw ma-
terials, many chemicals, and skilled labor, which diverted these to
other war industries; and a priority on shipping and tonnage that
made the floating of supplies secondary to the transportation of
troops. Again, difficulties were entailed by the congestion at base
ports and shortage of transportation that militated against prompt
handling of supplies after their arrival in France.
With the exception of the initial equipment of three of the larger
laboratories and a few base hospitals, laboratory supplies from the
United States were not available for issue in appreciable quantities
until a month before the armistice. Furtliermore, laboratory sup-
plies in large quantities have never been available by purchase in
France.
1326 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
It became apparent early that it would be months before the auto-
matic supply of laboratory apparatus from the United States would
become available and that it was necessary to reduce all equipment
and supplies to the absolute minimum consistent with efficiency. The
commanding officer of the central Medical Department laboratory,
designed a transportable laboratory in which the necessary laboratory
equipment and supplies were reduced to approximately 150 items.
The equipment and supplies were placed in eight chests so designed
that they w^ere capable of expansion in numerous ways so as to meet
the essential needs of any type of laboratory. In March, 1918, this
officer was sent to Englancl to place orders for, and supervise the
manufacture of these laboratories. The initial order was for 100
complete laboratories. Deliveries began a month later, and each
division, mobile hospital, and evacuation hospital arriving in France
was given its equipment before entering the zone of the advance.
This transportable equipment was also utilized with verj'^ satisfac-
tory results in many camp hospitals, base hospitals, and even in
base hospital centers and base laboratories pending the arrival of
stationary equipment. The satisfactory service that this equipment
has given under most varying circumstance leads to the conviction
that similar equipment should be procured and stocked in field
medical supply depots in time of peace for future expeditionary
forces.
d. The technical laboratory service. — {a) Introductory. Many
types of technical laboratory work (e. g. gastric analyses, tumor
diagnoses, etc.) of peace time have little place in the service of a
military expeditionar}^ force. Instead, large numbers of examina-
tions of a relatively few ordinary types of the rule, with occasionally
a highly specialized study to meet an emergency.
The laboratory officer assists the attending medical officer and
surgeon by determining the physical condition of the patient by
urinah'scs, blood-cell examinations, etc., and by determining the
types of bacteria in wounds. His word is final in the diagnosis of
many infectious diseases. He also takes a large part in the specific
prevention and treatment of these by administering vaccines, thera-
peutic sera, salvarsan, etc. He is consultant to the epidemiologist
concerning the character and extent of water pollutions and in locat-
ing immune disease carriers. He inspects the chlorination work of
the water supply department and. in large measure, the professional
work of the attending medical officer and surgeon by pointing out
at the autopsy errors in diagnosis or treatment.
From November 1, 1917, to June 1, 1918, the laboratoiy work
consisted principally of routine clinico-pathologic and bateriologic
examinations. During the winter months considerable special work
was necessary in the study of pneumonia, both bacteriologically and
at autopsy. Four hundred and thirty-four autopsy protocols have
been received for the seven-months period from November 1, 1917,
to June 1, 1918. Detailed reports of the other examinations for this
period are very meager.
For the period from June 1 to November 30, 1918, the monthly
reports are much more complete, covering probably four-fifths of
the total work done.
For the period from December 30, 1918, to April 30, 1919, the
monthly reports are complete.
A. E. F. — LABORATORIES. 1327
K. PATHOLOGIC SEBVICE.
(a) Cli/nical pathology. — The total number of routine blood ex-
aminations, as indicated b}' the leucocyte counts and urinalyses, has
shown a gradual increase, apparently parallel with the number of
patients in hospitals. Similarl}-, the examinations of sputum for
tubercle bacilli and smears for gonococci have shown a gi-adual in-
crease, since tuberculosis and gonorrhea are constantly present,
reaching the highest point in January, 1919. On the other hand,
the examinations for malarial parasites were somewhat increased in
July, August, and September (the mosquito months) falling off
thereafter. There was a sudden increase in the total number of ex-
aminations of feces for parasites, entamebae. etc., in August, which
lasted through to the end of November, after which it decreased.
There was increase in October in the examinations of smears for
meningococci, principaly from a search for carriers among contacts
with sporadic cases and small outbreaks of meningitis, and a reduc-
tion thereafter.
(5) Anatomic pathology. — The number of autopsies each month,
which should have paralled and approximated the monthly mortality
in hospitals, was lowered early in the development of the laboratory
service of the American Expeditionary Forces by the scarcity of
pathologists competent to make post-mortems. This condition was
rapidly remedied by special request for pathologists from the United
States and the placing of those available at the most advantageous
points. By August a very efficient autopsy service had been de-
veloped. The number of autopsies given in the table is summarized
from the monthly laboratory reports and does not equal the number
of autopsy protocols already received. The figures will be revised
when the returns are complete. In a few instances commanding of-
ficers of hospital organizations, not appreciating the importance of
tne inspection at autopsy of the professional work of attending
medical officers and surgeons, failed to use the time of the patholo-
gists for the best interest of the sick and wounded.
L. BACTERIOLOGICAL SERVICE.
Cultural bacteriologic procedure, with the exception of cultural
control of water chlorination, varied greatly in the six months period
parallel with the incidence of epidemics of various communicable
diseases in the control of which they were most essential. While
there was a very marked increase in the total number of examina-
tions in July over those in June, the greatest increase in the total
number was in October and November.
In the examinations of blood (for typhoid, streptococci, etc.) the
greatest increase occurred in September. In cultures of feces for
dysentary, typhoid, and paratyphoid, a very sharp rise in the num-
ber occurred in July which rapidly increased, reaching its peak in
October, then dropping in November. This was due to the out-
break of enteric diseases beginning with the Chateau Thierry offen-
sive. A second rise in the examinations for typhoid and paratyphoid
bacilli marks the appearance of typhoid in December, 1918, and con-
tinues thereafter. Cultures from sputum for pneumococci showed
1328 REPORT OF THE SUEGEOX GENERAL OF THE ARMY.
the greatest rise in the curve in September, the peak being reached
in October with a slight reduction in Xovenibcr. corresponding to
the epidemic of influenza. In the number of cultures for B. dip-
thcris there was a very sharp rise in July, followed by a descent
through September, and then a rapid rise with the highest peak
reached in December. These represent largely examinations for
diphtheria carries for which examinations were begun on the onset
of several epidemics in various places in the American Expeditionary
Forces. Of the cultures for meningococci, there was a sudden in-
crease in July, after which a plateau was maintained until October,
when a very great rise occurred, followed by a slight diminution in
Xovember and thereafter. The monthly numbers of wound cultures
varied with the offensives, with a marked rise in July and August
after the Chateau Thierry offensive, followed by a reduction in Sep-
tember and an enormous rise in October and Xovember, coincident
with the Argonne offensive. The marked rise in July of the number
of cultures from water is due to the examinations following the diar-
rheas in the Chateau Thierry offensive. That in December and there-
after is coincident with the develojDment of typhoid fever at that
time.
M. SEROLOGIC SERVICE.
Agglutination tests with bacteria were very few until the increased
incidence of typhoid fever in November following the Argonne of-
fensive. Wassermann tests have shown a steady increase coincident
with the increasing total strength of command and of laboratory
facilities. The number of these tests has been greatly increased
since the armistice.
N. CHEMICAL SERVICE.
The chemical analyses of water were relatively few in num-
ber, though important, and were rather evenly scattered throughout
the six months period. A few other important chemical analyses
were also done.
O. RESEARCH SERVICE.
The laboratory research work before the signing of the armis-
tice was directed principally to determining means of combating
trench fever, wound infections, gas poisoning and shock, and secur-
ing data for tl^e improvement of certain surgical operations, par-
ticularly on the chests. This information was utilized as soon as ob-
tained. Much valuable information along other lines was also ob-
tained incidently. Careful analyses of these data have been recently
comjDleted or are now in progress and will be given in detail later.
F, MUSEUM AND ART SERVICE.
The laboratory section has collected several thousand pathologic
and other specimens of mediial interest for the Army Medical
Museum. It has made several hundred drawings, paintings, and
photographs recording subjects of surgical and pathological interest.
In addition, it has directed the taking of photographs, moving pic-
^ A. E. F. LABOEATORIES. 1329
tures, etc., by the Medical Department and by the Signal Corps for
illustrating the Medical History of the War. These cover about
10,000 subjects.
Q. KAT INVESTIGATION.
The investigation of the incidence of rats, mice, and other animal
pests about the docks, warehouses, supply depots, bakeries, and in the
trenches and dugouts of battle areas has been a duty of the division
of laboratories. Much valuable information has been collected and
a persistent campaign of extermination carried on, resulting in a
great saving of food and clothing and many other supplies.
C. SECTION OF INFECTIOUS DISEASES.
The conception of the proposed activities of this section was early
indicated as follows:
The function of the subdivision of infectious diseases is to provide
an instrument for the prompt epidemiological and bacteriological in-
vestigations of transmissible diseases among troops of the American
Expeditionary Forces. It constitutes, therefore, a direct liaison be-
tween the division of sanitation and inspection and the laboratories,
and is grouped with the latter only because its activities require the
occasional mobilization of laboratory facilities, and because its per-
sonnel should be capable of directing on the spot any laboratory
work which the thorough study of any given situation may require.
Wliile operating from the laboratories as a basis, therefore, this sec-
tion constituted actually a part of the machinery of sanitation.
In Circular Xo. 40, issued from this office July 20, 1918. the duties
of this section were more specifically outlined, as follows: (a) Ad-
viser of the chief surgeon in matters relating to the prevention and
control of transmissible diseases, (5) collection and distribution of
literature and preparation of circulars relating to methods of pre-
vention and control of transmissible diseases, (c) general supervision
of laboratory research, (d) advisory supervision of all activities
looking to the control of transmissible diseases including direct
liaison with division surgeons, (e) assignment of specially trained
personnel and equipment for the investigation of suggested pro-
phylactic methods for the prevention of infectious diseases and
recommendations relative to their general adoption, (r/) collection of
epidemiologic data on infectious diseases, and (A) cooperation and
coordination with the water suppl}^ services, American Expeditionary
Forces, in the supervision and control of water supplies.
Due to the large territory over which American troops were dis-
tributed, decentralization became necessary for proper supervision
and prompt action, and in the original plan it was contemplated
that a selected and trained officer for epidemiologic and l)acteriologic
studies of outbreaks of infectious diseases be stationed in every sub-
division of the Services of Supply. Ordinarily, this officer was ex-
pected to handle problems arising in his section, but in times of
stress extra personnel and equipment would be immediately supplied
from the central office. Later, as a result of conferenc.es with repre-
sentatives from the various sections and replies to a circular letter
sent to the chief surgeons of the sections on the organization of epi-
1330 REPORT OF THE SURGEON GENERAL OF THE ARMY.
demiologic work and the control of infectious diseases, a plan for a
desirable organization for the sections was submitted. In general,
this proposed plan has been adopted, with some variations to meet
the i^articular local problems. As a result the sections have taken
care of their own problems and have operated more or less inde-
pendently, calling upon the division of laboratories and infectious
diseases for ijersonnel and material when needed.
It was in the beginning intended that in the advance section and
zone of the advance the epidemiologic work would be centralized at
the office of the director of laboratories and infectious diseases.
Through the office of the chief surgeon the director of this sub-
division was to be kept constantly informed concerning the incidence
and location of infectious diseases and was to have sufficient per-
sonnel and mobile laborator}' equipment to immediately respond and
render assistance where necessary.
The officer responsible for sanitation in a division was, as hitherto,
the sanitary inspector, who functioned as an assistant to the division
surgeon. All ordinary matters of general sanitation were attended
to by him with the assistance of two officers, one the division labo-
rator}' officer who had charge of a simple laboratory, equipped for
clinical pathology but insufficiently supplied for extensive cultural
work. The other assistant was the divisional water officer, whose
training had been largely in water examination but who had had
some training in general bacteriology as well. Later much of this
personnel received a short course of instruction before being assigned
to a division.
It was intended that the divisional laboratory officer should act
not only as a technical laboratory worker for the division but should
assist the sanitarj^ inspector in making epidemiologic surveys and
sanitary insi^ections. It may be said, in passing, that in many cases
this hope was disappointed because of the lack of transportation.
This divisional organization was quite adequate under ordinary cir-
cumstances to deal with conditions that threatened the health of the
troops, but because of insufficient laboratory equipment and shortage
of personnel it was necessary in anj^ considerable outbreak of com-
municable disease to send reinforcements.
In order that such service niight be rendered promptly and
efficiently. Bulletin No. 32, general headquarters, was issued, which
authorized division surgeons to communicate directly by telephone
or telegraph with the director of laboratories and infectious diseases
when assistance was needed. Mobile laboratory cars, constructed and
equipped (with some modifications) accordingly to the English plan,
manned usually by one commissioned officer, a driver, and a tech-
nician, responded to these requests either from the central Medical
Dej^artment laboratory or from Army Laboratory No. 1, according
to the area from Avhich the request was received.
Subsequenth', as American troops were now concentrating in the
advance section and in the zone of the advance, and more and more
divisions were beginning actively to participate in com])at, the desir-
ability of a further system of daughter organizations to be split off
from the central office of the section of infectious diseases, and based
upon Army corps or field Army units, arose. As the result of
experiment it was decided that the field Army unit was the most
desirable in wdiich to construct an organization.
A. E. F. — ^LABORATORIES. 1331
Accordingly, a sanitary inspector was assigned to the Second Army
and there was planned and put into operation a system more or less
similar to that already in vogue in sections of the Service of Supply
but with modifications to meet the problems of combat and mobile
troops. In consequence the sanitary organization of a field army
likewise became largely independent, except for personnel and labo-
ratory supplies, of the central office. When the Third Army was or-
ganized to constitute the army of occupation in Germany a sanitary
division was created as part of the office of the chief surgeon. Third
Army, and all matters relating to general sanitation, the preven-
tion and control of transmissible diseases, and the laboratory service
in the Third Army were under the direct supervision of this division.
A.S a result of this sectional organization and the placing of men
trained in epidemiologic work and laboratory procedures where
they might keep intimately in touch and be directly responsible for
the control of infectious diseases in a definite area or or<ranization of
troops, it has been possible, with the aid of mobile laboratories, to
render prompt assistance; make surveys for carriers and corrections
in sanitary defects and to materially aid in the prevention and sup-
pression of epidemics. During its operation this subdivision,
through its representatives, has conducted numerous investigations
of outbreaks of various infectious diseases, including scarlet fever,
diphtheria, measles, meningitis, influenza, pneumonia, diarrhea, dys-
entery, and typhoid, and made recommendations for their control.
Complete reports of these investigations are on file and will afford
valuable information upon which to base future operations. Labo-
ratory methods of early diagnosis, detection of carriers, and prac-
tical measures of control of infectious diseases have been stand-
ardized and put into general operation.
This subdivision has also occupied itself with the preparation and
issuing of information and circulars upon communicable diseases, a
function which it assumed in its capacity as adviser to the chief sur-
geon in matter concerning this branch of sanitation..
D. FOOD AND NUTRITION SECTION.
The steps leading to this organization may be briefly summarized
as follows : In August, 1917, there was organized in the Office of
the Surgeon General a division of food and nutrition and its officers
were authorized by letter of the SecretaiT of War dated October 16.
1917, to inspect food supplies in camps, to endeavor to improve the
mess conditions, and to studv the ration suitability and food re-
quirements of the troops. Officers of this division were sent to
camps in the United States and while in camp gave instruction tc
cooks, mess officers, and unit commanders and also made extensive
studies of ration requirements and suitability. In March 1918. it
was decided to send a group of these officers to the American Ex-
peditionaiy Forces to organize similar work in France. To this end,
on March 7 six officers left the States for that purpose. This party
proceeded first to England and remained there from March 16 to
April 2. Through the courtesy of the British A. M. C. opportunity
was afforded to make a thorough study of the British rationing
system and a preliminary survey was made of the American rest
camps in England. As a result, one officer was left in England to
142367— 19— VOL 2 23
1332 REPORT OF THE SURGEON GENERAL OF THE ARMY.
continue the work there and on April 3 the other five officers pro-
ceeded to France, reportino; to the chief surgeon at Tours on April
12. It was decided to send the officers, one each to a different sec-
tion of the Service of Supply for a preliminary study of conditions,
and one to Dijon for duty in the advance section under the direction
of the director of laboratories, under whom the section of food and
nutrition was later established. The other officers were assigned to
the chief surgeons of the intermediate section and base sections 1, 2,
and 5. Each officer visited and inspected organizations in his sector
and reported his observations. Later the group came together at
Dijon. The following extract from the report of the director of the
section summarizes the results of this preliminary survey :
The results of this preliminary inquiry and of the reports and conferences
led to the conclusion that although the garrison ration being issued generally
to troops was adequate to total food material and the quality of the articles
as a rule good, in many places the feeding of the men was poor, due in large
part to the unfamiliarity of mess sergeants and cooks with the ration in kind
and to their general inefficiency under the conditions existing in France, to
a lack of interest in or attention to mess conditions by company commanders
and higher officers, and in the advance section where daily automatic issue
was in force, to the issue of too many components on a single day, in corre-
spondingly small amounts, i. e., to an unwise issue system. There was nearly
everywhere great waste of food with consequent underfeeding. The rapid
growth and multiplication of camps, the scarcity of material for construction
of kitchens or mess shacks, delays in transportation and the scarcity of re-
frigerator cars for fresh meat produced conditions to which officers and men,
coming from relatively well equipped camps in the United States found it diffi-
cult to adapt themselves. Also the composition of the rations issued appeared
in some particulars not suited to the field service.
As a result of this conference it was decided by the director of
laboratories to establish, with the consent of the chief surgeon, a sec-
tion of food and nutrition in that office which was assigned the fol-
lowing duties: (a) Representing the chief surgeon in matters af-
fecting the nutrition of the troops; (h) investigating Army food re-
quirements and consumption; (c) acting in an advisory capacity
in the formulation of rations and dietaries for the American Expedi-
tionary Forces; (d) inspecting food supplies and mess conditions
with troops, hospitals and prison camps; and (e) giving instruc-
tion in food inspection and mess handling, mess management, and
other measures for the maintenance of nutrition and conservation of
food.
The functions of the section have fallen naturally into two classes,
first, of a technical and scientific character having to do with a gen-
eral study of the food situation, the inspection and analysis of food,
the investigation of the suitability of the ration and the formulation
of desirable changes on the basis of food requirements and the nu-
tritive value of food stuffs, and advisory relationship with the chief
quartermaster and General Staff on these matters; and, second,
field work in mess inspection and instruction for the improve-
ment in the handling and preparation of food.
To carry out the second phase and to secure data for the first
phase, necessitated an organization of field parties. These were or-
ganized through the cooperation of G-5, general headquarters, and
consisted of an officer and instructor, mess sergeants and butcher sup-
plied by the quartermaster department. These parties served with
combat divisions, in sections of the Services of Supply, and where-
A. E. F. — LABORATORIES. 1333
ever there were detachments or other units of troops. They studied
the needs at first hand and continued active instruction to mess of-
ficers and cooks and sergeants in the field. Their reports formed
the basis for the formulation of ration recommendations and this
section wrote General Order 176, which was adopted with few changes
by the quartermaster general and general headquarters.
A food laboratory was established at the central Medical Depart-
ment laboratory, and this has conducted analyses for the quarter-
master department on varied materials submitted for this purpose.
Another phase of the work to which this section has contributed
was a series of investiffations in connection with the bread making
for the Army in which one of our officers cooperated with the
bakery service. This officer later made inspections of factories of
the American Expeditionary Forces and through his eflPorts suc-
ceeded in producing satisfactory sanitary conditions in the French
factories manufacturing food for the American Expeditionary
Forces. The section also cooperated with the quartermaster in saving-
beef through proper instruction to medical officers and others as to
its proper handling. It has through its field officers also kept the
quartermaster informed as to ration shortages and by communicating
directly with regulating officers and the supply department of the
quartermaster department, been able to secure prompt remedy of
these conditions in many places. In addition to field instruction it
has cooperated with G-5 in planning the formulation of schools for
cooks and mess sergeants, and the automatic menu maker is part
of its contribution to this sort of work. One phase of its work has
been the investigation of needs of labor troops and advice to the
quartermaster on this subject.
Since November the following ncAv features have developed in the
work of the section :
(a) The supervision and assistance in the organization of the
large embarkation messes at the base ports. This has covered base
sections 1, 2, 5, 6, and the embarkation center at Le Mans.
(h) At these same base ports a member of this section has in each
base served officially on the boards which inspect transports to de-
termine the proper food equipment of the same.
(c) At advanced general headquarters one of our officers has
served as food and nutrition consultant on the staff of the officer in
charge of civil affairs, and there rendered valuable service in de-
termining the food supply of the occupied territory.
Aside from these new features, officers of the section have con-
tinued their usual inspection and follow-up work in the First, Sec-
ond, and Third Armies and in base ports. In carrying out the pro-
visions of General Order 176, we have investigated over 300 requests
for labor ration increases and filed recommendations on the same
with the chief quartermaster.
Several of our officers have been placed during this period on de-
tached service with the Auierican relief administration investigators
in service, Montenegro, and other Balkan regions.
In this work the section has utilized a personnel of some 40 officers
largely supplied from the food division of the Surgeon General's
Office. In addition, it has had the assistance of some 60 mess in-
structors and butchers from the enlisted personnel of the quarter-
1334 REPORT OF THE SURGEON GENERAL OF THE ARMY.
master rlonnrtment. The cjeneral distribution of these officers has
I '^n ns follows:
1. At Dijon the director of the section, an assistant, and thp
laboratory.
2. In thp combiit divisions, renlacement divisions, and in the sec-
tions of Services of Supply field parties for investig^ation and
instruction as noted above.
3. Special assionments to particular problems as thev arose, such
as the meat problem, the bread problem, factory inspection, etc.
E. THE WATER SUPPLY SECTION.
The water supplv section was orsranired early in 1918 in accord-
ancp with an asreement between the chief snrs^eon. American Ex-
]ieditionarv Forces, thp water snnplv officer, office of the chief engi-
neer. American Expeditionary Forees. and the water supply officer,
officp of the chief enonneer. Li^es of Communication.
Officers and enlisted men of the Sanitarv Corps were detailed as
representatives of the Medical Department for service with the Ensri-
neer Department water supply service. A personnel, familiar with
water purification and control, was chosen from men already present
in the American Expeditionary Forces, iucludinsr officers and men
attached to the 26th Enp'ineers. water supply troops, the Sanitary
Corps personnel attached to the 301st and the 302d water supply
trains, and the division sanitary inspection of water. Additional
men were obtained from the United States. At the time of the sign-
ing: of the aiTnistice the section had expanded to an orsranization
bavins: 11 laboratories or sections of laboratories in the Services
of Supply and 5 transportable or mobile laboratories, in the zone
of the advance. The personnel consisted of nearly 100 officers and
more than 100 men devoting their time almost exclusiyely to the con-
trol of the quality of water supplies.
The work of the section included (1) general supervision of the
quality of the water delivered to water points by the water supply
engineers. (2) quality control of water furnished from water points
to the troops, (3) sanitary surveys of the water supplies in the divi-
sional training areas and in various sections of the zone of advance,
(4) training of divisional water inspectors for their duties, and
(5) study of special problems connected with water supplies.
1. Sanitary Corps officers attached to engineers, water supply serv-
ice, were made responsible for the quality of water furnished at
water points, both in the Services of Supply and the zone of the ad-
vance. They have had charge of purification plants which included
coagulation, sedimentation, filtration, and sterilization, depending
on the character of treatment required to deliver a potable water.
Approximately 150 water purification or sterilization plants were
under the general super\'ision of the Sanitary Corps officers. Labo-
ratory w-ork was handicapped by delay in receiving apparatus and
chemicals.
2. Sanitary inspectprs of water acting as assistants to the division
sanitary inspectors have been made responsible for the quality con-
trol of water furnished troops. This has included sanitary surveys
and the supervision of chlorination of water in Lyster bags and
A. B. F. LABORATOBIBS. 1336
water carts whether the divisions were in training areas or in the
zone of the advance.
3. The Sanitary Corps officers with water supply engineers and
sanitary inspectors of water have made water surveys showing the
sources of water supplies in the training areas and in the zone of
the advance. Keports and maps were prepared and appropriate
signs placed on various supplies to indicate the character of the
water. Ihe work in the held was greatly handicapped by lack of
transportation.
4. Especial courses of instruction were given at the central Medical
Department laboratory at Dijon to the divisional sanitary inspectors
of water in order that practical and uniform methods of cliiorma-
tion procedure would be toilowed m the held. Practical instruction
was given m the proper method of chlorinating water m Lyster bags
and water carts, ilie Sanitary Corps omceib, with the water suppiy
enginfcers, were given bpecial instructions at the water analysis
laLK>i-atory at Pans. Special attention was given to methods of
analysis, and to the operation of liquid chlorine machines and mobile
purincation units.
5. ;2ipecial problems have been investigated by the personnel
attaclied to tJie various laboratories. Oiten several laboratories
have cooperated in the studies and the results have been col-
lected and coordinated. Ihese studies include: {a) 'ihe compila-
tion of a builetm (JNo. 25, central Medical Department laboratory)
on Methods of Water Analysis adapted for use in water analysis
laboratories of the American Ji.xpeditionary Forces, published by
the American Red Cross ^society. (6) An article on the use of
liquid chlorine in water treatment, published m French. It has
been of great assistance in explaining the process to city otiicials
where it was desired to have a municipal supply treated, {c) Water
supplies for troops m transit, 'ihe water has been improved both
in quality, quantity, and facilities for its distribution, {d) Assist-
ance given the Air Service in the installation and operation of
Permutit water-softenmg plants, (e) The discovery and removal
of a serious pollution oi the water supplied to the Fort de Com-
merce and United States transports at Brest, by waste products from
hydrogen manufacture. (/) Inspection and analysis of calcium
hypochlorite used for sterilizing water in Lyster bags, and recom-
mendations to improve quality, methods of packing and shipment.
{ff) An investigation and report submitted recommending the instal-
lation of a water-softening plant for the laundry at St. Pierre de
Corps, which would save soap, soda, and tonnage, (h) Investiga-
tion of boiler water conditions at La Rochelle and a recommendation
made for softening water used in boilers of locomotives and unload-
ing cranes. Pending construction of water-softening plants, scale
was removed from boilers and recurrence of scaling or foaming pre-
vented by proper treatment.
F. SUMMARY.
The work of this division may then be summed up by saying that
each of its four sections — laboratories, infectious diseases, food and
nutrition, and water supplies — has attacked its special problems
promptly, vigorously, and intelligently. Though each at all times
1336 REPORT OF THE SURGEON GENERAL OF THE ABMY.
has been greatly undermanned and handicapped for lack of person-
nel, equipment, supplies, and transportation, in no instance has it
been defeated in its attempts to grapple with the serious sanitaiy and
health emergencies of the Amci-ican Expeditionary Forces. An in-
estimable amount of sickness has been prevented. Though, in Jthe
presence of unavoidable conditions, serious epidemics of communi-
cable diseases have developed, in most instances the flames have been
extinguished before they became a conflagration. Only influenza
lias leaped all barriers," and that has overwhelmed the civilized
world. The wounded have been infected but the infective agents
have been found and the means of neutralizing their effects pointed
out. Men have died before their condition was rightly understood,
but even they have not died in vain since the laboratory has gieanecl
the naked truth concerning them and placed it. where it has saved
others. And yet, when the war ended the division was but catching
its stride — a few months more and this most efficient organization
for the combat of preventable diseases and the maintenance of high
i-tandards of medical and surgical diagnosis and treatment under
war conditions would have been perfected to a degree not hitherto
known.
6. Hospitalization.
The first requirement in hospitalization was the securing of build-
ings suitable for hospital purposes, properly located and with ca-
pacity to provide sufficient beds for the troops of the American Ex-
peditionary Forces. The two possible sources from which these
might be obtained were to take over (1) existing buildings from the
French, such as schools, hotels, casernes, chateaus. and French hos-
pitals, and (2) by construction.
A conference was held on July 8, 1917, between representatives of
the chief surgeon's office, American Expeditionar}- Forces, and the
French Service de Sante with a view of projecting a study-for the
organization of 50,000 beds which it was the tentative intention of
the American General Staff to locate in French territory during the
remainder of 1917.
It was agreed that these representatives should make studies : (a)
In the region of the naval bases of St. Xazaire, La Rochelle, and
Bordeaux, (h) in the vicinity of the camps at Gondrecourt and
La Valdahon. and (<?) along the lines of communication.
In carrying out this project, studies Avere made of prospective hos-
pital sites in the neighborhood of the following cities: Angers, St.
Xazaire. Savenay, Nantes, La Rochelle, Bordeaux, Perigueux, Lim-
oges, Chateauroux, Tours, Consne. Xevers, Cercy la Tour, Beaune.
Dijon. Le Valdahon, Besancon, Langi'es, Chaumont, Neuchabeau.
Vittel, Martigny, Contrexeville. Rigny-la-Salles, Churches, Epinal.
and Sens.
As a result of recommendations from the chief surgeon, based
upon the above-noted studies, the commander in chief on August 13,
1917, authorized the chief quartermaster and the chief engineer, in
cooperation with the chief surgeon, to take steps immediately to
provide hospitalization on the lines of communication for 300,000
men, having in view the increase required for 2,000.000 men. as
follows : Base section, west of Tours, 38,000 ; intermediate section, be-
A. E. F. — HOSPITALS. 1337
tween Tours and the French zone of the armies, 21,000; advance
section, 14,000.
By September 20. 1917. French hospitals with a total capacity of
6,250 beds had been turned over to the American Medical Department
by the French Service de Sante, and the following sites selected for
the construction of barrack hospitals :
Beds.
Nantes 2, 000
La Rochelle 4, 000
Perigueux 5. OOO
Bordeaux 5. oOO
Tours 4, 000
Dijon 5.000
Neufchateau (Bazoilles) 5, 000
Beaune 1, 000
La Baule
Limoges 1, oOO
Fassy
Poitiers 1,000
Angouleme 1, 000
Vichy ^ 3.000
Moulins 2, 000
Confidential Memorandum No. 76, Headquarters American Expe-
ditionary Forces, dated August 30, 1917, had previously directed
that, where suitable buildings could not be found for the purpose,
300-l3ed camp hospitals would be constructed in each divisional
training area.
On November 1, 1917, the commander in chief approved an altered
distribution of the 73,000 beds in the first progi"am, so as to give
about 40,000 in the intermediate section and about 20,000 in the base
sections, upon the recommendation of a joint board of American
and French officers, previously appointed to make a further study
of American hospitalization.
Prior to June 1, 1918, all matters of hospitalization involving new
projects and new construction required the approval of the com-
mander in chief. The more rapid arrival of troops in France than
had been expected, the many difficulties that were encountered in
securing and transporting materials and labor and in securing and
leasing suitable hospital sites, which rendered projects involving
new construction not available for six months, and the recognition
of the fact that the provision of adequate hospital accommodations
should keep pace with the arrival of troops made it necessary to
adopt a more comprehensive, definite, and settled policy on hospi-
talization, one which would provide for an automatic supply of beds
computed on the total American Expeditionary Forces' strength of
troops in Europe. On that date, acting upon recommendation from
the chief surgeon, American Expeditionary Forces, the commander
in chief authorized the Medical Department to maintain an actual
current bed status aggregating 15 per cent of the total American Ex-
peditionary Forces' troops in Europe. This numerical bed allow-
ance was to include the accommodations provided in all fixed hos-
pitals, irrespective of type, as well as convalescent camps, computa-
tion to be made on the basis of ordinary bed capacity, and was not to
include temporary increases in capacity by the use of tentage in
fixed formations or the temporary hospitalization provided in mobile
sanitary formations.
1338 REPORT OF THE SURGEON GENERAL OF THE ARMY.
In order that the Medical Department could make timely pro-
vision in anticipation of future needs it was authorized to utilize
an additional credit of 90,000 beds over the 15 per cent flat rate, to
be made up in monthly allotments of 15,000 beds each. This authori-
zation permitted the expansion of existing hospitals, hospital centers,
and the construction of camp hospitals without reference to general
headquarters, but required all matters of hospitalization involving
new projects to be referred for consideration. This authorization
provided a satisfactory working basis ui)on which the chief surgeon
could plan hospitalization upon a priority schedule, based upon the
expected arrival of troops in Europe and made it possible to avoid
any conflict of opinion as to the ratio between combat and other
troops.
A. LOCATION.
The location of American hospitals offered very considerable
difficulty. It was desirable to have them near the troops they were
to serve and near the lines of communication. It was some time after
America's entry into the war before it was decided in what sector
the Americans would operate and where the line of communication
would be, as a result of which the Medical Department was ham-
pered in making definite plans as to the location of hospitals.
In locating the hospitals consideration had to be given to the
transportation situation and to the problem as to whether or not-
the treatment of the greatest possible number of cases would be
required toward the bases or toward the front. Attention had to
be given to the matter of sidings for the purpose of unloading sup-
plies and patients at the hospitals. It was necessar}^ to locate the
hospitals in such places as would not interfere with the training of
troops, the location of camps, and the establishing of depots.
The training areas for the Americans had been centered around
Neufchateau and the lines of communication extended back through
Dijon, Nevers, Bourges, Tours, Angers, Nantes, St. Nazaire; and
from Bourges through Chateauroux, Limoges, and Perigueux to
Bordeaux, and the logical location for the greater number of Ameri-
can Expeditionary Forces hospitals was m these areas and along
these lines of communication. The base ports of Bordeaux, St.
Nazaire, and Brest required considerable hospitalization as debarka-
tion ports for the permanently disabled and for the prospective cart
of sick from troops returning to tlie Ignited States from the Ameri-
can Expeditionary Forces.
B. BUILDINGS.
a', existing FRENCH BUILDINGS.
By 1917 the French and English had almost exhausted the supply
of available buildings in France for hospitalization and the large
influx of French and Belgian refugees from the devastated areas had
made heavy demands upon any remaining reserve. The buildings
which could be turned over to the Americans by the French at this
time were not well suited to American hospital organization and
■ methods. In many cases the offerings were inaccessible, in a con-
dition of bad repair, without modern sanitary plumbing, and too
A. E. P. HOSPITALS. 1339
small and scattered to be operated to advantage under the American
system of hospitalization. School buildings, hotels, casernes, and
French hospitals, while not well suited to hospital purposes, were
secured later in large nmnbers, however, and were with difficulty
operated as military hospitals with more or less success. French
hospitals generally were small institutions of from 25 to 300 beds,
widely scattered, personneled largely by voluntary workers who
lived at home. If taken over by the American Expeditionary Forces,
it would have been necessary to quarter the personnel in the hos-
pitals, thereby lessening the bed capacity. The administration of
small hospitals requires the distribution of the sanitary personnel
in small groups, which results in a very considerable increase of
the total personnel required. The allowance of sanitary personnel
in the American Army had been fixed at a figure so low in propor-
tion to combatant troops that their work could be effectivel}'' ac-
complished only in large groups. The hospital unit had been in-
creased to a thousand beds capacity capable of being expanded
in emergency by providing crisis expansion in tents. From the
beginning it was apparent that French hospitals could not be util-
ized to advantage by the Americans except to meet the needs of
small camps or to form a nucleus around which barrack hospitals
could be constructed.
b'. hotels.
Hotels as hospitals had not only the objections of being hard to
administer, extravagant in the requirement of personnel, but were
otherwise not generally suited for hospital purposes because of the
numerous halls, small rooms, and many stairs. Those available were
very largely summer hotels without heating facilities, with insuffi-
cient water and very limited plumbing, were expensive to operate
in that the rental was high, many alterations had to be made, dam-
ages were sustained to the furniture in being removed, and, when
returned to the owners, complete restoration was required to be made
under the French law.
Inasmuch as construction was unavoidably delayed, it was neces-
sary to lease hotels in large numbers and operate them as hospitals
in order that the sick and wounded of the fast arriving troops could
be cared for, notwithstanding the many objections to their use.
C'. CONSTBUCTION.
Two standard types of hospitals were adopted for constniction,
types A and B, plans for which were furnished the Engineer Depart-
ment bj^ the chief surgeon. These differed only in that the wards
of the type B hospital were smaller. The type B usually had a ca-
pacity of about 300 beds and were utilized as camp hospitals; the
type A had a normal capacity of 1,000 beds and were used for base
hospital purposes. Vacant ground was left adjoining the wards for
the erection of crisis expansion sufficient to double their capacity.
The crisis expansion consisted of tents with floors, with water and
light installations, and when equipped served a most useful purpose
in caring for the sick and wounded in emergency.
1340 REPORT OF THE SURGEON GENERAL OF THE ARMY.
C. HOSPITAL CENTERS.
The necessity for economy in Medical Department personnel, tht
recognition of the difliculties to be encountered in the transport oi
medical supplies, and, particularly, the transportation of the sick
and wounded from the battle line, the necessity for sidings foi
American hospital trains and unloading stations, the necessity for
economy in building materials, led the Medical Department soon
after the arrival of American troops in France to the consideration
of plans for the concentration of hospitals in groups. After con-
siderable study by the chief surgeon of French and English hos-
pitalization, of the American lines of communication, of French
ports available for the use of the American Army, of transportation
and personnel difficulties, of available and suitable sites for hospitals,
reconmiendations were approved by the commander in chief for the
erection of hospitals in gxoups which were officially designated as
"hospital centers."
The scheme of the organization of these centers was to have from
2 to 20 independent base hospitals and a convalescent camp operate
under one administrative head. It was contemplated that the larger
centers, with crisis expansion and convalescent camp, provide for
from 30,000 to 36,000 patients. Each center was provided
with its own auxiliary activities such as Quartermaster and Medical
Department depots, laundry, bakery, motor transport park, electric-
light plant, detachments of Quartermaster, Engineer, and Medical
Department troops, with military police and headquarters detach-
ments.
The commanding officer's staff included, for instance, in the case of
Mesves hospital center, the following officers :
1 assistant commanding officer, major, M. C.
1 captain, adjutant.
1 lieutenant, medical supply officer.
1 major, laboratory officer.
2 captains, assistants to laboratory officer.
1 major, evacuation officer.
1 captain, assistant to evacuation officer.
1 captain, sanitary inspector.
1 lieutenant, motor transport officer.
1 lieutenant, assistant motor transport officer.
1 major, quartermaster.
8 first lieutenants. Quartermaster Corps assistants.
1 captain, central purchasing agent.
1 captain, salvage and burial officer.
1 lieutenant, railroad transportation officer.
1 captain, commanding officer, headquarters detachment, fire marshal, and
band.
1 lieutenant, statistical officer.
1 captain, provost marshal.
4 iirst lieutenants, assistants to provost marshal.
1 intelligence officer.
1 captain, supervisory of buildings.
1 major, medical inspector.
1 chief nurse, for the center.
1 lieutenant colonel, medical consultant.
4 majors, medical consultants.
The immensity of some of these centers will be recognized when it
is noted that from November 11 to December 5, 1918, Mesves hos-
pital center reported daily a capacity of 25.000 emergency beds.
A. E. F. — HOSPITALS. 1341
This center, on November 16, 1918, had a total of 20,186 patients. On
November 21, 1918, tlie number of permanent personnel on duty in
that center was 8,642. On November 16, 1918, the total strength of
the command in that center, including personnel on duty and patients
in hospitals, was 28,828, the strength of a division of infantry.
In these centers the hospitals were grouped to the best advantage
and the system permitted the development of special hospitals to a
high degree of perfection. Special hospitals were a feature of all
the centers, there being, as for instance at the Savenay center, a
tuberculosis, an orthopedic, and a psychopathic hospital in addition
to those used for general surgery and medicine.
Highly skilled specialists were detailed as consultants on the staffs
of the commanding officers to supervise the proper care of the sick
and wounded. These specialists were of the most skilled that
America has produced, many of the leading and most prominent
surgeons, neurologists, orthopedists, internists, bacteriologists, and
roentgenologists of our country having come to the aid of the Medi-
cal Department at the outset of the war.
~ Hospital centers were of two types: a' (1) Those established in
French buildings and h' (2) constructed barrack hospitals.
Those established in Franch buildings consisted of groups of hotels
or casernes where hospital units of personnel operated from 2 to 7
base hospitals, with capacities varying from 1,000 to 16,000 emer-
gency beds. The two most prominent of these were the Toul and
Vichy centers, the hospitals for the former occupying casernes
largely, and those of the latter being established in hotels at that
famous watering resort.
The constructed centers as authorized were to consist of from 2 to
20 complete type A hospitals, with a crisis expansion sufficient to in-
crease the caj^acity of each from 50 to 100 per cent, and a convalescent
camp with a capacity of 20 per cent of the normal beds of the center.
The type A hospitals had a normal capacity of 1,000 beds. One base
hospital personnel in emergency with crisis expansion could care for
from 1,500 to 2,000 patients.
When the armistice was signed there were 5 centers in operation
in French buildings with a total capacity of 38,340 normal and 51,523
emengency beds, and 14 centers operating in constructed barrack
hospitals with a total capacity of 69,059 normal and 127,270 emer-
gency beds.
D. BED CAPACITY NOVEMBER 11. 19 IS. '
The total capacity of the 153 base hospitals, 66 camp hospitals, and
12 convalescent camps operating on November 11, 1918, was 192,844
normal and 270,347 emergency beds of which 184,421 were occupied.
E. INFIRMAEIES.
Infirmaries of from 10 to 50 beds capacity were authorized for
organizations in camps, such as regiments, and for detachments in
towns where the number of troops present did not justif}' the estab-
lishin.q- of camp hospitals. The function of these infirmaries was to
care for the slightly sick that did not require hospital treatment.
They were operated by Medical Department personnel attached to
(lie organization served.
1342
REPORT OF THE SURGEON GENERAL OF THE ARMY.
F. ADMINISTRATION.
Hospital centers and independent base hospitals, for the purposes
of administration, were operated under the direct supervision of the
commanding general, Services of Supply, but for purposes of supply
and discipline they were under the jurisdiction of the commanding
officer of the section in which they were located. The administration,
supply, and discipline of camp hospitals came under the jurisdiction
of the section commanders. Camp infirmaries were administered and
supplied under the supervision of commanding officer of the local
troops served.
G. MISCELLANEOUS.
The total number of patients that passed through hospital centers
up to and including March 31, 1919, is as follows:
Mesves 38, 765
Allerey 33, 658
Keiiiuou 24, 533
Rimaucourt 21, 067
Beau Desert 47,238
Nantes 29, 538
Mars 33, 2.56
Joue-les-Tours 13. 701
Bazoilles 66, 284
Savenay 61, 973
Vichy 46, 297
Limoges 23, 818
Riviera 13, 446
Beaune 13, 500
Perigueux 4, 540
Vittel-Contrexeville 44, 855
Toul 67, 866
The maximum number of beds reported from hospitals in the
xVmerican Expeditionary Forces was 299,838 emergency beds on
November 21, 1918 (including convalescent camps).
The maximum number of occupied beds reported was 193,026 on
November 12, 1918 (including convalescent camps).
List of iiospital centers witti numbers of base hospitals in each one:
Commercy center 2
Toul center 7
Bazoilles center 7
Vittel-Contrexeville center 4
Rimaucourt center 5
Langres center 2
Beaune center 7
Allerey center 7
Mars center 9
Mesves center 11
Vichy center 5
Clermont Ferrand center 4
Orleans center 1
Tours center 2
Vannes center 2
Angers center 2
Nantes center 4
Savenay center 8
Beau Desert center 7
Perigueux center 2
Limoges center 3
Pau center 4
Riviera center 3
The maximum hospitalization for which buildings and property
had been acquired follows:
Normal. I Emergency.
Base hospitals
Camp hospitals
Convalescent camps
322,376 437,744
38,686 ; 40,835
62,660 62,660
423, 722
541,239
On and including April 30, 1919, 96 base hospitals had ceased oper-
ating, 70 of which had sailed for the United States and 4 disbanded
in the American Expeditionary Forces. Sixty-one camp hospitals
A. E. F, HOSPITALS.
1343
had ceased operating, 41 of which had been disbanded and 20 released
for return to the United States as organizations. Seventeen evacua-
tion hospitals had ceased operating. 13 of which had sailed for the
United States and one disbanded in the American Expeditionary
Forces. Twelve mobile hospitals had ceased operating. 7 of wbicli
had sailed for the United States.
Attached hereto is a statement of the status of hospitalization on
November 11, 1918.
Status of hospitalization on Nov. 11, 1918, showinq normal and emergency beds
in French buildinr/s and construction, normal beds as authorized for future
expansion.
N
ov. 11, 1918.
Sections.
Conva-
lescent
camps.
United
States
Army
construc-
tion.
French buildings.
Total
normal
beds.
Crisis ex-
pansion
emer-
Rency
beds.
Schools.
Hotels.
Castles.
5,000
14,829
17, 790
26, 181
400
13, 577
14,536
2,030
1,695
4,882
2,800
1,982
100
7,576
11,939
21,180
9,379
5,106
3,370
5,022
5,695
53,301
67,190
8,306
24,229
24,961
8,070
480
4,594
1,300
413
17,330
46 273
Intermediate
Paris
3 928
Base Section No. 1
3,500
5,303
1,800
345'
5,517
10 455
Base Section No. 2
Base Section No. 3
Base Section No. 4
480
964
300
Base Section No. 5
3,500
""i'ooo"
400
Base Section No. 6
Base Section No. 7
i25
288
Total
28, 692
78, 139
12,913
22,660
50, 440
192,844
83,503
Future as authorized
Sections.
Normal
beds.
Tent.
United
Army
construc-
tion.
French buildings.
Schools.
Hotels.
Castles.
68,672
174,083
17,207
36,693
44,899
18,020
11,500
19, 514
13,400
2,082
11,600
36,800
8,000
6,350
7,325
31,371
121,436
3,400
27,081
31,214
10,980
10,000
16,800
1,695
6,152
6,336
3,332
950
7,576
29,592
28,030
14,903
7,471
Intermediate
Paris
2,720
6,150
345
400
3,560
6,585
6,695
620
Base Section No. 2
Base Seer 'on No. 3
Base SectiOii No. 4 ....
2,000
480
844
300
Base Section No. 5
1 870
Base Section No. 6
13,100
Base Section No. 7
425
1,657
Total
406,070
72,075
252,707
22,089
59,883
71,391
7. Sick and Wouxded Record Divisiox, Chief Surgeon's Office.
The sick and wounded division of the chief surgeon's office was es-
tablished August 22, 1917. At that time it consisted of one medical
officer and two enlisted men whose function was to audit the few sick
and wounded reports that were received from the scattered units
then in France, then forward them to the Surgeon General of the
Army. The sick and wounded division now occupies offices in a large
three-story building in Tours, an old French residence which was
altered and renovated for the purpose. The personnel consists of 1
1344 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
medical officer, 5 officers of the Sanitary Corps, 86 enlisted men, and
80 French women.
As early as September, 1917, when the American troops began to
arrive in France in large numbers and the period of activity in-
creased and changes in organization and replacements were being
inaugurated, it was realized that the method of reporting the sick
and wounded, as called for in the Manual for the Medical Depart-
ment, was inadequate and unsuitable to the conditions confronting
the American Expeditionary Forces. Orders for special reports of j
all sorts were received from the commander in chief. General Staff,
and other agencies of the American Expeditionary Forces, which
could not be filled. The chief surgeon being convinr^ed of the im-j
possibility to furnish the required information under the old system,]
and the imprarticability of its being carried on in times of active
combat at the front, appointed a board of medical officers to revise
the method to meet the needs of the American Expeditionary Forces. ■
About this time, The Adjutant General's Department was under- ^
taking the organization of the statistical section (later became the
central re-^ords office). Their program required numerous and elab-
orate reports from hospitals. The necessity for coordination in this
matter was obvious in order to reduce the clerical work of hospitals
to a minimum, and at the same time furnish the necessary informa-
tion to both The Adjutant General and Medical Department.
After careful study and frequent r-onsultation on the subject with
authorized representative of The Adjutant General's Department, a
system was proposed which in brief comprised —
(a) Field medical card and envelope, which was attached to the
patient at the first dressing station to which he was admitted, and
accompanied him until his case was finally disposed of.
(h) A daily report of casualties and changes for patients in hospi-
tals and infirmaries functioning as hospitals.
(c) A telegi^aphic report of communicable diseases.
(d) Special venereal report.
(e) A monthly report consisting of a complete sick and wounded
card for every case completed in the American Expeditionary Forces
and for every case evacuated to the United States.
The latter report to constitute the permanent record of the soldier
in the War Department.
In order to obtain complete records of our troops serving with the
allied armies, arrangements had to be made with the French and
British authorities in France and England, for reporting American
patients in their hospitals. This was effectuallv a'^complished and
suboffices were established at the Service de Sante in Paris: at Eouen,
and at London. All reports of patients in allied hospitals were sent
to one or the other of these branch offices where they were transcribed
on American Expeditionary "Forces forms and forwarded to the chief
surgeon, Ameri' an Expeditionary Forces.
The inauguration of the new system meant the handling of thou-
sands of reports in the office of the chief surgeon. Inasmuch as the
statistical division of The Adjutant General's Department had
adopted the same form of daily report for patients in hospital, and
theoretically there would be a certain amount of duplication of work
in the two offices, it was suggested by the statistical division that the
medical record section of the chief surgeon's office bo consolidated
A. E. F. — MEDICAL RECORDS. 1345
with the central records office. There were a few advantages in such
an arrangement, but in the opinion of the chief surgeon the plan was
considered inexpedient and was disapproved. The daily report of
casualties and changes from some 500 or more hospitals, showing
every change of status of patients in hospital, had to be made avail-
able for statistical purposes and for answering hundreds and thou-
sands of inquiries regarding the whereabouts and condition of sick
and wounded soldiers. The central records office has assumed the
responsibility for this latter purpose and had so been charged with
this function in general orders, general headquarters. American Ex-
ipeditionary Forces. However, in the last analysis it was considered
Ithat the chief surgeon's office should have all the available informa-
;ion concerning patients in hospital and should be able to furnisli
t in case of necessity. Experience has proven the wisdom of such
I decision, as this office was able to answer hundreds of inquiries
.iaily from the central records office, American Red Cross, Knights
of Columbus, Jewish Welfare, and Christian Science committees, and
other agencies of the American Expeditionary Forces and War De-
partment. In addition the monthly sick and wounded reports from
the same number of units had to be checked and corrected in detail
before they could be forwarded to tlie War Department as a final
and permanent record. To handle this great volume of work the
Hollerith tabulating equipment was installed.
From the beginning the difficulty of obtaining complete and accu-
rate reports was realized. Each day new obstacles had to be over-
come. The daily evolution in connection with the replacements,
changes of status of hospitals, classification of patients, shifting of
troops, splitting up of some units and consolidation of others, all of
which vitally aflPected the work of the records division, took place
with such rapidity that it was impossible to keep track of them from
this office. Many reports were lost in transit and had to be dupli-
cated. In many instances when organizations were called upon for
duplicates they would reply that their retained records had been
lost in action.
In addition, there was the personal equation of inex])erienced
medical officers and personnel to contend with. To combat these con-
ditions a field force consisting of trained medical officers and experi-
enced registrars was established. Their function was to inspect hos-
pital records, give instruction in the preparation of reports, and
keep the office advised in all matters affecting report of sick and
wounded.
To avoid loss, hospitals were required to send their reports by spe-
cial courier when they were too bulkv to be sent bv registered mail.
A suboffice was established at Joue-les-Tours. where the retained
records of hospitals that had been closed were sent and made avail-
able for use in case of necessity. Many reports that were lost in
transit to the United States were duplicated from this source. This
office has also proved of inestimable value in furnishing information
to the central records office.
In order that no organization would leave France before rendering
the required reports, registrars of outgoing units were required to
bring to the chief surgeon's office the final report of sick and wounded.
1346 REPORT OF THE SURGEON GENERAL OF THE ARMY.
with certain other records, where they were checked and, if found
complete and correct, clearance was given.
8. INIedical and Hospital Supplies,
July 1, 1918, saw the supply division of the Medical Department
confronted with many problems and diiEculties. Troop movement
was accelerated in April extending through May and June, and on
July 1 there were 1,000.000 men in France, whereas plans of five
months previous had provided for about half that number. Although
the production of medical supplies for military needs was pushed to
the utmost in the United States, the necessities of the concentration
camps there prevented the accumulation of a large reserve, so that
it was very difficult to meet the great increase in our demands.
The difficulties of transportation were numerous both in the
United States and here. At home the docks were congested with
all classes of war supplies, and the problem of handling and trans-
porting same expeditiously had still to be worked out. On this side
the lack of dock facilities and inadequate storage plants at the base
ports at this time, the congestion of the railroads, shortage of cars
due to the immense number required to transport the incoming
troops prevented prompt utilization of supplies which had been
floated from the United States.
From the beginning the Medical Department realized the im-
portance of economy in ocean tonnage and every effort was made
to reduce shipments from the States to a minimum. To accomplish
this many items on the suppl}?^ table formerly considered essentials
were cut off. The number of medicines was reduced by one-third,
and many bulky articles of furniture were also eliminated. Incon-
venience, particularly to hospital attendants, was caused by the lack
of furniture and equipment to which they were accustomed, but it
is believed that no additional suffering to patients was caused by
this elimination. It is certain that many of the medicines habitually
used by physicians are unnecessary, and it is remarkable that so little
adverse comment was heard relative to the restricted list.
It was early recognized that it was a matter of vital necessity to
establish as many distributing depots in France as possible and thus
save inevitable delay in filling requisitions due to the difficulties of
mail communication and the uncertainty of delivery of supplies,
especially in less than carload lots. At this time there were two
distributing depots, the intermediate medical supply depot at Cosne
and the advance medical supply depot at Is-sur-Tille. There was no
reserve of many of the items on the supply table, this being par-
ticularh' true of surgical instruments, dental, laboratory, and vet-
erinary supplies, so that it was impossible to secure stock sufficient
to establish additional issue depots. However, as rapidly as large
hospital centers were established, supnly depots were opened in each
center. These depots carried a fair reserve of all the essential items
which could be furnished, and as other items became available the
list was extended to include all supplies required by large hospitals
operating in these centers. This resulted in actually conserving sup-
plies since the reserve ordinarily carried by individual hospitals
were collected in the center depot.
A. E. F. — SUPPLIES.
1347
Until July 1 the distribution of all supplies from the base ports
was controlled from the intermediate medical supply depot at Cosne,
but this function was then taken over by the chieiF surgeon's office.
Reports of all supplies received at the base storage stations were sent
to that office, where stock records were kept on specified items, termed
" controlled stores." The number of these items was increased as
rapidly as sufficient stock was received to build up reserves, and their
distribution to the issuing depots and hospital-center depots was con-
trolled from the chief surgeon's office. This plan made it possible to
have accurate data as to the quantity of supplies in France and their
location. It also made possible the routing of a large amount of sup-
plies direct from base ports and docks to the places where they were
needed. It obviated much reshipment and reduced the time for
transit, thus relieving the issue depots of much work and in effect
increasing our reserve.
A. SUPPLY DEPOTS.
Suitable buildings for supply depots were not available in France
and construction was necessary in every instance except at Cosne, the
first depot established. At the base ports, at Gievres, and at Is-sur-
Tille buildings of similar type were erected. Construction could
only keep pace with the actual necessities of the day, thus making it
impossible to reserve space for expected shipments or to properly
segregate in separate buildings the various classes of supplies. At
the time of the signing of the armistice the Medical Department had
established and in operation the following depots :
Capacity
(square feet).
Issue depots:
Cosne 72, 000
Is-sur-Tille 125,000
St. Nazaire 20,000
St. Sulpice 2.5. 000
Stompe nnd issue depot :
Gievrw? 375,000
Base storage depots:
Montoir 146,250
St. Sulpice 22.5,000
Mirimas 76,000
Hospital center depots :
It.izoilles-sur-Meuse 10, 000
Vittel-Contrexeville 6, 000
Rimaucourt- 5, 200
Hospital center
Continued.
Langres
Beaune
Mars-su r-All ier
Mesves
Vichy
Savenay
Alleray
Toul
Beau Desert
Clermont-Ferrand
Capacity
(square feet).
depots —
2,000
5,000
12,000
11.200
9,000
8,000
10,300
13,500
6.000
6,000
Total 1,168,450
B. PURCHASES IN EUROPE.
All purchases in Europe of supplies for general issue were made
through the medical purcliasing officer, who was a member of the
general purchasing board at Paris, and as far as possible these were
made through the French and English Governments in order to avoid
competition and duplication of supply. After four years of war,
raw materials in Europe were very scarce and the shortage of coal,
lack of labor, and difficulties of tran.sportation^ made procurement
very uncertain and often almost impossible. While it was possible
to obtain certain articles in sufficient quantity to result in the saving
142367— 1&— VOL 2 24
1348 REPORT OF THE SURGEON GENERAL OF THE ARMY.
of some tonnage, the only dependable source was the United States,
as the most annoying shortages were due to failure to procure de-
liveries on orders placed here.
There was established at Paris an instrmnent repair shop, an X-ray
repair shop, and an optical unit. These installations were necessary
on account of the scarcity of labor and material in France and the
impossibility of procuring spare parts for American-made appara-
tus. The instrument and X-ray repair shops not onlv did much
repair work but also did considerable manufacturing, makinsr manv
instruments and appliances which could not be otherwise obtained.
The optical unit ground and finished many spectacles which could
not have been purchased here. The demand for lenses was large,
as men were accepted bv examining boards who would have been
rejected in peace time due to errors of refraction.
C. PERSONNEL.
A well-trained force is necessary for the proper handling of medi-
cal supplies, but the very rapid growth of the work required such
increase in personnel that each new depot establi'^hed could be sup-
plied with only one or two experienced men and they were obliged
to organize and train their entire force. Under these circumstances
accurate property returns were impossible and errors frequently oc-
curred, but under the pressure of active operations men develop with
surprising rapidity and the results obtained by the untrained were
much better than seemed possible.
9. Finance and Accounting Division, Chief Surgeon's Office.
a. purpose.
An act of Congress, dated September 24. 1017. authorized the
Comptroller of the Treasury and the Auditor of the War Department
to send to the American Expeditionary Forces a portion of their
organization for performing there the functions of their office. As a
result of the establishment of the Office of the Assistant Comptroller
of the Treasury and the Assistant Auditor for the War Department
in France, and in accordance with the request of the commander in
chief American Expeditionary Forces, the chiefs of the various de-
partments within the War Department organized units to perform
in the American Expeditionary Forces the work done by the finance
and property divisions of their several departments in the United
States. The unit formed in the Medical Department eventually
became the finance and accounting division of the office of the chief
surgeon, American Expeditionary Forces.
B. PREPARATORY WORK.
The unit was in process of formation during the months of
October. November, and Deceml^er. 1917, durinrr which time consid-
erable studying was done in the Office of the Surgeon General and
military training was received at Governors Inland, N". Y. On Janu-
ary 3. 1918. 5 officers and 100 enlisted men embarked, and on Janu-
ary 23, 1918, 2 officers and 37 enlisted men left the United States.
The first detachment landed at St. Nazaire on January 17, 1918, and
K. E. F. SUPPLIES. 1349
was shortly thereafter sent to Blois, where it remained until Febru-
ary 13, 19i8, during which time the training in the work to be done
was continued. On that date the detachment was transferred to
Tours, whi< h was then headquarters lines of communication, and on
March 22, 1918, began actual operations as a division of the office of
the chief surgeon.
C. PERSONNEL.
In order to secure men qualified for the work in the United States,
communication was had with the principal banks of the East and
as far west as Chicago, and also with a large number of insurance
companies, railways, and mercantile establishments, and men from
these institutions who were already in or about to enter the service
were secured. Of the original personnel of 7 officers and 137 men, a
large number were detached in the early days in France to assist in
statistical work elsewhere, so that only 6 officers and 47 enlisted men
remained when the unit began functioning. Later additions were
made until the maximum strength of 10 officers. 132 enlisted men,
and 15 French civilian employees was reached in February, 1919.
D. OUTLINE AND SCOPE OF ORGANIZATION.
The scope of the work also increased, beginning with 4 sections
and finally growing to 15 sections, as follows :
1. Disbursing. — This section paid French commercial bills, all
doubtful vouchers which were referred to it by other disbursing offi-
cers of the Medical Department, all laundry accounts, and all civilian
personnel pay rolls. Up to April 30, 1919, this section paid 4,593
vouchers, same being the largest number handled by any disbursing
officer in the Medical Department.
2. Auditing money vouchers. — In this section, all payments, except
civilian pay rolls, made by any disbursing officer of the Medical De-
partment in the American Expeditionary Forces were audited, and
so far a,s possible, errors corrected prior to forwarding to the Treas-
ury Department for final audit. Vouchers were examined as to
legality, as to being correct Medical Department charges, as to con-
formity with authorization for the disbursement, as to arithmetical
correctness, and as to possible duplications.
3. Analysis and recording of disbursements. — In this section ab-
stracts were made of all vouchers before same passed out of the
hands of the Medical Department.
4. Analysis and recording of civilian pers&rmel. — Here all pay
rolls of civilian personnel were audited and abstracts made before
being forwarded to the Treasury Department for final audit.
5. Auditing and recording of hospital funds. — This consisted in
auditing the individual hospital-fund statements of the various
Medical Department units, in maintaining a file of custodians of hos-
pital funds, and also in maintaining records covering the amounts
due to the various hospitals from individual officers for subsistence
while patients in hospital. At the peak in this work, there were 691
units rendering monthly statements, and the transactions represented
1350 BEPORT OF THE SURGEON GENERAL OF THE ARMY.
by these statements aggregated approximately 35,000,000 francs in
one month.
6. Traveling auditors of hospital funds. — A small staff of travel-
ing auditors were maintained partially for the purpose of checking
up records where there appeared anything which might be irregular,
but more especially to explain to hospital-fund custodians and mess
officers how to keep their records, and to assist in straightening out
any tangles. These auditors also did educational work in teaching
the proper method of handling disbursing and property papers.
They also assisted very materially in closing up money and property
accounts of units returning to the United States.
7. Custodianship of central hospital fund. — This work was taken
over about September 13. 1918, It involves the handling of the cen-
tral hospital fund, the loaning or giving to new organizations small
amounts to start with, the transferring between organizations and
receiving back from organizations which were disbanding the end-
ing balances. The amount of currency actually handled constituted
a very large figure.
8. Liaison with finoMce divisions and the Treasury official. —
Through the medium of this section close liaison was maintained with
the Treasury officials in the American Expeditionary Forces, with the
finance officer, the financial requisition officer, the bureau of accounts,
the divisions similar to this one in other departments, and with
numerous other interests.
9. Issuance of clearance certificates. — Through this section clear-
ance certificates were issued covering money and property accounta-
bility. These were issued to the Treasury Department in the case
of deceased officers and to the officers themselves when returning
to the United States for discharge or being discharged in the Ameri-
can Expeditionary Forces. During the latter part of the historj- of
this division this work assumed considerable proportions.
10. Billing Allies for hospitalization charges. — This consisted in
compiling from all available sources data relative to hospitalization
of allied troops, converting this data into proper bills and rendering
same to the various Governments. It was surprising how many dif-
ferent nationalities were involved. At a recent date this work was
turnad over to the Medical Department representative at Paris, in
compliance with orders charging that officer with the handling of all
financial transactions with foreign Governments. A small amount
of billing was also done against other departments of the American
Expeditionary Forces in the early stages. It was also recently
turned over to the Medical Department representative at Paris.
11. Compiling of statistical data and financial reports. — Monthly,
semiannual, and annual reports of various kinds were compiled and
rendered, together with special reports, which were of special value
at certain times.
12. Examination and filing of property vouchers. — The volume of
vouchers handled in this section was very large, averaging 3,500 or
more per week during the heaviest period. There were 7,500 to
10.000 individual files, each representing an accountable or respon-
sible officer. In this section invoices were compared with the receipts
and discrepancies noted. The vouchers were filed against the officers.
A. E. F. — SUPPLIES. 1361
and certificates were audited, recorded, and filed, and a card index
maintained of all officers responsible for medical supplies.
13. Examination of property returtis.— More than 1,000 returns
were received and audited. The work in this section would have
completely overwhelmed the force available had not Circular No. 68,
office chief surgeon, dated February 8, 1919, based upon existing
orders, reduced the officers accountable for Medical Department
property to those at base hospitals, supply depots, and schools, thus
eliminating thousands of officers who would otherwise have been
required to render returns.
14. Legal reference lihrai-y. — In this section complete files were
maintained of general orders, bulletins, and circulars issued by the
different headquarters ; also files were maintained and indexed rela-
tive to decisions of the Assistant Comptroller of the Treasury, the
Judge Advocate General, etc.
15. Files. — Independent files were maintained by the division at all
times and all outgoing mail abstracted before mailing.
E. RESULTS ACCOMPLISlfi:D.
It is possible to outline only a few of the most important results
obtained, as there was scarcely a day passed in which some new prob-
lem was not presented. Because of the abnormal conditions, prece-
dents could not be followed very closely, and it was necessary to meet
each problem as it arose and to devise the most economic and at the
same time the most expeditious method of handling same.
1. Disbursing. — Considerable savings were effected in this section
by eliminating duplicate payments and by arranging for the hos-
pitals to use existmg facilities instead of purchasing supplies and
labor in the open market. The use of Quartermaster Corps laundries
is an example. Records were maintained of time elapsmg between
the date of purchase and the date of payment, and every effort made
to keep this time as low as possible, thereby creating good will with
the French vendors. Records were maintained as to the average
amount of purchases made direct by field organizations, and by com-
parison it was possible to eliminate many expenditures made by cer-
tain units which were prone to extravagant expenditures and
wastage.
2. Auditing money vouchers. — In this section accounts which had
already been paid were analyzed as to time elapsing between delivery
of supplies and payment, as to size of average purchase, and compari-
son was made of volume and prices of similar purchases at different
units. Based on this information, it was possible to speed up pay-
ments and to eliminate unnecessary purchases, and more nearly stand-
ardize the prices paid for the same articles by different units. As a
result of the careful auditing done, very few suspensions were made
by the Treasury Department in the accounts of Medical Department
disbursing officers. By cancellation of erroneous vouchers and by
securing the agreement of other corps to pay items which properly
belonged to their appropriations, payments aggregating many million
dollars were eliminated, so far as the Medical Department was con-
cerned. A considerable cash saving was also effected by set'uring
refund of overpayments. These refunds would probably aggregate
$15,000.
1352 REPORT OF THE SURGEON GENERAL OF THE ARMY.
3. Analysis and recording of dishursements. — A verj important
record was compiled in this section, same being an index to all
vouchers paid, showing the- name of the vendor, material, price paid,
date paid, and by whom paid, etc. It is thought that these files will
prove invaluable in future years in the settlement of claims which
previous wars have shown will continue to be made for many years.
4. Analysis and recording of civilian fersonriel. — Similar impor-
tant records were maintained in this section showing every civilian
employee, name, authority for emplo3^ment, when and where em-
ployed, when paid, and by whom, etc. These files, too, will prove
invaluable in future years in settlement of claims against the Govern-
ment by reason of nonpayment for civilian services. Many erroneous
items were eliminated prior to payment, and some refunds from er-
roneous payment secured, also some payments transferred to other
corps. Considerable thought was given to expediting payment of
civilian personnel, and by various plans at different locations quick
payment was accomplished. When it is considered that there were
3,800 civilian employees in the Medical Department on November 30,
1918, the importance of prompt payment as a means of creating good
will is realized.
5. Auditing and recording of hospital fund. — Many overpayments
and underpayments were corrected, and deficits were prevented by
warnings, and in some cases, where gross negligence appeared, liqui-
dation was secured from private funds, by arranging for the transfer
of food stocks between organizations and by securing, through
decision of the Comptroller of the Treasury, the right to retain
proceeds from sale of waste and by securing, from the same source,
the right to turn into the Quartermaster Corps unused food stocks,
savings aggregating a very large figure were accomplished. Here,
too, every effort was made to see that French civilian bills were
promptly paid.
6. Traveling auditors for hospital funds. — The assistance which
these traveling auditors rendered was much appreciated by the units
in the field, and there were on hand always more calls for their serv-
ices than could possibly be taken care of.
7. Custodianship of central fund. — The balance in the fund May
1, 1919, was over 150 times the balance in the fund at the date it was
taken over by the division. This was only accomplished by very
careful watching at all times. The one item of interest earned alone
amounted to nearly as much as the starting balance.
8. Liaison with finance divisions and Treasury officials. — The close
liaison maintained was of immeasurable value in keeping posted on
the various developments along financial lines in the American Ex-
peditionary Forces, and appeared to be welcome by the other finan-
cial divisions and officials affected.
9. Issuance of clearance certificates. — So far as possible advance
information was secured as to officers and units under orders to re-
turn to the United States, and in this way it was possible to prepare
clearance certificate to an officer within a few minutes after the time
he reached the office, and arrangements were made so that certificates
could be issued at all hours of the day and night. Up to April 30,
1919, of the total clearance certificates issued others than those to
deceased officers only 156 were partial clearance, and in all other
cases complete clearance was given. This was accomplished by assist-
A. E. F. — FINANCE. 1353
ing officers in every way possible to put their accounts into correct
form, and departing officers almost invariably expressed apprecia-
tion. Every eit'ort was made to create for the department good will
among the officers returning to the United States and to civil life.
In the case of certificates re deceased officers only 312 were for par-
tial clearance, and practically all of these were for small charges
while patients in hospitals.
10. Billing Allies for hospital charges. — Aggregate of bills for
hospitalization during the time this work was handled by the divi-
sion was $194,081.32. The data upon which this work was handled
by the division was from various miscellaneous sources, and con-
tinual outlook was kept for any information having a bearing on the
subject.
11. Compiling of statistical data and financial reports. — These
financial reports were rendered to various people interested, and
covered almost every phase of the financial operations of the Medi-
cal Department, and seemed to be considered of nmch value by the
recipients. From statistical data maintained by this division it is
possible to trace completely the history of all Medical Department
funds from the time they left the United States Treasury until they
finally became expenditures for material and labor. These records
cover the financial transactions from the beginning of the American
Expeditionary Forces to and including April 30, 1919.
12. Examination and filing of property vouchers.
13. Examination and filing of property returns. — The question of
property accountability was throughout the entire history of the
division a troublesome one, but the records are now cleared on this
matter and returns to date audited. Statements of difference were
drafted where necessary and the balance of the returns filed in such
a way as to be accessible and to show the final disposition of same and
authority for said disposition.
14. Legal reference libray^y. — This section was started originally
merely for the use of this division in settling questions of legality
and keeping posted relative to existing orders, etc., but eventually
indices compiled by it were used by Treasury officials, by the finan-
cial bureaus, by other departments of the Army, by various officers
of the Medical Department, both in the office of the chief surgeon
and the field, and some of the indices were published in War Medi-
cine, a magazine published by the Red Cross. This section was also
called upon to draw up contracts.
15. Files. — The volume of work handled in this section is inter-
esting, as indicative of the volume of business done by the division.
Tb<^ work was light until the summer of 1918 and then increased
soA^ewhat, continuing about the same until October, 1918. With the
signing of the armistice the work in all sections rapidly in -reased
until it reahed the peak in March, 1919. The volume of outgoing
mail that month was over five and one-half times the volume during
the month of October, 1918. Beginning with April, 1919. decrease in
volume became very rapid, and the month of May has practically
the same volume as that of October, 1918.
r. GENERAL RESUME.
The aim of the division throughout its history has been, first, to
assist those responsible for money or property, to maintain records
1354 REPORT OF THE SURGEON GENERAL OF THE ARMY.
which would be in accordance with all existing Army orders and
Treasury regulations, and to keep same in the simplest form possible;
and, second, to maintain general records in the division which would
cori-ectly and fully interpret financial and property operations and
be of value to those charged with administrating the Medical De-
partment. It was surprismg how much could be accomplished with
what would appear to be dry statistical records toward creating good
feeling with European vendors, upon whom the department was
largely dependent for supplies, toward conserving the very badly
needed supplies, toward locating supplies which had gone astray,
toward keeping the units supplied with necessary funds, etc. At no
time was the necessity for correct accounting for Government funds
and property and for careful economy and elimination of waste lost
sight of and in the aggregate the savings effected without in any way
handicapping operations would total a considerable figure. During
the course of the division's history an officer was sent to the United
States to secure from the files there all information relative to finance
and property operations in the American Expeditionary Forces, so
that the records of the division might be absolutely complete so far
as operations in the American Expeditionary Forces were concerned.
From the formation of the bureau of accounts and finance bureau in
Paris a member of this division has been in liaison with these bu-
reaus and has been permitted to pass upon many contemplating plans
affecting financial operations in so far as same would affect the Medi-
cal Department. Effort has been made to keep posted on French
banking and financial laws. The financial transactions of the Medi-
cal Department, while small in the aggregate as compared with other
departments, probably represent as many and as varied purchases.
Total cash expenditures to April 30, 1919, were $15,000,000. This
does not take into account many large items pro and con between the
Medical Department and similar departments of allied armies which
will be included in a general settlement later.
G. DISPOSAL OF RECORDS.
Some of the work of this division has recently been transferred to
the office of the chief surgeon. Third Army. The financial phases of
the disposing of Medical Department property in Europe and liqui-
dation of liabilities has recently been turned over to the Medical
Department representative at Paris. A small nucleus of the division
will remain at Tours for doing such disbursing as may be left and
for acting as liaison with the United States, and a small unit, to-
gether with the retained records, will soon be sent to the United
States. The plan is to set up there all records, both financial and
property, in the same form they now exist in the American Expe-
ditionary Forces and to leave them in the custody of sufficient per-
sonnel so that any question which may be asked can be answered and
any data requested given relative to Medical Department financial
and property transactions in the American Expeditionary Forces.
A. E. F. FINANCE. 1356
10. Disbursing Officer and Technical Representatbe, JMedical
Department, American Expeditionary Forces, London.
a. early history of medical purchases in england.
Owing to the numerous changes of personnel which have occurred
at these headquarters since the time when they were first established
and to the comparative paucity of highly definite records of the very
early purchase transactions, a statement of what early conditions
were must necessarily be fabricated partly from records and partly
from imagination. It seems highly probable that in the very begin-
ning there did not exist a definite intention of utilizing Great
Britain as a supply base, but merely as a sort of line of communica-
tion by which to facilitate the arrival of United States troops in
France in greater degree than was possible by debarking all troops
directly onto French soil.
For some months such a system was perpetuated, but by the end
of that time the aggregate of troops beginning to tarry on English
soil for a longer or shorter period had steadily increased, and thereby
a local demand for medical supplies was established. Likewise the
American troops actually arriving in France were becoming rapidly
augmented in numbers, and, as in shipments from the L^ nited States,
the urgency for supplies abroad was compelled to give way to the
urgency for men, there soon sprang up in France a demand for the
purchase in Great Britain of needed medical supplies. The general
conditions mentioned were those existent from the time American
troops first began to debark in England until practically the close of
the year 1917.
During this time a distinct and imperative demand had arisen for
the purchase of medical supplies in Great Britain to meet the needs
of the American Army in France and the needs of a growing con-
tingent of American troops in England, the latter not wholly stable,
but tarrying for varying periods of time en route. To meet this de-
mand, and particularly to meet the condition of scarcity, either im-
mediate or anticipated, of supplies of all characters available within
England, there was organized in London the office of purchasing
agent to represent in England the general purchasing board which
had been organized in Paris and for the purpose of having the needs
of all departments of the American Army presented through one
and the same channel to the British authorities, in order that the
latter might effectively control the release of such supplies as were
available to the service where most needed and to equalize distribu-
tion and make it conform to supply and productive ability.
This action established a purchasing agent to act as an interme-
diary between all departments of the American Army and the Brit-
ish market, as controlled by the British war office, but it did not
establish in London purchasing officers of the various departments
who should understand the needs of their several departments and
originate orders and follow up the details of manufacture, inspec-
tion, and shipment of supplies of the special character required by
them and ultimately effect payment therefor.
The need for such purchasing officers became more and more acute,
and as a result these purchasing functions were gradually assumed,
in addition to their other duties, by such heads of staff departments
as happened to be stationed in London.
1356 REPORT OF THE SURGEON GENERAL OF THE ARMY.
In this manner the purchasing function in England for the Medi-
cal Department became devolved upon the office of the chief surgeon
of what Avas originally a part of the service of the rear, but was
later nominated as part of the service of lines of communication, and
still later as part of the Services of Supply.
At this time circumstances required the placing of a few orders
for the supply of troops in England, but the greater number of med-
ical Orders originated in France and were transmitted to London
to be placed in the British market, and in the earlier days such
orders Avere placed sometimes through a medical representative in
London and sometimes through the commanding general, and even
occasionally, perhaj)s, directly through the purchasing agent. Such
a diffused method of placing orders at as, of course, not strongly con-
ducive to complete an accurate record of purchases, and, besides, it
left no one directly responsible for following-up orders and it failed
entirely to provide a method of payment of accounts.
B. ORGANIZATION OF OFFICE.
The cable request to the United States was for a supply and dis-
bursing officer to be stationed in London for duty in charge of pur-
chases, Medical Department, who was to be accompanied by an ade-
quate disbursing and supply-depot personnel and operating material.
C. METHODS OF PURCHASE OF MEDICAL SUPPLIES.
From the date of actual organization of this office, about May 15,
1918, absolutely no purchases of supplies were made save through
the purchasing agent for Great Britain, this being in strict conform-
ity to orders from headquarters American Expeditionary Forces.
When supplies were wanted a written request, enumerating such
supplies in detail, was made to the purchasing agent in order that he
might place the actual order either with the British war office, op-
erating through its division of contracts, or if after reference to the
British Avar office the articles desired were released by it for open-
market direct purchase, then with a dealer or manufacturer direct.
Plaving once released an article for open market direct purchase,
the British war office exercised no further control over and had no
further interest in it, and after such a direct order had once been
placed by the purchasing agent this office then followed up directly
delivery and completion of the order. Such direct purchases could
be made either under ordinary Avritten order or under formal con-
tract, and both methods of procurement were available in obtaining
supplies for France or for England.
Delivery of supplies purchased under direct open market orders
was accepted by the American Government direct from the dealer
or manufacturer; his iuA^oices coA'ering same were transmitted to this
office through the purchasing agent, and were then vouchered and
paid by this office to such dealer or manufacturer, the British war
office not being in anyway involved in the transaction.
When supplies called for were of such character or in such
amounts as to merit the careful consideration and supervision of
the British war office by reason of the market conditions of supply
and demand attendant upon a state of war, the entire matter of
A. E. F. FINANCE. 1357
purchase was effected by the British themselves, that Government
through its officials acting as agents of the American Government.
In such capacity the British war office obtained supplies in any
manner or from any source or by any method (whether ordinary
written order or formal contract) most pleasing to it, the condi-
tions of manufacture, time of delivery, prices, etc., being deter-
mined and fixed by it in accordance with its ideas of market prices
as governed by the cost of material and labor, the United States
Government accepting and agreeing to the arrangements so made.
After purchase had been completely arranged on such orders by
the British war office, the American Government accepted deliveries
from the contractors direct; the invoices of the contractors being
presented by them to the purchasmg agent for Great Britain,
audited and certified by this office as correct on proof of delivery
and then forwarded by the purchasing agent to the British war
office, by which the contractors were actually paid: Thereafter the
invoices were returned to this office (through the purchasing agent)
in the form of a claim for reimbursement to the British Government,
and in such form were vouchered and paid by this office to the
British Government, the assistant financial secretary.
D. GENERAL CLASSES OF SUPPLIES PURCHASED.
The supplies purchased ranged through a varied category all the
wav from ambulance trains to white mice and bacterial cultures,
embracing such articles as tents and hutments for hospital purposes ;
motor ambulances; X-ray and mobile-laboratory motor cars; gas
masks; chemical, laboratory, and dental outfits and supplies; medi-
cines and surgical dressings, instruments and appliances; hospital
beds, bedding, furniture, and clothing; various forms of medical
field equipment; together with books and other medical publications;
vaccines, serums, etc., in fact every imaginable article which would
be required for the complete care and treatment of the sick or
wounded.
E. APPROXIMATE MONEY VALUE OF PURCHASES.
The largest orders placed were for 48 complete ambulance trains
of 16 coaches each at an approximate total cost of $12,579,600. De-
livery was ultimately made before the termination of hostilities by
armistice of only 19 of these trains, cancellation of the order for
the remaining 29 being then requested.
Approximately.
For England. For France
The total value of ail orders placed was i $971,342.91
The total value of all supplies delivered was 897,210.25
The total value of all potential savings by cancellations was (as of Dec. I
31, 1918) : 63, 018. 08
$22,017,760.38
10,827,339.81
3,444.650.68
The total value oi all actual known savings by cancellations to date was. . | 11, 114. 58 4, 146, 825. 53
As soon as possible after the signing of armistice and under in-
structions from general headquarters, cancellation was requested
1358 REPORT OF THE SURGEON GENERAL OF THE ARMY.
on all orders and contracts where delivery had not been completed'
The estimated amount involved in such request is stated above under
the heading, " potential savings by cancellation."
Owing to certain conditions beyond the control of this office, it
will be impossible to effect actual savings of a very considerable por
tion of the amount stated under potential savings and it will devolve,
and is now devolving, upon the United States Government to
accept delivery of numerous supplies which are so far progressed in
manufacture as to render dealers and manufacturers unwilling to
consent to cancellation, particularly without the payment of a money
indemnity. This is especially true in cases of contracts which con-
tain no effective " break clause " and in cases of direct open marketJ
purchases. Wherever purchases have been made for the United!
States Government by the British Government officials it has been
mutually agreed that such purchase orders shall be terminated and
adjusted in the' most businesslike manner feasible by the British
Government, the United States Government agreeing to accept and
approve such terms of settlement as may be made, whether actual
acceptance of delivery or any supplies is involved or not, the British
Government being, however, advised that the United States Govern-
ment does not wish to accept any supplies more than existent con-
ditions render absolutely mandatory.
11. Medical Department Transportation.
A. TRAINS.
Transportation of the Medical Department comprises trains, am-
bulances, and canal barges. The trains consist of those obtained
from the French and those from the British. There were two
French trains made up of cars converted to hospital train purposes
from either passenger or baggage-car type and 50 trains, some of
which were ordinary box cars, fitted with litter racks, others passenger
coaches for sitting cases. The first idea of the American Army was
to adapt ordinary box cars for hospital train purposes by mtro-
ducing fittings for supporting tiers of litters. These fittings were
metal posts capable of being screwed into the floors of the cars so
that they would take up little space and could be cleared away
readily when not wanted, permitting them to serve the double pur-
pose of evacuating wounded from the front and, when empty of
wounded, carrying back supplies to the armies. Both the British
and French armies .adopted this procedure, but found it impracti-
cable.
The American Government, profiting by the experience of those
armies, promptly placed orders with the British Government for a
sufficient number of the latest and best tjpe of hospital trains.
Owing to the gi'eat distance from the United States and the shortage
of cargo space, no coaches were imported from home.
The trains were, for the most part, supplied through the agency
of the British railway executive committee — appointed a special
committee to make all arrangements relative to design, equipment,
transportation, etc. — in conjunction with a military advisory com-
mittee in France. These trains were designed primarily for the
evacuation of the sick and wounded and were not intended strictly
A. E. F. — TRANSPORTATION. 1359
as hospital trains in the sense of treatment, operative or otherwise,
for patients, and were in accordance with what experience has
proved the best. Great importance was attached to standardization
and simplicity was combined with usefulness.
_ Nineteen of these trains, obtained from Great Britain, were de-
livered prior to the signing of the armistice. The cai^s, completely
equipped, were transferred from England by special ferries to a
port in France, in order that the trains might be ready for service
as soon as they arrived in France. Each train consists of —
1 brake and " lying " infectious car.
1 staff car,
1 kitchen car with section for " sitting " sick officers.
9 ordinary " lying " ward cars.
1 pharmacy car.
1 kitchen and orderlies' me? s room.
1 personnel car.
1 brake and stores car.
16 Total number of beds available for patients '« lying." 360.
Long coaches, 54 to 56 feet in length, were used, instead of the
short continental coach type, to insure a comfortable journey for the
patients. These trains are so attractive in appearance and arouse
such interest in the public that they have been frequently placed on
exhibition in England before shipment to the continent/ so that the
public may see what excellent care is being taken of the soldiers by
the Medical Department, United States Army.
The first of these trains was delivered in France February 11,
1918, and the last at about the time hostilities ceased.
The beds of the ward cars, 36 in number, especially designed, are
removable, and in case of necessity can be used as stretchers. They
are capable of being folded against the sides of the coach and lowered
to the floor, become converted into a couch for the patients able to
sit up, whilst the top bed is still available for lying-down cases. By
this arrangement the less seriously wounded are made comfortable
and can either sit up or lie down. A so-called "sitting" case can
not sit up for a prolonged period, and it is necessary to provide a
bed which a " siting" case mght use some time during a long journey.
This conversion of beds into seats, with litters placed in front of the
doors, enabled these trains to evacuate as many as 720 " sitting "
cases.
The two French hospital trains and the 19 trains constructed in
Great Britain were used principally for secondary evacuations and
the 50 trains borrowed from the P'rench were used principally for the
so-called primary evacuations.
In so far as the personnel, materiel, supply, and maintenance of
the equipment, the hospital trains were administered under the di-
rection of the chief surgeon American Expeditionary Forces. As
railway units, however, they were operated under the direction of the
officers to whom they were assigned, and were repaired by the trans-
portation service. Assignments of hospital trains, operated in the
zone of the Army, were made by G-4. general headquarters, to regu-
lating officers, and in the Service of Supplv they were under the
jurisdiction of the chief surgeon American Expeditionary Forces.
An officer of the Medical Department was assigned to each regulat-
ing station as part of the staff of the regulating officer, and as a rep
resentative of the chief sursfeon.
1360 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The chief surgeon American Expeditionary Forces allotted a re
quisite number of beds daily to each regulating officer, advising himi
by telegraph as to their number and location. These beds were re-
served for the exclusive use of the regulating officer to whom allotted '
and daily notice of any changes in these credits were furnished him.
The G-4 of the Army furnished the regulating officer daily all data
bearing upon evacuations in order that the latter could judge the-
sufficiency of trains and beds at his disposal and take necessary steps
to correct a shortage. Upon receipt of advice for the necessity for •
evacuating patients from a given hospital, the representative of the
chief surgeon at the regulating station, cognizant of available beds
in different hospitals, indicated destination of train. The command-
ing officer of the evacuation hospital was charged with seeing that
the necessary steps were taken in order that the train might be loaded
promptly in the time allotted. The regulating officer notified the
commanding officer of the receiving hospital of the contents of each
train, showing the number of officers, soldiers, and enemy prisoners,
rumber of " sitting " and " lying " patients, number of contagious
diseases, toaether with any other information which would facilitate
the unloading of the train.
The cost of each train was approximately $200,000.
B. HOSPITAL BARGES.
In August, 1918, the chief surgeon proposed that barges be used
for severely wounded and gassed soldiers; the type of cases to be
those with compound fractures, chest and abdominal wounds, many
of which Avould have been nontransportable by hospital train.
At the time of the signing of the armistice there were about 60
barges being converted to hospital purposes.
During the Chateau-Thierry drive many patients were evacuated
by this means of transportation from the Chateau-Thierry sector to
Paris. Barges were operated in flotillas of six, motive power bei'tig
furnished by tugboat.
C. AMBULANCES.
The Medical Department was charged with the responsibility of
procuring ambulances for the American Expeditionary Forces. In
the early days of the war the G. M. C. type of ambulance was adopted
because of its capacity. The ambulances were shipped to France,
unassembled, the constituent parts of the bodies being placed in crates
and a series of envelopes were made up containing the number of
screws, bolts, and nuts necessary for assembling the ambulances.
Each operation was numbered and the corresponding number was
placed on the envelope containing the hardware used. This ambu-
lance body was not what is regularly known as a Iniockdown body, and
it was appreciated that considerable difficulty would be encountered in
its assembly, unless trained men fully familiar with body construc-
tion were available in France. The Surgeon General's Office accord-
ingly organized a unit known as the motor ambulance assembly de-
tachment, comprised of 3 officers in the Sanitary Corps and 60
body builders and motor experts. Probably no organization ever
arrived in France better equipped than this ambulance assembly unit.
I
A. E. F. — TRANSPORTATION. 1361
It began operations on January 2, 1918, at St. Nazaire. Within two
weeks the necessary shelters had been constructed, power lines had
been run, and the ambulance assembly commenced. A number of
chassis and bodies had been accumulated on the beach at St. Xazaire
and there was an urgent call from various organizations and divi-
sions then in France for ambulances. The shop soon took on the ap-
pearance of a modern American factory, and ambulances were turned
out at the rate of four a day. This number was gradually increased
until a daily output of 15 was reached.
It was expected that all motor transportation would be delivered
at the fort of St. Nazaire. This, however, proved to be impracti-
cable, and before long ambulances were being received at Le Havre,
Brest, Bordeaux, Marseille, and La Pallice. Certain numbers of
the original motor ambulance assembly detachment were sent to the
parks at these ports and soon built up assembly organizations com-
posed of Medical Department personnel and Motor Transport Corps
personnel, and the same efficiency was obtained as at St. Nazaire.
In general orders, general headquarters, American Expeditionary
Forces, and headquarters, Services of Supply, ambulances were
classed as special vehicles, while orders covering assignments have
been prepared by the Motor Transport Corps to assign ambulances to
the points where they were most needed. Many organizations to
which ambulances were assigned in the United States delivered them
to the ports of embarkation and they were shipped to France when-
ever practicable. However, no notice of prior assignment was taken
in France and all motor transportation received was pooled.
Many assembled ambulances arrived at base ports in France, but
in most cases they were in such bad condition that a request was
cabled to the United States asking that they discontinue the prac-
tice, as nearly every motor was damaged to such an extent that re-
pairs were necessitated. Nearly all the accessories were missing, and
in many cases it was not worth while to attempt these repairs on
account of the shortage of spare parts.
About one month before the armistice was signed a new type of
knocked-down body was shipped to France. Inasmuch as it was
assembled and painted in the factory and was then down in sections
and shipped in crates, considerable time was saved in the final assem-
bly at base ports in France and very much less personnel was re-
quired to operate the body shops. Four men could assemble two
bodies in a day.
One of the greatest difficulties which has been encountered has
been the question of spare parts. It is believed that, in the future,
if it is necessary to send ambulances outside of the limits of the
United States, some arrangement should be made to supply spare
parts with every chassis that is shipped and these parts should be
inclosed in the crate with the chns-is Another perplexity was
caused by the arrival of the shipment of the chassis at one base port
and bodies at another. This made it necessary to assemble the chassis
and drive overland to the motor reception parks where the bodies
were being assembled, thus causing a divergence of much personnel
and expenditure of considerable gasoline. Bodies and chassis should
be shipped on the same boat.
1362 REPORT OF THE SURGEON GETTERAL OF THE ARMY.
There were shipped to France (and Italy) 3,070 G. M. C. ambu-
lances and 3.805 Fords. i_ , j • • n
Patients evacuated from France have been embarked principally
from St. Xnzairo and Brest, and laterly from Bordeaux.
Hospitalization on a lai-fje scale was planned at Savenay in order
that cases selected as suitable for transfer to the United States
might be collected and evacuated from there through St. Nazaire;
and at Beau Desert, near Bordeaux, for evacuation through the lat-
ter place. Owins to the fact that Brest was not contemplated as a
port of embarkation hospitalization on a large scale was not pro-
vided at that place until the latter months of the war. As the large
boats could come onlv to that port, however, direct evacuations were
made through Brest" from the hospital center, Savenay. The hos-
pital center at Kerhuon, on the outskirts of Brest, was constructed
and a capacitv of 4,000 beds reached at the time of the signing of the
armistice. Owing to the lack of good roads leading to this place
it could not be extensively used until after the armistice was signed.
The secondary evacuations of cases chosen for transfer to the
United States were made from base hospitals in the advance and
intermediate sections to the hospitals at base ports where they were
both giA-en final hospitalization and preparation for embarkation.
This preparation consisted in the completion of medical records in
so far as it was possible, the arrangement of passenger lists, the
forming of a number of patients into convoy — divided into various
types of cases which enabled na^al authorities in charge of trans-
ports to properly and rapidly place them aboard ships. As the trans-
ports usually arrive in large convoys proportionately large groups
of patients could be evacuated at a given time.
Patients that were selected for return to the United States were
those permanently unfitted physically for any military duty and
those who would require at least six months' further hospital treat-
ment before becoming class A. Boards of officers passed upon these
cases at base ports and determined the class into which they fell as
well as the fact that they were capable of standing transportation
overseas. Supplemental records were prepared for those whose
sem'ice records were not received at the time of evacuation. Each
enlisted man evacuated was issued sufficient clothing to enable him
to travel in comfort and, in addition, a toilet kit bag containing a
shaving outfit, soap, tooth brush and paste, and a hand towel.
12. Veterinary Corps, American Expeditionart Forces.
By an act of Congress, on June 3, 1916, the Veterinary Corps of
the United States Army was transferred from the Quartermaster
Corps to the ^Medical Department. At the outbreak of the present
war the Sure-eon General took steps to have the Veterinary Corps
put on an efficient basis, and on October 4, 1917, General Order 130,
War Department, was published. This general order authorized 1
veterinary officer and 16 enlisted men of the Veterinary Corps for
each 400-animal strength.
On September 18. 1917, General Order 39, general headquarters
American Expeditionary Forces, was published, which created a re-
mount service in the Quartermaster Corps and placed the veterinary
service under the remount service.
A. E. F. CONSULTANTS. 1379
distinctions are often puzzling, for the complaints are often vague.
One must remember that psychic disturbances are present and may
possibly form the essential underlying factor of the complaint. Xo
system of therapeutics can be considered adequate which does not
take all these facts into account. We mean, in the convalescent
camps now coming into being, to introduce whatever aids are avail-
able in the attempt to treat this condition physically and psychically.
C. Activities of Xeuro-Psychiatric Service,
a', organization.
At this hospital there has been ajfforded an opportunity of observ-
ing nervous and mental symptoms Avhich has probably been unsur-
passed in any of the forces engaged in the war. All cases, except
those evacuated through England, were grouped for return to United
States at this point. All types, therefore, were encountered, and in
numbers quite exceeding those seen in anv similar centers in civil
life.
Lest any misapprehension should arise, it should be stated that,
considered as a whole, the mental attitude of soldiers of the expedi-
tionary forces was to a high degree that of normal and healthy men.
Just as one was impressed by their physical vigor and hardiness, so
in general a healthy and stable mental attitude was observed. This
is true of at least 90 per cent of the men.
But it should not be inferred that difficult adjustments were not
encountered by the men of the Army. A nation could not be con-
fronted with all the emotions incident to the gi-eatest war in his-
tory without a marked emotional reaction. Then when we consider
the intimate association of different nationalities in the United States
Army and the sudden alteration in social relationships between men,
it is readily seen that adjustments of an extreme degree were neces-
sary. With the hardships unavoidable in any campaign, the delays
in mail and pay added to physical and nervous exhaustion, it takes
little imagination to understand the state of mind in which many
men found themselves.
Men have been subjected to emotional experiences heretofore un-
known. It is therefore in the sphere of the purely mental reactions
that the most unusual conditions were found. The nervous states
and the neuroses, arising as they did from anxiety and anticipation,
at times associated with physical exhaustion, conformed more closely
to what is seen in civil life.
Administration of the neuro-psychiatnc service. — Until Novem-
ber 6, 1918, the neuro-psychiatric service at Savenay was under the
direction of the commanding officer of Base Hospital 8. It func-
tioned separately with a chief of service, medical staff, and special
])ersonnel. For" the first six months comparatively few cases Avere
admitted, from Januarv 1 to June 1. 1918. the admissions being 369.
After June 1, 1918. the admission rate rapidly increased and ad-
ditional wards became necessary. Three more wooden barracks were
used as required for this service, providing accommodations for about
500 patients. In the meantime, wards of special construction de-
signed by the chief surgeon had been erected for this service in a
142367— 10— VOL 2 2G
1380 REPORT OF THE SURGEON GENERAL OF THE ARMY.
location some distance from the main liospital, on a slight elevation
of frround. This unit was occupied the latter part of August, 1918.
There were accommodations for something less than 200 patients, but
l)v using officers' barracks and enlisted men's barracks, the capacity
was expanded to over 250.
In October. 1018, four additional buildings of concrete block were
added to the 11 wards above mentioned. When these were com-
pleted the original barracks of base hospital 8 were relintpiished. No
diminution in the admission rate after the cessation of hostilities
occurred, and therefore the unit as finally constructed proved inade-
quate. Admissions were so rapid that the commanding officer of the
unit found it necessary to temporarily designate ^yards from two
adjacent units, i. e., base hospital 69 and base hospital 113, for the
use of the neuropsychiatric service.
During the latter part of December evacuations had been so rapid
and admissions delayed to such an extent that for a short time there
were but 65 patients in the hospital. Admissions, however, soon
increased so that early in January, 1919, the population exceeded 700
patients, including 40 officers. Under these circumstances the com-
manding officer of the center gave directions that one of the new
1.000-bed units be taken over as a neuropsychiatric hospital.
The new unit Avas occupied January 21. 1919. The construction
was not completed and sj)ecial construction was necessary, this being
done chiefly by patients.
The large building adjacent to the mess, used in other units for
surger}" and dressing, was fitted up for a workshop. This workshop
was especially well equipped. It has the advantages of the use of
material formerly used at base hospital 117, consisting of brasswork
tools, lathes, carpentering sets, and an acetylene welding apparatus.
Looms for weaving were made by the patients, and woven bags, belts,
and mats were manufactured. A forge was made by one of the
patients. A supply of salvage material for use in the shop was se-
cured from the salvage department at Tours. Six aides were en-
gaged in giving instruction. The average number of patients en-
gaged daily was 42. A large amount of material of various kinds
was manufactured in this shop. Much of this material, such as
benches, tables, chairs, cabinets, and office furnishings, were used to
equip the administration buildings and wards of the unit. In the
metal department rings, trays, and other souvenirs were made in
great number. A considerable amount of material made was taken
home by the patients.
After June 1, 1918, the admission rate increased rapidly. In
June 258 cases were admitted ; in Julv, 405 ; in August, 588 ; in Sep-
tember, 887 ; in October, 658 ; in November, 809 ; in December, 412 ;
m January, 1919, 885; and in February, 1919, 824.
b'. clinical summary.
A large amount of clinical material passed through this hospital,
no less than 6,093 cases having been admitted up to March 1, 1919.
Observations were necessarily incomplete and the recording of cases
w^as impossible. The various types, some quite unusual, came under
observation with such frequency that they became fairly familiar
and therefore clinical pictures, which otherwise would have been un-
A. E. F. CONSULTANTS. 1381
certain, became well established. It is desired to discuss the clinical
material under headings as indicated below, the number of each
class being likewise stated.
Psychoses 1, 916
Psychoneuroses 1, 663
Epilepsy 752
Constitutional psjcliopathic state 634
Mental deficiency 524
Organic nervous diseases ^ 148
a" . PSYCHOSES.
The number of frank psychoses, amounting in all to 1,916 cases,
is probably not excessive considering the forces engaged. Interest
in these cases is more in their clinical character than in their num-
bers. It was soon observed that, in addition to ordinary civil-life
types, many unusual cases were encountered. It is true that many
cases of dementia priecox, general paresis, and other familiar dis-
eases were admitted through this period, but they were not the only
types seen. Soon after active hostilities began cases appeared with
which the staff' were unfamiliar in their civil-life experience, and in
these unusual cases the reactions and the clinical pictures did not
conform to any recognized t^'pes.
War psychoses. — It has been stated by some observers that the war
has failed to bring to light any unusual forms of mental disorder, all
cases being merely those familiarly met with in civil life, possibly
colored by a war setting. This is not in accordance with the observa-
tions of the staff of this hospital. Unusual grouping of symptoms,
and in fact entirely imusual clinical pictures, were encountered to
such an extent, as stated above, as to warrant separation of these
cases into a group.
No actual record of their number was kept, but they probabh^
amounted to one-fifth of all the cases diagnosed as psychoses. Many
of them improved considerably Avhile at the hospital, and it is quite
probable that by the time they reached the United States the acute
s3^mptoms had disappeared.
The following clinical pictures is a composite of what was most
frequently observed. Patients on admission were dazed, confused,
and disoriented, and. as a rule, they were not accessible during the
acute period. The}' generally thought themselves at the front under
fire, and were anxious and apprehensive. They wandered about
rather aimlessly and showed bewilderment and confusion. Some
were quite agitated. Frequently they preferred to be by themselves
and volunteered very little in the way of conversation. As a rule,
they were depressed,' at times profoundly so, to the extent of making
suicidal attempts. A few cases were observed in which there was
an elevation of mood. The possibility of a manic depressive condi-
tion was considered in these particular instances, but was regarded as
improbable. In this general setting of clouding of consciousness,
confusion, and bewilderment, there was active hallucinations of sight
and hearing. Patient complained of seeing shells bursting and of
Itearing the whistling of shells and bullets.
The symptoms were worse at night, but were by no means confined
to the night time. This general condition had some features in
common with the psychoneuroses, such as anxiety, fearful dreams,
1382 REPORT OF THE SURGEON GENERAL OF THE ARMY.
visual halliu'inations: but the condition differed in that they were in-
accessible, disoriented, and confused with marked mood changes and
no insight. Not infrequently there were delusional ideas of transient
character and of a changing nature, the content of which had to do
witli war experiences.
Tlie English have designated these cases as acute confusional
psychoses. It is thought, in view of the anxiety, the depressions, the
character of the hallucinations, and the emotional conditions, that
emotion and excitement have played quite as prominent a part as
exhaustion. Patients, as a rule, were inaccessible and no clear idea
could be gained as to what they had experienced. It is possible that
many of them had been under" heaxj shell fire, but under what cir-
cumstances this was experienced can"^not be stated. It was necessary
to return these patients to the United States as soon as their condi-
tion warranted transportation. The impression here was that the.
])roji:nosis was good.
Another small gronp of cases was observed resembling somewhat
those above described but different in a number of respects. Such
patients were admitted in a delirious condition. As a rule these
patients had not been at the front, possibly having but recently
landed in France. They were confused, rambling in conversation,
inaccessible, and restless. They were disoriented and presented the
picture of delirium. The thought content was not remarkable. The
condition was considered an hysterical delirium, arising in predis-
posed individuals.
A number of cases of dementia praecox appeared to have devel-
oped since enlistment. Some gave a history of symptoms previous
to enlistment and a fair proportion of these had had previous hos-
pital residence. In the maniac depressive cases they were relatively
more with depression than with elation. Both showed a war color-
ing, especially the depressions, and, in fact, the thought content of
many of the self-accusatory and depressed patients had to do solely
with war conditions. They frequently had the idea that they were
being accused of betraying their country or of being German spies.
It is a noteworthy fact that comparatively few acutely maniacal
cases were encountered.
B." PSTCHONEUROSIS.
As a rule when these patients reached this hospital the symptoms
had existed some Aveeks and even months, and so they presented
clinical pictures differing in character and degree from those seen in
the arvance section. Only observations as to the general character
and disposition of these cases as it pertains to this hospital will be
made at this time.
It is probable that no cases coming under the care of medical
officers were as imperfectly understood at the beginning of hostili-
ties as the psychoneuroses. During the early part of hostilities, as
stated a1)ove, the psychoneuroses did not always come under the ob-
servation of the officers designated to take care of them. Some of
these patients were sent from advance areas directly to base hospitals
where they were admitted to the various w^ards of the medical or
surgical service. The fact that the case was a neurosis and not a
physical disease was not always appreciated. They were retained
A. E. F. — CONSULTANTS. 1383
in base hospitals without improvement and many of them eventually
arrived at Savenay for disposition. A number of others were classi-
fied by a medical board at base hospitals, sent to training camps
not fully recovered, and having been found unfit at these places were
transferred to Savenay. It can readily be seen that these cases, while
relatively few in number, were unfavorable types for early recovery.
Fortunately, their number was not great. The general management
of the ps}^choneurosis of the war, as demonstrated by results accom-
plished, emphasized the fact that to be successfully treated they
must be fully understood. Proper treatment of these conditions
has been one of the most difficult problems confronting the physi-
cians of civil life. While it is true that these cases have always
been understood by a number of physicians, it must be admitted thfit,
as a rule, too little knowledge of them is gained by students in medi-
cal schools, and the fact that the condition is a disorder in the func-
tioning of the mind and not of the body is not always fully appre-
ciated.
Two general types were recognized, namely, those resulting from
battle experiences and those of ordinary civil-life type, the latter
probably existing prior to enlistment. The civil-life type, such as
neurasthenia and psychasthenia, as a rule, came under observation
soon after arrival in France and never reached the front.
The psychoneuroses arising from battle experiences came from two
main sources. At one time a number came from base hospitals or
reclassification camps, not having previously had special treatment.
It was possible to return a considerable number of these cases to
duty, and some were sent to Base Hospital 117. Other cases came
from neurological hospitals in the advance section, mainly from
Base Hospital 111. Cases arriving from these hospitals were in-
tended for evacuation to the Ignited States, being considered consti-
tutional types with unfavorable outlook for recovery in the imme-
diate future. After hostilities ceased, arrangements were made by
which the psychoneuroses of all sources eventually came to this hos-
pital, and this accounts for their increase in number during the lat-
ter months of this report. It was not the policy, after the armistice,
to classify these cases for limited service and therefore they were
returned to the United States for disposition, the severe cases under-
going a period of treatment here before evacuation.
There was one feature of the symptomatology observed in this
hospital which was probably not seen elsewhere. It was found that
;i number of cases of mental deficiency, epileps}^, and mental dis-
eases exhibited war neuroses, such as mutism, tremors, or hysterical
hemiplegia.
C." EPILEPSY.
A comparatively large number of cases were diagnosed epilepsy,
amounting in all to 752. In addition to these well-known mani-
festations of epilepsy the constitutional make-up of such patients
formed an important part of their disability, and at times was of
more significance than the actual seizures. The vast majority of
these cases were slightly neurotic, indeed, to such an extent that
at times it appeared that the disease should be interpreted as a
severe degenerative neurosis of which the seizure, while the most ap-
parent symptom, was not the most important. Those observers who
have favored this interpretation of many cases of epilepsy would
1384 REPORT OF THE SURGEON GENERAL OF THE ARMY.
see inueh in the clinical material of this hospital to support their
contentions.
]klany border-line cases were seen, which were thonoht to belonj;
to this'<reneral aroup. Sucli cases frequently had slight mental de-
fect and were siu<>:o:ish in mental reactions. They presented numer-
ous neurasthenic complaints of years' standing. With this condition
would occur minor attacks of loss of consciousness with slight con-
fusion and with occasional frank epileptic seizures. In these cases,
of which there were a great number, the mental defect and the con-
stitutional neurotic condition were of more importance than the ac-
tual attacks. Many cases came under observation who had had frank
seizures at frequent intervals since childhood. These cases were
readily recognized. Numerous types of epileptic equivalents were
also encountered. Epilepsy was often associated with alcoholism.
The anincsUi-s. — These cases are discussed at this time because of
the relationship of a number of them to epilepsy. A relatively large
number of cases were encountered in which patients absented them-
selves from their organizations for periods varying from several
days to several weeks. These patients maintained that they had no
memory whatever of what had transpired. They either returned
themselves or were picked up by the military police. Such instances
occured in both officers and men. A number of them were frank
cases of epilej^sj^, the period of amnesia occurring either before or
after a seizure, or being an epileptic equivalent. Many other cases
occurred after the excessive use of alcohol. After excluding both
epileptic and alcoholic cases, however, man}' instances of amnesia of
the t3^pe mentioned above remain to be explained. Such cases are
not entirely clear. They were considered by many observers in-
stances of hysterical amnesia, and this interpretation appears the
most probable one, thus bringing such cases under the general group
of psychoneuroses of the hysterical type. If this view is held, the
amnesia could most readily be explained as a mechanism operating
subconsxi'iously, in which the individual escaped from a difficult or
intolerable situation by wiping out from memory all circumstances
associated with it. It is also probable that a number of such cases
were conscious delinquencies, but the relative number of the latter
type is thought to be comparatively small.
I)". CONSTITUTIONAL PSYCHOPATHIC STATES.
Of this grou}), amounting to G34 cases, were included patients who.
while not suffering from frank mental disease, nevertheless were in
mental condition sufficiently abnormal to bring them in serious con-
flict with those about them. Patients of this kind might nuike fair
progress in civil life where they could change occupation and sur-
roundings, but in the military service this was not possible and thev
broke down nervously as a result. • Indeed, they frequently suffered
from temporary mental disorders. In this group were included some
cases of alcoholism and drug addiction in whom such states were con-
sidered as symptoms in those constitutionally predisposed.
e". MENTAL DEFICIENCY.
Five hundred and twenty-four cases admitted were diagnosed men-
tally defective. The classification in respect to duty of these cases,
A. E. F. CONSULTANTS. 1385
particularly those with the lesser degree of defect, was a question of
considerable importance. It was considered that while defectives as
a rule could not be used with combat troops, still there were many of
them serviceable in labor organizations. The disposition, therefore,
was to reclassify such cases as were considered fit for duty in rear
areas. The record of how these patients had conducted themselves
in the militar}^ service was considered of greater importance than
testing of mental age by scale. A case with mild defect, if irritable
and emotional, was often found unfit, while a case with stable tem-
perament, even with considerable defect, was considered fit for lim-
ited service. The emotional constitution of such patients was of con-
siderable importance.
In many instances physical defect was found to accompany the
mental defect, this defect varying in character and degree, at times
being expressed merely by awkwardness in simple movements, at
times making itself manifest by the gross, ungainly physical make-up
of the mental defective. In still other cases appeared a constitu-
tional physical defect of ill-defined type. These patients were
stooped, had a narrow, ill-developed chest, and often a prominent
abdomen. Such cases often complained of numerous neurasthenic
symptoms. They were related to constitutional neurasthenic types
frequently seen in civil life, with mental deficiency added. It was
soon found that it was unwjse to return these cases to duty of any
kind.
r". ORGANIC NERVOUS DISEASES.
This organization did not receive cases with lesions of the central
or peripheral nervous system resulting from battle casualties. The
other organic nervous cases, amounting in all to 143, Avere cared for
at this hospital. Peripheral neuritis, occurring after diphtheria, in-
fluenza, or other toxic conditions, was frequently encountered. Evi-
dence of syphilis of the central nervous system was found in more
cases than might have been expected considering the average age of
the patients. Several cases were diagnosed brain tumor. A number
of patients presented mental symptoms or epilejotiform seizures sub-
sequent to brain injury. Comparatively few cases of paresis or tabes
were observed, although other manifestations of syphilis of the cen-
tral nervous system were not infrequent.
Encephalitis of undetermined type. — During January and Feb-
ruary, 1919, a group of organic cases of unusual interest were ad-
mitted to this hospital. In all there were about one dozen cases of
this particular group.
The most striking feature of these cases was that they bore a rather
close resemblance to paralysis agitans. They showed a stolid mask-
like expression, a tremor suggestive of paralysis agitans. although
differing somewhat from it, a shuffling gait, and a rigid posture,
which suggested rigidity of the muscles of the neck and trunk. These
cases also appeared dull mentally, but this was more in appearance
due to lack of expression than in reality. There was no actual paraly-
sis of the facial muscles, merely a lack of mobility and of expression.
One patient could smile but very slightly, and could not laugh. An-
other had noticed by looking in the mirror that his expression had
changed. The head and neck in these cases were held in a stiff and
rigid position, but little, if any true rigidity was found. The arms
1386 REPORT OF THE SURGEON GENERAL OF THE ARMY.
wcro held in :i somiflexure both when the patient was wulking or
sittinir. Here. too. however, there was not actual rigidity. The
tremor was of a rather coarse type. The hand, as a rule, was held
partly closed, but a })ill-rolling motion was not observed. As a rule,
both sides were involved, but one more than the other. The gait
was shuffling and awkward; in fact, all movements were slowly and
awkwardly performed. The gait suggested paralysis agitans but
was not entirely characteristic of that disease.
Physical signs indicating disease of the central nervous svstem, ex-
cept those described above, were not marked. One case showed a
renuirkable lateral and rotary nystagmus with exceptionally wide
excursions. Otherwise the eye symptoms Avere negative. There was
no actual i)aralysis of facial muscles. One case showed considerable
tremor of the lips which made it appear that the patient was about
to weep: however, there was no emotional instability. The deep re-
flexes showed nothing marked except in some instances the knee jerks
were very active. The superficial reflexes were normal. There was
no actual motor weakness, but motor functions were performed
awkwardly. Xo abnormal sensory symptoms were apparent. The
liver showed no evidence of disorder, and other physical findings were
negative. Unfortunately, complete serological examinations were
impossible. Spinal punctures were done in a few cases. Xo increase
of cells or globulin was found, but punctures were done late in the
disease and little definite information could be inferred from these
negative findings.
While these cases had a fairly close resemblance to each other,
sufficient it was thought to place them in one group, they did not have
that close resemblance throughout u'hich is found in most cases of
paralysis agitans. In some the tremor of the hands was the most
marked symptom. In others the gait, and in others the lack of facial
expression or the rigid posture. All, however, had some of the
symptoms enumerated above to a certain extent.
Paralysis agitans is mentioned in connection with these cases for
descriptiA-e purposes only, not that they were thought to have any
true relationship with that disease. The condition was thought to be
encephalitis of unknown origin, the toxic agent showing a selective
action. probal)ly for the lenticular nucleus. Xo etiology could be
established. Some cases had had a febrile reaction before admission
and had been diagnosed influenza. Others gave no histor}^ of any
acute illness. Some of these cases had been confused and delirious at
the outset of their illness, previous to their admission here. In favor
of interpreting these cases as encephalitis of selective type is the fact
that a number of other cases were admitted about this time in which
the cranial nerve nuclei of the brain stem were involved. One such
case showed first involvement of one-seventh nerve. A few days later
the other side was involved. Both gradually improved and then a
slight ptosis of both sides was observed. Later the sixth nerve on one
side showed slight involvement, and there was also mental dullness
during this period. All serological findings and physical findings
were negative in this case. Other similar cases were observed during
this time. Both French and British writers have recently described a
condition which they term lethargic encephalitis. This condition may
have some relationship to the cases of encephalitis observed here.
Cases seen here, hoAvever, Avere not particularly dull or letharp-ic, and
A. E. F. CONSULTANTS. 1387
although ptosis occurred it was not as constant as observed by the
French and British writers.
Diagnosis of rases admitted.
Psychoses 1,916
Psychoneuroses 1, 663
Epilepsy 752
Constitutional psychopathic states 634
Mental deficiency 527
Organic nervous diseases 148
Otherwise diujjrnosed 200
Awaiting disposition, Feb. 28, 1918 1 253
Total 6.093 »
D. MEDICAL RESEARCH LABORATORIES, AIR SERVICE, AMERICAN EXPEDITION-
ARY FORCES.
American aviation medicine had its inception directly it was
[realized that America was to enter the European conflict.
More than 50 examining units were established in various cen-
ters in the United States with a medical personnel running into
the hundreds. Approximately 100,000 men applied for the air
service. From this group those considered the most fit were se-
lected, the standard for admission being made high in order to in-
sure as fine an average type of aviator as possible. Training was
commenced whereupon trouble appeared. Despite the fact that the
standard was high, and the flyers, a group especially selected for
their physical fitness, some were found to be good, others poor flyers.
This meant that new problems confronted the medical service, prob-
lems which proved so complicated and difficult that the necessity
for a special research board became apparent.
Our British colleagues state that during the first year of the war
60 per cent of all the air casualties were due, not to faulty planes or
enemy fire, but to physical unfitness of the flyers. The second year
this was reduced to 30 per cent, and the third year to 12 per
cent. This reduction in fatalities was accredited to a more care-
ful selection of the candidates, a system of classification, and to the
medical care of the flyer.
These factors led in the States, more than a 3'ear ago. to the crea-
tion of a medical research board. The powers delegated to the
board were as follows :
1. To investigate all conditions which affect the efficiency of pilots.
2. To institute and carry out, at flying schools or elsewhere, such
experiments and tests as will determine the ability of the pilots to
fly at high altitudes.
3. To carry out. at flying schools or elsewhere, experiments and
tests to provide suitable apparatus for the supply of oxygen to the
pilots at high altitudes.
1. To act as a standing medical board for the consideration of all
matters relating to the ]:)hysical fitness of pilots.
In accordance with this authority, the board instituted the fol-
lowing departments. Cardio-vascular. otological. physiological.
|)>«ychological, ophthalmological, and psychiatrical : each being in
■liarge of men trained especiall}' in these branches of Avork.
1388 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The iininediate inilittiry problem of classification of aviators was
preceded by certain necessary research, sufficient to establish the
basis of such classification. Alaboratory was built at Mineola, Long:
Island, and equipped with all forms of apparatus desirable for this
work.
New api^aratus was developed for the study of aviatore and the
problem involved in aviation. The following are the more important
coutributions:
FKOM THE UEPAKTllKNTS OF PHYSIOLOGY, PSYCHOLOGY, AND MEDICINE.
The rthreathlng apparatus. — Two types of machines were per-
feoted. the Henderson-Pierce and the Henderson-Gibbs. The same
principle is used in both and each has special features, of which the
respiration valves, absorption chamber, and respiration recording
devices are most important. These machines are used to reproduce
under experimental conditions the low oxygen tension of high alti-
tudes, and to determine the aviator's ability to adapt himself to high
altitudes.
The Dunlap apparatus for the study of low-oxygen effects on
voluntary coordination and attention. It is an elaborate electrical
device for the determination of the capacity of the flyer to recognize
and act upon stimuli aifecting sight and hearing.
2'he low-presmre chamber. — Two were constructed at Hazelhurst
field, Mineola, Long Island, and one at the third aviation instruc-
tion center, American Expeditionary Forces. Each is a cylindrical
steel tank of sufficient size to accommodate comfortably five or six
men. By means of a vacuum pump, ventilating and check valves,
the subjects and observers can be subjected to the influence of re-
duced atmospheric oxygen pressure. A reduced pressure correspond-
ing to an altitude of 38,000 feet can be secured.
The first problem taken up in the medical research laboratory was
a study of the physiological effects of altitude on the aviator. Start-
ing with the knowledge that the altitude influence is due to a lower-
ing of oxygen pressure, the physiologists sought for a method of sub-
jecting men to decreased oxygen in order to determine to what extent
they would adapt themselves to a decreasing oxygen supply. Re-
breathing experiments in which the subject continually rebreathed a
certain volume of air from which the carbon dioxide was removed by
an absorbent, gave the conditions required. The Henderson rebreath-
ing apparatus as perfected subjects men to the influence of artificial
altitude or lowered oxygen pressure.
With the aid of this apparatus was studied the manner in which
men compensate, so as to secure sufficient oxygen for t1ie needs of the
body when the oxygen supply is gradually decreased. It was early
found that the adaptive compensatory responses are chiefly an in-
crease in breathing and a more rapid blood flow, which is e\'idenced
by an increase in the rate of the heart beat. Furthermore, it was
found that some men responded well to a decrease in oxygen pressure
while others did so only moderately well. A few failed entirely to
react, and, therefore, should not be allowed to ascend to very high
altitudes.
This early investigation gave the basis for the altitude classifica-
tion examination, and also for a study of cardiac, psychological.
A. E. F. AIR SERVICE. 1389
ophthalmological, internist, ophthalmologist, and psychologist fur-
nished the classification examination as used on nearly ever}^ aviation
field in the States, and in the second and third aviation instruction
centers in the American Expeditionary Forces.
An analysis of 374 of the classification examinations showed that
the men responded to low oxygen as follows : Ver}' well, 40 per cent ;
moderately well, 35 per cent, and poorly, 25 per cent. Xo limitations
as to altitude were placed on the first group, the middle group were
advised not to fly above 15,000 feet, and the last not above 8,000 feet.
About 5 per cent of men commissioned as fliers were considered
physically unfit for this work.
The factors involved in the compensation to altitude were the
subjects of a number of physiological investigations. These included
pulse rate, arterial blood pressure, venous blood pressure, the carbon
dioxide and oxygen tensions of the alveolar air, vital capacity, rate
and depth of breathing, the influence of the expansion of the in-
testinal gases on breathing, the oxygen and carbon dioxide capacity
of the blood, the changes in hemoglobin and erythrocytes of the blood
and acidosis.
Other problems considered were vasomotor tone and endurance of
low-oxygen, the postural and exercise pulse rate, and blood pressure
changes as an index of physical fitness and the effects of flying upon
the pulse rate and arterial pressures.
APPARATUS NOT IN GENEKAL USE, EITHER DEIV'ISED OR MADE USE OF BY OPHTHAL-
MOLOGICAL DEPARTMENT.
An 84-inch tangent screen on curtain roller. A dye and rubber
stamp was made for use with this unusually large screen.
Retinal sensitivity; a wedge made of a mixture of gelatin and
neutral dye was devised and marked off in millimeters, each milli-
meter representing a definite per cent of light transmission. Neu-
tral gra}^ squares with 13 perceptible differences were used as test
objects.
Test objects for plotting diplopia fields; a long, black rod, at one
end of which is a battery and at the other end an ophthalmoscope
lamp, covered by a small circular black box, with a 10 millimeter
opening protected by a ground glass through which the light could
be observed.
A pair of goggles was devised for use in taking diplopia fields and
the field of binocular fixation ; the lenses were toric, one red and the
other green.
Method and apparatus for testing fatigue of accommodation and
convergence; Howe's ophthalmic ergograph was used, with one or
two modifications.
Test for inertia of adjustment or accommodation; the Ferree ap-
paratus was procured for this purpose, although there was no oppor
tunity for determining its practical value before going overseas.
The Ives visual acuity test; this apparatus has proved of gi^eat
value in testing the visual acuit}' during the rebreathing test and in
the low pressure chamber, and in detecting malingering.
Johnson's visual acuity apparatus : It is a valuable scientific instru-
ment. The only reason why it is not used for all tests is that it was
devised for use at 2 meters, which permitted the accommodation to be
1890 REPORT OF THE SURGEON GENERAL OF THE ARMY.
t(K) ^leat a factor. It could be modified for use at 20 feet and would
be of <rreat value in uiaking scientific records.
The Prince rule was uschI for testinfy acconnnodation and conver-
gence, and the in-oxiuuil end was gou<ied out to fit over the nose to per-
mit the test type to be approached in the mid line. A black dot per-
mitted the recording of the near point of convergence.
Tiie Schweiger perimeter was fitted with an extra U-shaped piece
for binocular use.
Studies have been made of the effect of altitude upon visual acuity,
visual reaction time, stereopsis, color vision, retinal sensitivity to
light, retinal sensitivity to colors, field of binocular fixation, muscle
balance, muscle strength, near point accommodation, near point con-
vergence, fatigue of accommodation, fatigue of convergence, intraoc-
ular tension, and fields for form and colors.
Other problems considered were the effect of tobacco and amyl
nitrite upon the ocular functions, the best form of test object for the
near point of accouimodation, the relation between field of motion,
field of direction of motion, and field of form, the simple visual and
visual discrimination reaction times. In addition, the blind angles
in aviation were studied by means of stereoscopic and moving
cameras and the value of the eye in making landings bj^ means of
stereoscopic cameras.
Experiments on goggles: Best method of ventilating goggles,
value of colored lenses, value of goggle with resisting surface, lessen-
ing the danger from rim cuts, improving tlie field of vision, and re-
ducing size of central bar.
raOM THE OTOLOGICAL DEPARTMENT.
The rotating chair and various types of special apparatus were
used in an endeavor to throw additional light on the problems con-
cerned with the sensing of motion.
The relative importance of the eyes, the motion-perceiving portion
of the ear, and the deep muscular sense, in the maintenance of equi-
librium, were also studied by experiments in elevators in high build-
ings, in aeroplanes, and in special apparatus. Blind-folded deaf-
mutes were studied under actual flying conditions to determine the
importance of the deep muscular sense as a factor in equilibration.
FLIGHT SURGEONS AND PHYSICAL DIRECTORS.
One of the earliest needs recognized in this work of caring medi-
cally for the aviator was an intimate and close contact with him in
his work. Accordingly, flight surgeons were created. These men
were trained in the central laboratory in all the essentials of recently
acquired medical knowledge relating to aviation, and then sent to the
training fields to befriend and assist the fliers in every possible way.
These flight surgeons had an excellent opportunity of studying the
student flier from every point of view. Living with them he soon
learned their habits of life — their physical, temperamental and men-
tal makeup — their problems, collectively and individually. He
brought to bear all that his general medical training furnished and
in addition the special knowledge gained from his laboratory train-
A. E. F. AIR SERVICE. 1391
ing. In turn he brought to the laboratory new problems, and an
intimate knowledge of the needs of the aviator.
In order to improve the physical condition of the fliers, well-
known trainers of college teams in the United States were given a
commission and detailed as physical directors under the supervision
of the flight surgeons. These officers were sent to the laboratory at
Mineola for a course of two weeks study, before being placed in
the various flying fields. They, like the flight surgeons, lived with
the men. messed with them, became the counselors and friends of the
student fliers, and formed an important connecting link between the
fliers and the flight surgeons. They were all men interested (humanly
and scientifically) in the service and entered upon their duties with
great enthusiasm and patriotism.
The work of the laboratory and of the flight surgeons evoked
much interest and proved of very great value to the training schools
of America. A British scientist wrote : *' I wish to congratulate the
American research committee on what will be the most accurate
method of examining pilots." This type of work was requested for
the American Expeditionary Forces.
This problem was the same as in America but inasmuch as the
American Expeditionary Forces was not so well equipped with ex-
amining boards the research laboratories took on this function. Only
one difference was encountered. Whereas in America all applicants
voluntarily chose the air service it was soon learned that many ob-
servers were assigned to this duty and in many instances in spite of
their preference for other branches of the service. This made a
material difference both in their attitude toward the examination
and to the service.
(a) Reexamination of -filers. — This consists of a careful, general,
and special medical overhauling, by a group of consultants, of men
referred by the training department, by the flight surgeon or when
returned from the front for special study.
Following each examination the board met, decided the treatment
necessary, referred the case to the hospital, recommended leave or
sick leave, prescribed glasses, returned the flier to flying status or
grounded him, as the case demanded. In this connection, the work
was greatly facilitated through headquarters authorizing the com-
manding officer of the post to grant leave or sick leave immediately
upon the recommendation of the board when indorsed bv the com-
manding officer of the hospital. Pursuant to third indorsement from
headquarters, commanding general. Services of Supply, dated Sep-
tember 20, 1918, " leave up to two weeks mav be granted subject to
Sec. II, Xo. 7, C. S."
A ward of the hospital was turned over to the board, which gave
the opportunity for carrying out minor and special surgical pro-
cedure and for the medical care of sick fliers.
In addition, members of the board acted as consultants to the hos-
pital in all cases in which consultation was desired.
In the development of the work relative to the flier, the board was
confronted by the very serious problems of where to send the conva-
lescent, tired or stale men. This need was covered in the plans of the
air service with the cooperation of the Red Cross to open chateaux in
desirable districts for rest homes for tired aviators.
1392 REPORT OF THE SUROfeON GENERAL OF THE ARMY.
(b) Classification examination of amators in relation to altitude. —
Fliers were examined by the rebreathinof test, as occasion arose, to de-
termine their ability toVithstand the effects of low oxygen, and their
instructors or commandino' officers were advised as to the altitude at
which thev could work efficiently.
{c) Education of fliers in matters relating to health and effi-
ciency-— Talks were given from time to time, concerning such matters
as the eye, the " flu '' and how to avoid it, the health of the flier, et<;. A
series oi articles was published in the Plane News by various mem-
bers of the board concerning medical matters relating to the health,
efficiency, and problems of the flier. The importance of training and
clean living was emphasized.
AH experionce up to date has impressed oue crucial fact on medical men :
only tlie fit should lly. In the flier, as in men generally, this is dependent upon
the' simple fimdamental things of life, such as sleep, exercise, diet, and habits.
These four great factors can be summed up under the one word — training.
Training is essential to fitness.
THE VALUATION, STANDARDIZATION, AND SIGNIFICANCE OF TESTS UTILIZED
STUDYING THE FLIER.
With the signing of the armistice, the English group and the
ophthalmo-otological group returned to their parent organization.
The English group bringing with them a vast amount of informa-
tion concerning the methods employed by the British in their work
with the aviator. The completion of the laboratory made available
infinitely greater facilities for work, while the return of the flier
from the front through the second and third aviation instruction
centers, afforded a splendid opportunity for the investigation of the
methods used by the board. This made possible the correlation of
their findings with the result of the crucial test of experience. Conse-
quently the board requested that groups of fliers, aces and failures,
be cleared by the research board before returning to America, and
that pilots returning from the front bring with them statements from
their squadron commanders concerning their ability" in actual war
work.
In all 186 fliers from the American squadrons at the front were
examined in this series. Of these 66 were observers, who were ex-
amined at the second aviation instruction center, and 120 i^ilots,
who were examined at the third aviation instruction center. In
addition 12 French fliers were sent to the third aviation instruction
center bv the French Government for this special study.
The study of men from the front comprised the following: The
pilot on returning had a conference covering his training, his work,
and experience at the front, then he was given a medical examina-
tion covering his general condition, his personality, the eyes, and
the ears. His reaction time was studied, the tactual, visual, and audi-
tory reaction times being taken with the D'Arsonval apparatus. The
English tests were applied. He was tested on the rebreather and
classified from the standpoint of his ability to withstand the effects
of altitude. Finally he was photographed, when possible, both in
profile and in full face. In this way a complete permanent record
was obtained covering his training, his work at the front, the opin-
ion of his commanding officer concerning him and his work at the
A. E. F. AIR SERVICE. 1393
front, his medical condition, his fitness, mental and physical, the
results of the English, American, and French tests, and the greatest
altitude at which he can do efficient work.
I
NAUSEA, VOMITING, AND \'KRTIGO AS THE RESULT OF FLYING.
" The hypersensitive to motion type of flier." About 10 per cent
of all the aviators who applied for various reasons to the medical
research board gave a history of being hypersensitive to motion.
They complained of being nauseated, of having vomited, or being
dizzy in the air to a greater degree. Many of these cases were re-
ferred by the monitors on the acrobatic fields because they believed
these men to be more than usually sensitive to motion. This group
of men was subjected to special study. Many of them gave a pre-
vious histor}' of being sensitive to swings, merry-go-rounds, or rid-
ing in cars, and also were more than usually sensitive to motion
at sea. Many of them showed hypei^sensitiveness to motion as in-
dicated by prolonged nystagmus or vertigo, marked falling and
past pointing in the chair. A few of those who were most hyper-
sensitive in their air work showed no corresponding indications in
their labyrinthian examinations. It also became apparent that a
certain type were able to overcome this sensitiveness and were
'' lached " quickly from the acrobatic fields. Certain pilots for whom
grounding was considered at first left this post finished and efficient
fliers. In combat, in which relativity of position plays a great role,
evidences of hypersensitiveness reappeared in some fliers. The board
has been impressed with the degree to which hypersensitiveness to
motion could be overcome through practice. One of America's fore-
most aces is credited with having been a vomiting type while under
training in the early days of the third aviation instruction center.
Vomiting seems to be less serious than vertigo in this connection.
DEPARTMENT OF OTOLOGY.
The work of the ear department concerned itself with the routine
ear, nose, and throat examinations of the men who passed the lab-
oratory.
The nose and throat examinations, developed nothing of scientific
interest. Approximately 150 minor operations on the nose and
throat were performed.
Two main problems were under study :
1. The value of the original labyrinthine standards for the admis-
sion of candidates into the air service.
2. The effect of air work on the labyrinthine reactions.
To this end statistical studies were made of the various types of
fliers in the American Expeditionary Forces, the fliers returning
from the front, the monitors, the testors, and the study of the men who
were working on flying fields where acrobatics constitute a large
part of the air work. A considerable amount of data has been com-
piled which is too voluminous for this report and will furnish the
material for a later detailed publication.
A study of the falling reaction with a self-registering control stick.
Marked vertigo in rotating chair examination is due usually to
the stimulation of the vertical canals. In virilles and tail spins.
the vertigo has resulted in many fatal accidents, and is due to the
1394 REPORT OF THE SURGEON GENERAL OF THE ARMY.
same cause. The method of stimuhitino; tlie vertical canals with the
chair, gives an approximately similar result when the aviator goes
into and come out of tail spins and virilles. It was thought that
if these conditions could be reproduced under laboratory conditions
some interesting data might be brought out.
1,"). ]Medical Director o?^ Chemical Warfare Service,
a. organization.
Owing to the importance of medical gas warfare measures, a
specially-trained medical officer will be appointed by the command-
ing general. American Plxpeditionary Forces, upon the recommenda-
tion of the chief surgeon, American Expeditionary Forces, to be
known as the director of medical gas warfare, American Expedition-
ary' Forces, who will be charged with the organization and control,
under the direction of the chief surgeon, of these different measures.
In view of the close relationship existing between the Medical De-
partment and the gas service, American Expeditionary Forces, in
connection with the subject of gas warfare, he will, for purposes of
coordination, be assigned to duty with the gas service as its medi-
cal representative. He will act as the liaison officer between these
two services, the medical gas services of our allies and all transac-
tions betAveen the services will be conducted through this officer.
The director of medical gas warfare will be the medical advisor
of the chief of the gas service aricl the gas advisor of the chief sur-
geon of the American Expeditionary Forces. Besides the duties
already specified he Avill collect for the chief of the gas service,
American Expeditionary Forces, all physiological and medical in-
formation having any bearing on the problems of gas warfare; he
will supply the chief surgeon such information as comes into the
hands of the chief of the gas service which has any bearing on the
medical aspect of gas warfare, especially concerning new treatment
of gas casualties, with i-eference to combatting the effects of the
enemy gas not only from a therapeutic, but also from a pro])hylactic
point of view. To this end the cliief of the gas service will supply
the medical director all information concerning gas warfare w'hich
has any bearing on medical matters.
He will prepare for publication and distribution to medical officers
and others extracts from reports pertaining to the medical gas mat-
ters sent to the gas service of chief surgeon. All expenses of such
publications will be borne by the Medical Department.
He will make recommendations for further cooperation of investi-
gation and observations along individual lines which may from time
to time seem advisable.
He will be prepared to lecture to medical officers and others on
the subject of gas poisoning. He will cooperate in every way pos-
sible with the chief consultant, medical services, American Expedi-
tionary Forces, and keep him thoroughly acquainted with all new^
or suspicious symptoms following gas attacks.
He will arrange for direct telephonic or telegraphic intercourse
with the division medical gas office, and others, whereby the chief
surgeon and the chief of the gas service can be notified immediately
following gas attacks.
A. E. F. CHEMICAL SERVICE. 1395
He will inspect, from time to time, troops along the front area;
hospitals, hospital trains, etc., as to methods and facilities for the
care of gassed cases.
When the chief of the gas service or the chief surgeon deems it
necessary to obtain fuller information in regard to a gas attack, the
medical director will proceed to the gassed sector for the purpose of
investigating and obtaining all possible information concerning
the attack. Being a member of the gas servire he will represent the
chief of the gas service in his interview with gas officers. Being a
medical officer he will represent the chief surgeon, American Expe-
ditionary Forces, in his transactions with meclical officers, and when
necessary he will examine carefully the casualties.
When conditions warrant he will call upon the director of labora-
tories for a pathologist, to proceed to the designated place for duty
in connection with special investigations. Copies of reports from
the pathologists to the director of medical gas warfare immediately
following such visits will be submitted direct. The latter will
incorjoorate the same with the general report of the gas attack which
will be made to the chief of the gas service, a copy of which will
be furnished to the chief surgeon.
During these investigations the medical director will cooperate
from a medical standpoint with the personnel of the gas service in
the study of any clinical manifestations which may suggest the
employment of new gases and in the investigation of its effects.
Any important information obtained by the medical director
during these investigations will be communicated immediately to
the chief of the gas service and the chief surgeon, American Expedi-
tionarv Forces, by telephone or telegraph, a full written report fol-
lowing immediately upon his return to his station.
Any important information obtained, together with suggestions
!• regarding treatment, received either through reports sent to the gas
service or based upon experimental information, coming into posses-
sion of the gas service will be forwarded immediately to the chief
surgeon in order that the same may be submitted to the chief con-
sultant, general medicine, and medical officers of the American Ex-
peditionary Forces.
The same information will be simultaneously supplied to our
Allies through proper channels.
In accordance with the foregoing plan, the chemical warfare serv-
ice (then called the gas service) on December 14. 1917, was organized.
The first work consisted in a careful study of the situation and a
survey of the field from a medical point of view, this work including
a visit to the British gas school at Rouen. One of the first activities
undertaken was the establishment of a " medical gas instruction cam-
paign," for the purpose of instructing medical officers in gas warfare,
for it was found that among the great number of medical officers con-
stantly arriving in the American Exj^editionary Forces few had any
degree of information on this important subject.
As a first step in this educational campaign the medical director
wrote an article on " Symptomatology and pathology and general
treatment of gas cases," which was published and distributed to
medical officers of the American Expeditionary Forces. This was
142367— 19— VOL 2 27
1396 REPOKT OF THE SURGEON GENERAL OF THE ARMY.
followed bv the i)ublication and distribution of other similar articles,
an ctfort beino- made bv this means to keep the medical officers of the
\i^Hnican Expeditioiuirv Forces conversant with the latest develop-
ments in medical «ras matters and with the actions of poisonous war-
fare o-ases The medical director also visited most of the divisions
and manv of the hospitals, and lectured to the officers and other
personnel on the subject of chemical warfare gases from a medical
point of view, laying special stress on the subjects of prevention and
treatment. . ^ ^ -, ■ ^.^ ..
Shortly after the medical director reported for duty, an attempt
was made to incorporate into the chemical Avarfare service a medical
division as one of the departments of this scervice. In the plan of
organization suggested it was contemplated to have specially trained
medical officers with all divisions as division medical gas officei-s,
thev to act under the medical director of the chemical warfare serv-
ice/ All medical gas research and laboratory work to be under this
department. The medical section to be in close liaison with the
medical department of the American Expeditionary Forces. This
plan, however, was disapproved in the general organization of the
chemical warfare service. ^ . . , • ,
Following a gas attack in the 42d Division, resulting from which
a large number of casualties were improperly treated, due to the
lack of knowledge concerning such cases on the part of the medical
officers, the surgeon of the division succeeded in having a division
medical gas officer appointed by order of the division commander.
Fortunately, one of the medical officers in the command had re-
ceived instruction in medical gas matters in the States and had given
the subject much study, and as a rasult he organized a thorough
and systematic method 'for handling gas cases in this division, which
proved highly successful.
The necessity for having division medical gas officers was appar-
ent from the beginning, but the appointment of these officers was
not accomplished untiriate in June. Our gas casualties were con-
stantly increasing : large numbers of casualties claiming to be gassed
were iDeing evacuated to the rear where, upon examination, it was
found that they were not gassed, this condition resulting in much
undue labor and greatly weakening the strength of front area
organization. Inspectors general report that the rank and file were
not properly instructed in medical gas matters. Keports were also
made that no one in the front areas assumed charge of this im-
portant work. After these facts were clearly understood, authoriza-
tion for division medical gas officers was made in paragi'aph 8,
General Order 144. General Headquarters, 1918. As soon as the
order was promulgated the matter of the appointment of these
officers was taken up and after discussing the subject with the chief
medical consultant of the American Expeditionary Forces, it was
decided to allow each division surgeon to select the medical officer
he desired as division medical gas officer.
A course of instruction was organized by which the division
gas officers were fully schooled in their various duties and the best
methods of meeting their problems. The duties of division gas
officers were specified as follows:
For each division, a medical officer of the grade of major o:
captain, will be assigned as division medical gas officer and directo:
019
:toJ
A. E. F. — CHEMICAL, SERVICE. 1397
of mobile degassing stations, and there will be assigned under him
one sergeant and one private, first class, or private, Medical De-
partment, to be selected b}^ the division surgeon. The medical gas
officer will bear the same relation to the division surgeon as does
the director of field hospitals and ambulance companies.
B. DUTIES or DIVISION GAS OFFICERS.
The divisioji medical gas officer is charged especially with the
supervision over all gas matters in the division to which he is as-
signed. In this connection he Avill institute measures to prevent the
depletion in strength in the fighting forces from avoidable errors in
connection with the management of gas casualties.
He will also institute measures for —
(a) The instruction and training of sanitary troops in the best
methods of handling gas cases and of the rank and file in first aid
to the "gassed.''
(5) The establishment at advance aid stations, dressing stations,
and other relief stations, of an efficient system and proper equip-
ment for the administration of first aid to the "gassed."
(c) The supervision of the evacuation of all gas casualties.
(d) The supervision of the methods of gas protection throughout
the aid stations, dressing stations, and hospitals of the division.
He will act as medical adviser to the division gas officer and will
cooperate with him in every way possible.
He will collect and transmit to the designated Armv laboratory
interesting post-mort<^m specimens resulting from the actions of
poisonous gases.
He will constantly be on the alert for suspicious symptoms in gassed
patients which indicate the use by the enemv of 'new gases or new
mixtures, and any signs of such will be cominunicated immediatelv
through the division surgeon to the medical director of Chemical
Warfare Service. The division gas officer will also be notified of
such information.
As director of mobile degassing stations he will direct and super-
vise the operation of the mobile degassing units attached to his
division and to that end he will, under the direction of the division
surgeon, designate the location of these units as may be necessary
during or after a gas bombardment and the closing and reassembling
of them as soon as practicable.
He will keep the division surgeon, division gas officer, and organ-
ization commanders thoroughly informed as to the location of the
degassing units and the shortest possible route leading to them.
His duties during the active operation of the units comprise the
supervision of the bathing of those exposed to the fumes of poisonous
gases, the careful examination of the men before being stri])ped and
during the bathin^r period, and the immediate removal to hospitals
of those showing signs of poisoning from the effects of the gases.
His activities, therefore, cover the entire period from the time the
gas attacks commence until the men participating therein have been
degassed and disposed of. In order to ]n-operly perform these duties
he must be thoroughly familiar with the terrain of the country
occupied by the division, as well as the location of the different
organizations.
1398 REPOET OF THE SURGEON GENERAL OF THE ARMY.
The division meclical gas oHicer will also inspect and report upon
the administration of the degassing units; the efficiency, mstmctions,
and ade(|uacy of the medical personnel in gas matters; the condition
of the hospitals and relief stations, in so far as they relate to the
care of ca-es sulfering from the effects of poisonous warfare gases,
tofrether with the facilities for handling them; and m general all
matters affecting the care, well-being, and comfort of gas casualties.
xVt the end of every month each division medical gas officer will
forward to the medical director of Chemical Warfare Service, for
transmission to the chief surgeon, American Expeditionary Forces, a
report of the conditions noted by him during the month, indicating
the principal medical gas defects, if any; the number of gas attacks;
number of actual gas casualties reported; number returned to duty as
not gassed ; measures taken for the prevention of gas casualties, and
sucl^other recommendations governing the same.
All literature, reports, records, etc., received by the division medi-
cal gas officer will be carefully preserved and filed and Avill form
i)art^of the records of that office. n ^^ ■> ^ j
The following plan of medical organization was finally adopted:
In order to c()inbat the results of this specialized warfare, a strong
and coordinate medical organization is required to combine all nat-
ural divisions or relief, including orzanizations in the zone of the
advance, organizations along the lines of communication, organiza-
tions at the base, and organizations for general research and de-
velopment. . , -^^r T T -I-.
To perform properly the duties assigned to the Medical Depart-
ment, the following measures looking toward the better prevention
and treatment of gas casualties are hereby ordered:
(a) The institution of all practicable protective measures to pre-
vent the depletion in strength of the fighting forces from avoidable
causes in connection with gas warfare.
(h) The establishment of courses of instruction for intensive
training of medical officers, nurses, and enlisted men of the Medical
Departnient in the best methods of treating the "gassed."
(c) The establishment of special centers for the treatment of
gassed cases. The designation of the center or hospitals to be made
in orders from time to time.
(d) The appointment of specially trained medical gas_ officers
with divisions; these officers to be known as division medical gas
offi ers.
(e) The establishment at advance aid stations of an efficient sys-
tem and proper equipment for the administration of first aid for
the "gassed."
(/) The prompt evacuation of all gas casualties.
{{/) The supervision of the treatment of gassed cases entering
all hospitals.
(h) The instruction of the rank and file in the theory and practi-
cal first aid to the gassed men.
C. PORTABLE TUNNELS FOR >'EUTRALIZTNG OF MUSTARD GAS CASES.
In January 1918. the French reported that they were neutralizing
mustard gas in clothing by the use of chlorine.
A. E. F. — BATHING AND DELOUSING. 1399
Based on this the medical director made recommendation to the
chief of chemical warfare service that portable tunnels be constructed
and mounted on trucks and follovv^ing mustard gas attacks they be
rushed to the sector involved, erected, and those exposed to the fumes
of mustard gas be compelled to apply their respirators and go into
the tunnel into which was thrown a strong concentration of chlorine
gas. This plan was approved by the chief, chemical warfare service,
and the tunnels were erected under the directions of the medical
director. This method was presented to the interallied gas confer-
ence which met in March, 1918.
D. MOTORIZED DEGASSING STATIONS.
In view of the importance of early bathing in connection with the
treatment of men exposed to the fumes of mustard gas, and the
fact that bathing facilities were scarce along large sections of the
front occupied by our forces, plans and specifications of a mortorized
mobile degassing plant were prepared by the medical director and
later approved by the general staff and authorized by paragTaph 8,
General Order 141, general headquarters. Americal Expeditionary
Forces. Two of these plants were authorized for each division.
E. MEDICAL GAS WARFARE BOARD.
On October 18, 1918, a special board to be known as a medical
gas warfare board was organized. The duties of this board were
to consider all medical gas matters, including the identification of
malingerers, the standardization of equipment for treatment of gas
cases, and the consideration of the subject of awarding wound chev-
rons for men gassed, all of which were taken up and reported upon
in detail.
16. Bathing and Delotjsing.
A. organization.
The following report pertains to the bathing and delousing of
the American Expeditionary Forces for the period beginning De-
cember 1, 1918, and terminating June 20, 1919. In this report an
endeavor only is being made to louch on the most interesting phases
connected with the work, the method of organization, and the va-
rious methods used for disinfesting and bathing.
Up to the signing of the armistice, our armies, like those of our
allies, were heavily infested with lice, and to such a degree that their
condition was alarming. From reports made to the chief surgeon
of the American Expeditionary Forces by sanitarv inspectors and
others, it was noted that over 90 per cent of the troops were in a
verminous condition. Considering that typhus fever was prevalent
in many of the areas which were being occupied by our troops, the
condition was alarming, and one requiring immediate action.
Inasmuch as the work pertaining to bathing and delousing was
assigned to the Quartermaster Corps, all activities pertaining to it
have been carried on exclusively through that department. However,
a large percentage of the personnel performing the work belonged to
the Medical Department.
1400 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
The pubiect of bathing- and delousinof is closely associated with that
of deniiivtnivlization of men subjected to mustard ^as fumes. Ihe
ChcMuical Warfare Service, throutrh its medical director had per-
fected a thorouo-h orcani/ation for administermg hot baths to men
•It the front who had been subjected to the fumes of mustard gas,
and in view of the fact that the services of this organization would
no lono-or be required after the signing of the armistice, it was
recomniended bv the chief surgeon and the chief (luartermaster,
and concurred in bv the chief of the Chemical Warfare Service, that
this entire organization be transferred to the Quartermaster Corps
■for the jiurpose of bathing and delousing infested men. This service
could be mo-t efficientlv applied to the work of delousing.
In compliance with this recommendation, the following general
order was issued :
GENEnAl. HEADQUARTERS AMERICAN EXPEDITION ARY FORCES.
General Order 1 i,r j^ o imo
No. 216. / France. Kovember 2, WIS.
II 1, The health of the troops deperds Inrsrely upon the completeness with
which delousing and hathinjr is done, ospociully during the coming period of
diminished activity and relatively permanent stations.
2. To provide for the carrying on of tliis important worlv, an officer of the
Medical Conis is herehy detailed for duty, under the direction of the chief
quartermaster, and phiced in charge of all activities with reference to the
delousing of the armies,
3. The ((luipment and personnel of the degassing service is attached to the
Quartermaster Corps.
4. Such part of section 7, CPiieral Order No. 144, these headquarters, and
Jill orders and instructions heretofore issued which conflict with the ahove are
rescin(-e(l.
By eoumiand of Gen. Pershing.
B. PERSONNEL.
In compliance with the above general order, the degassing service,
consisting of the following personnel, was transferred from the
Medical Department to the Quartermaster Corps in connection with
this work :
Commissioned.
Medical Corps:
Coloue's 1
Majors 7
Captains 27
First lieutenants 4
Sanitary Corps :
First Lieutenants 5
Second lieutenants 15
Total commissioned 59
Enlisted.
Medical Department :
Sergeants, first class 5
Sergeants 12
Corporals 33
Cooks 3
Privates, first class 13
Privates 178
Total enlisted 214
Grand total personnel 273
A. E. F. BATHING AXD DELOUSING. 1401
C. ORGANIZATION BATHING AND DELOUSING DIVISIONS.
Trained officers, in the majority of cases medical officers, and desig:-
nated as supervisorg of bathing and deloiising, were assigned with
every division. In most cases these officers were former division
medical gas officers and took with them their trained office personnel.
Under plans emanating from this office, these officers immediately or-
ganized their divisions, placing siibsupervisors of bathing and delous-
ing with all regiments, battalions, and smaller organizations.
When the division of bathing and deloiising was organized every
endeavor was made to avoid burdening the supervisors with an un-
due amount of paper work, etc., it was the plan to leave them free
from such encumbrances, thus permitting them to devote more time
to the essential features connected with the work. However, certain,
information was needed in this office; as a result, printed forms re-
quiring only such information as was actually wanted were supplied
for the purpose.
The supervisors were held strictly accountable for the carrj'ing
on of the work in their divisions, and as a rule, they were not inter-
fered with. As a result, the)^ performed most efficient services.
In each division a thorough s^'stem of bathing and delousing was
organized, by which arrangements were made for the complete and
thorough disinf cstation of units at definite intervals ; this plan proved
to be of the ntmost importance. Time-tables were drawn up and the
periods and places at which various units were to ])e bathed and dis-
inf ested were specified in orders.
As a rule, the iriits were deloused systematically either by com-
panies or battalions, so that the men who were freed from lice could
be kept together and not reinfested by men from other organizations
awaiting disinf cs-tr.tion. In delousing the men great care was also
exercised in the disinfestation of their belongings at the same time.
This was a mo-t important measure in combating the lice infestation.
It was essential that all clothing, including service dress and under-
clothing, should bo thoroughly and sjstematically disinfested. This
required a, certain amount of equipment which, in many cases, could
not be provided; as a result the troops were thrown on their own
resources and improvised many ingenious and successful contrivances
for carrying out the bathing and disinfestation ]3rojects.
For the prevention of reinfestation of troops freed from lice, the
following preventative measure was universally adopted in all
divisions.
(1) The detection of men who were infested with lice.
(2) The disinfestation of all clothing and bedding belonging to
lice-infested men.
(3) The cleansing of the man himself by bathing.
L (4) Cleansing of his billet or sleeping quarters.
f The relative importance of these measures was realized. The early
detection of lice-infested men was essential without which the rapid
spread of lice would follow. As a result, periodical inspections of
men to detect lice infestation were made and when possible these
inspections were conducted in the presence of a commissioned officer.
In conducting this work every attempt was made to gain the men's
confidence in the matter, thus getting their assistance. The men, if
suspecting infestation, were instructed to report immediately to the
1402 REPORT OF THE SUEGEOIT GENERAL, OF THE ARMY.
designated officer in charjre of the work in their units, where they
received everv con'^ideration.
As a result'of this organization the bathinof and delousinor of troops
of the American Expeditionary Forces has been carried out very
successfullv and in less than six weeks after the bathinor and delous-
ing was created the lice-infestation rate dropped from 90 per cent
to^'less than 3 per cent, which was due to the methods already de-
scribed, consistinor of —
(a) Thorough organization.
(b) Education of troops in matters pertaining to lice.
(c) The combined efforts of officers and men.
(d) The coordination of all departments of the American Ex-
peditionary Forces.
(e) The individual efforts of the soldier himself.
(/) Improved facilities for bathing and delousing.
DL'TIFS OF SUPERVISORS OF BATHING AND DELOUSING.
The supervisors of bathing and delousing were appointed upon
the reconmiendation of the chief of bathing and delousing of the
American Expeditionary Forces. In the majority of cases these
officers were fonner division medical officers. They were placed in
general charge of all bathing and delousing in the division or base to
which assigned and attached to the staff of the division or base quar-
termaster. Due to the close relationship existing between the Medi-
cal Department and the Quartermaster Corps in connection with the
work, they coordinated in eveiy way possible with these different
departments.
They prepared for publication and distribution to all organizations
in their division, extracts from reports and all other literature which
had a direct bearing on the subject, forwarded to them by the chief
of bathing and delousing division.
They gave numerous lectures to the different organizations on the
subject of lice infestation.
They arranged for the regular inspections and supervised the same.
The.y furnished the chief of bathing and delousing with all data
having any bearing on the subject, together with all required reports.
MEASX'RES FOR THE ELIMINATION OF LICE.
At the beginning of this work many adverse conditions were met^
all of which had to be overcome. There was a scarcity of bathing
and delousing equipment, and that on hand was not being utilized
judiciously. Laundry facilities were poor; as a result there was a
shortage of underclothing. The troops were unsettled, they were
constantly changing from one area to another, many were billeted in
private homes and places which could not be properly disinfested.
These were serious conditions which had to be eliminated before any
improvement in the verminous condition could be looked for.
It was soon discovered that the thoroughness of ridding troops
from lice depended upon its weakest link, for example, one organi-
zation was periodically disinfested and bathed, the commanding of-
ficer of the organization gave the matter his personal attention, reg-
ular schedules were followed and everything was done to eliminate
A. E. F. — BATHING AXD DELOUSING. 1403
lice infestation. However, these efforts were unsuccessful, and lice
were constantl}' being found. After a thorough investigation as to
the cause, it was traced to the condition of the underclothing which,
clue to lack of proper laundry facilities, was not laundered at the
same time ; as a result one man would have on clean underclothing and
another in the same billet dirty, with the result that lice were being
transferred from the dirty to the clean. When this condition was
remedied the lice disappeared. Eegularity in the changing of un-
derclothing, proper bathing and clisinfesting facilities, and the super-
vision of the work b}' a commissioned officer are the predominating
necessities for the successful elimination of lice.
In the carrying out of tliis work, two general methods of disin-
festing were followed :
(1) The mechanical method.
(2) The chemical method.
Under the mechanical method the following equipment was used :
Steam sterilizers (mobile and stationary),
Steam boxes,
Serbian barrels.
Hot-air disinfestors,
Canadian hot-air disinfestors,
Hot boxes,
Heated caves,
Flat irons.
Heated cans, etc.
Under the chemical method the following were used :
Acetic acid, 10 per cent vinegar, for head lice, can not be relied upon, for
the reason that it does not dissolve the chitinons tubes of the nits.
Alcohol, absolute, or strong spirit, for head lice or crabs.
Benzine for head lice and body lice.
Benzol.
Camphorated alcohol (camphor 1 part in 90 per cent alcohol). Wash the
hairy part in soap and water, dry ; then wrap the parts affected overnight.
Camphorated oil.
(Carbolic acid, A per cent, followed by olive oil.
Chlorine — kills the lice but not the nits.
Cresol solution, 5 per cent cresol soap solution — kills nits and lice in 30
minutes. Three per cent kills in one hour.
Formalin condemned as useless.
Mercury for capitis, corporis, and pubic.
IMercury ammoniated, white precipitate ointment.
Mercury and vinegar.
Mercury one to two thousands.
Naphthaline 9G parts, creosote 2 parts, and iodoform 1 part. Known as N.
C. I.
D. DIFFERENT STYLES OF DISINFESTORS.
Several different styles of steam disinfestors were employed in this
work and when handled with care have proved successful. Much
unjust criticism has been made relative to the inefficiency of certain
types of steam disinfestors, but after investigations it was found in
nearly all cases the fault was not due to the apparatus but to other
causes, generally to inexperienced personnel, overcrowding of the
chambers, and lack of proper exposure. At one camp frequent com-
plaints were made that live lice were found in clothing after having
been sterilized. The matter was investigated, when it was found
ignorance was the cause of the trouble.
1404 REPORT OF THE SURGEON GEXER.VL OF THE ARMY.
a', sebbian barrels.
Serbian barrels and modifications of tlie same and, in many cases,
ordinary steam boxes in which steam was generated in galvanized
cans, etc., were used successfully.
In Germany several organizations used improved steam disinfector
chambers constructed from large hogsheads, at one end of which a
trap door had been prepared for admitting articles to be disinfested.
Steam for the disinfesting was generated in gasoline bedons from
Avhich it was conveyed to the hogsheads in ^-inch piping.
B.' CANADIAN HOT-AIR DISINFESTORS.
These were used quite extensively and built according to plans fur-
nished from this office. Many other different types of hot-air dis-
infestors were constructed, some of the simplest of which were those
built in hillsides, covered with galvanized iron and then banked with
dirt, very much like charcoal ovens.
Flatirons. hot bottles, heated tomato cans, and other contrivances
were also used quite successfully.
C'. PORTABLE HOT-AIR DISINFESTERS.
The necessity for portable disinfesting equipment soon became ap-
parent. To meet the demand a Gilchrist portable hot-air disinfester
and six steam sterilizers of American Sterilizing Co., Erie type, were
employed. The former is mounted on a 3-ton Packard chassis, con-
sisting of a sheet-iron, asbestos-lined, chamber (G by 14 by 6 feet)
containing 34 crossbeams, each fitted with 14 hooks. The clothes
and equipment of 17 men are hung loosely on these hooks.
In using this disinfester it was of the utmost importance that care
be taken, hanging the articles of clothing very loosely to insure the
proper circulation of heat, and hung high enough to prevent catching
afire. A temperature of 210 to 220° is maintained in the chamber by
two gasoline blowtorches such as are used on the portable bathing
machine. These are located on a standard by the side of the truck.
An L-shaped sheet-iron pipe conveys and circulates the heat through
the bottom of the chamber. By this method of delousing, the clothing
and equipment of 17 men can be handled every 45 minutes. The
portable steam sterilizers can disinfest the clothing and equipment of
from 6 to 8 men every 30 minutes, but there is an appreciable shrink-
age of clothing resulting.
The hot-air disinfester was especially successful when used in con-
jum tion with the mobile bathing plant, description of which appears
in this report.
E. BATHING APPARATUS,
All sorts of bathing apparatus were used by the troops, some sta-
tionary and many portable. The mobile bathing plants, description
of which follow, have proved very successful. In view of the fact
that they were motorized they could be moved from one area to an-
other, thereby rendering efficient service in places void of other
means.
A. E. F. BATHING AND DELOUSING. 1405
T'-. rORTABLE BATHING AND DELOUSIXG UNITS IN THE BILLETING AREAS.
With the occupation of large niiinbers of men in the small towns
in the vicinitv of base sections^ and large concentration camps, which
Averc used for billeting purposes, the important question of adequate
bathino- fa ilities and means of disinfestation of clothing and equip-
ment was presented. Local facilities for bathing were extremely
meao-er, and permanent shower baths were installed only in the
hiro-?r towns. Thus the question of bathing and delousing the men
o, cupying small villages remained to be met by some means of port-
able equipment.
The Chemical Warfare Service had already m use a type of portable
liathin<r machine. This machine was used to great advantage in the
work. ^It consists of a 1.200-gallon water tank mounted on a 5-ton
Pierce Arrow truck with all^the necessary appliances for a warm
liower bath. The water is heated bv a highly efficient instantaneous
^vstem attached to the rear of the truck frame. The gasoline burn-
ers six in number, are cone-shaped, constructed m a circle with a
preheating burner in the center. The 7-gallon gasoline feed tank
i- attached to the left side of the truck frame. A centrifugal pump,
belt-driven from the flvwheel of the truck motor, has three functions:
(1) P^illino- the tank from anv stream or reservoir, (2) keeping vip
a continuar circulation of water through the heating system, and (3)
maintaining the pressure for the baths.
The standards, from which the shower heads are suspended, are
of the demountable type and during travel are fastened on the side
(.f the truck on racks especially constructed for them. The simplicity
of construction facilitates the erection of the shower-bath equipment
and putting it in operation in 15 minutes. Allowing each man d
o-allons of water, 400 men can be bathed with each tank of water
The baths having a capacity of 24 men, can easily accommodate 300
men per hour. , .„ . i„
In operating these machines in the billeting area some bupple-
mentarv equipment was required in which to house the shower baths.
Two 50- foot hosintal ward tents, sufficient lumber to construct a tem-
porary platform for the showers, and tarpaulins to cover the ground
'erved to meet this demand. Besides it was necessary to carry an
adequate supplv of gasoline for both the motor and for the heating
.vstem. Except in extremely inclement weather this tentage and
equipment, meager as it was, provided a sufficiently comfortable place
for men to dress, disrobe and bathe. Two large coal stoves kept the
tents comfortably heated in cold weather. i u ..ffi
The showers, occupying one-third of one of the tents left suffi-
cient space to accommodate 24 men while 48 men were allotted to the
remaining 10 for dressing and disrobing. By this arrangement the
showers were kept in constant operation, thus insuring the maximum
capacity from the bathing machine.
Work in the billeting area showed that four men cou d propeih
operate this bathing outfit. These were distributed as follows : 1 wo
men to operate the burners and control the valves relating to the
water supply, one man in charge of the showers and one man to
direct the men preparing for the bath. It was highly "» ^^^'^^^ .^ le
these men be well trained as the efficiency of each mans woik de-
pends wholly on their interrelative efficiency.
1406 REPORT 01' THE SURGEON GENERAL OF THE ARMY.
Batliiiiff by orfraniztition roster was insisted upon. If a medical
ollicer was avilable eacli man was inspected for manifestation of
Ijody and crab lice before entering the bath. The names of suspects
Avere taken and the men ordered to report to the orrjanization in-
firmary for further treatment. Suggestions such as the use of hot
irons, Serbian barrels, etc., were readily complied with.
G. THE CAMP AXCOXA DELOUSIXG PLANT.
At Camp Ancona, Besens, near Bordeaux, where 8,000 stevedore
troojjs are stationed, frequent epidemics of infestation resulted in
the installation of a delousing plant. The bathing facilities were
furnished by one of the mobile bathing machines, the delousing being
accomplished by the hot air disinfestor and four steam sterilizers.
The plant was operated in accordance with a daily schedule, issued
b}' the commanding officer of the medical detachment, which called
for two companies, totaling from 400 to 700 men. The men were sent
to the plant dressed in slickers, the balance of their clothing ha\T;ng
been prepared in bundles at their quarters. A non-commissioned
officer checked off each man's name on the company roster as his
bundle was placed in the sterilizer. The man's identification tag was
attached to the bundle. He was then given a hot shower bath under
the direction of an orderly who instructed him to pa}^ particular
attention to the hairy portions of his body. After the bath the men
were examined by a medical officer for body and crab lice. Those
infested were shaved by attending medical department orderlies.
The men then passed into a second tent where they waited for their
sterilized clothing, carrying their bundles back to their quarters for
redressing. Meanwhile the company barracks- were scrubbed and
afterwards sprayed with cresol solution, so that the men returned to
absolutely clean quarters. Bedsacks were also refilled.
H. BATHING OF TROOPS AT BASE PORTS.
At the signing of the armistice troop movements to the United
States commenced almost immediately. A large percentage of the
troops transported were verminous. As a result of this condition
many complaints, and just ones, were received from the other side.
The condition became so alarming that the commanding general,
Services of Supply, directed that immediate steps be taken to delouse
all troops before embarkation on board ships and to arrange for the
necessary measures to carry on the work.
^ After visiting the several base ports and carefully studying the
situation it was decided the most feasible method for conducting the
work and handling the large numbers which would have to be con-
sidered would be in a division of all camps into two sections: (1) A
reception or dirty section (2) a clean or evacuation section. All
troops arriving at the camps to be assigned to the dirty section and
retained there until such time as they could be thoroughly deloused
and equipped with clean clothing, then to be transferred to the clean
or evacuation section, a complete line of demarkation separating the
two. To put this plan into operation would require large bathing
and delousing plants, of sufficient size to handle the maximum num-
ber scheduled to pass through the camps. The plan was submitted
A. E. F. BATHIISTG AXD DELOUSIIsTG. 1407
to and approved by the commanding general, Services of Siipplv.
The next important matter to be handled was in connection with the
type of delousing plant to be adopted. No plans of bathing and
delousing plans of the kind were available in the American Expedi-
tionary Forces. As a result, hasty drawings of a contemplated one
were prepared in this office, approved by the chief quartermaster and
commanding general, Services of Supply, and submitted to the
Engineer Department for construction.
In planning this building the following departments were decided
upon as being absolutely necessary; department for —
1. The general inspection of all clothing and equipment for the purpose of list-
ing such articles that would be required, the substitution of clean clothing and
equipment for condemned articles.
2. The checking and compiling of all individual personal records.
3. The delousing of all clothing and equipment retained after passing the
general inspection.
4. The venereal inspection.
5. Bathing.
6. Complete medical examination.
7. The reissuing of such articles of clothing as required.
8. Shaving of the hairy parts of the body when necessary.
9. Final dressing.
I. DESCRIPTIOX OF BATHING AXD DELOUSING PLANTS.
The approved bathing and delousing plants were 175 feet long,
85 feet wide, and consist of a main building with two projecting
wings. The main building was 85 feet long, 55 feet wide, and con-
tains the bathing, medical examination, and clean clothing depart-
ments. The wings are 125 feet long by 38 feet wide running parallel
to each other with an interval of 20 feet between. Each wing was
divided into 10 compartments and lettered from A to J with seats
arranged on either side of the compartments for the accommodation
of 16 men. Along the outer side of each wing and connecting with
each compartment was a passageway 5 feet wide. On the floor of
the compartments and extending through the disinfecting chambers
were Decauville tracks for the transporting of movable racks. The
racks were 7 feet long and 3 feet wide, divided into sections with
hooks for hanging clothing, and numbered according to the seats.
J. HOT-AIR DISINFECTING CHAMBERS.
The hot-air disinfecting chambers were constructed in the open
space between the wings 120 feet long by 15 feet wide and 7 feet high,
cement floored, refrigerator walls with cinder packing above. They
were lined on the outer and inner sides w'ith corrugated iron, making
them fireproof. Double doors each 3| feet Avide were placed on both
ends opposite eacli compartment for the entrance and exit of movable
racks. These chambers, three in number, were numbered respectively
1. 2, and 3. The inside dimensions of Xos. 1 and 3 being 37 feet long,
13 feet wide, and 7 feet high ; No. 2 is 45 feet long, 13 feet wide and
7 feet high : Nos, 1 and 3 containing 3,367 cubic feet and No. 2, 4.459
cubic feet ; chamber No. 1 accommodated the racks from compart-
ment A, B. and C ; No. 2, D. E. F, and G ; and No. 3, H, I, and J.
1408 REPORT OF THE SURGEON GEXERAL OF THE ARMY.
K. GASOLINE IIEATIXG,
Prior to iiiptallation of the steam pipes in the hot-air chambers
four rrasoline heaters of five burners each Avere installed. These
heaters were located in cement pits below the level of the floor. This
method of heating the chambers was not entirely successful, but was
installed merelv as an emergency, pending a better plan. The prin-
cipal criticism to this method being (1) danger from live fire, (2) the
air being a combustion product and low in oxygen had a tendency to
leave the material fumigated with an obnoxious odor, (3) the danger
conneaed with overheating the oven.
In view of the fact that large 125-horsepower boilers were later in-
stalled in connection with the plants for the purpose of heating the
water for bathing, the heat from these boilers was also used to heat
the disinfesting chambers.
Tlie original plan was to use the heat in addition to that produced
by the gasoline torches, but after the conducting pipes were installed
it became evident that this plan alone furnished the necessary heat;
as a result, the gasoline burners were discontinued and held as a
reserve method in case of emergency.
In order to convey the proper amount of steam heat into each
chamber to give the required temperature necessitated the installa-
tion of the following:
In chambers Xos. 1 and 8, three heaters were installed each con-
sisting of 64 lengths of 1-inch pipe 13 inches long, arranged with 180°
return bends. 8 pipes in a titr and 8 tiers high. The total being a
radiating surface of 277 square feet or the three heaters in the oven
having a total surface of 831 square feet. It was found at the
Bordeaux plant that this style of heating radiated approximately
200 B. T. W. S. per square foot of sui-face at a steam pressure of 120
pounds per hour, and at this rate the surface was sufficient to main-
tain a constant temperature of 106° C. in the chambers.
In chamber Xo. 2, four heaters of similar construction were in-
stalled.
To overcome the irregularity in temperatures in the chambers, the
air was kept circulating by means of electric fans. Prior to this it
was noted the difference between floor and ceiling temperatures was
nearly 40°.
L. PLAN OF OPERATION.
When the plant is in operation 180 men report at a time; they are
divided into platoons of 18 men each, each platoon being placed in
charg." of a noncommissioned officer who is a compartment chief.
The men are instructed by the compartment chief to proceed to a
certain stall designated by a capital letter and to a certain numbered
seat. At the same time the man's clothing slip is marked with the
letter of the stall and the number of the seat assigned him. The
men are then called to " attention " and quietlv but emphatically
instructed as follows :
Place your shelter half in three folds on the tloor. Take everything out
of your barrack's bag. Put all handkerchiefs, lefigins (bunched), caps, socks,
small articles, etc., together (pile No. 1). Put all ordnance, extra shoes,
souvenirs, such as shells, gas masks, etc., in pile No. 2. Turn all clothing
inside out and arrange so that it can be easily hung up. Underwear and socks
that are being worn will be retained and salvaged and shoes will be worn.
A. E. F.— AMBULAK^CE SERVICE. 1409
When rack is to be loaded the compartment chief directs that each
man with one movement place the contents of pile No. 1 on top of
the rack taking care to spread everything out so that the heat will
have maximum effect and contents of pile Xo. 2 transferred to the
floor of the rack.
The wearing apparel is hung up on the hooks, care being taken
that articles are not crowded together so that the free circulation of
air will be prevented.
M. BATHROOM.
Those found free from venereal disease in the first instance, pass
immediately into the bathroom and are required to thoroughly soap
their head and hairy parts and scrub themselves vigorously. Towels
are provided which after having been used are discarded through a
port hole in the wall. These towels are gathered up promptly and
laundered in portable laundries of the French type which are oper-
ated near-by. After a thorough disinfestation these towels are re-
turned to the towel room for further service.
X. MEDICAL EXAMINATION ROOM.
After the bath the men dry themselves and ])ass in single file in
front of a line of medical officers, each a specialist, where careful and
complete examination of the throat, lungs, heart, skin, etc.. are made.
Those found suffering from any serious disease are sent to the hos-
pital for further examination, classification, and treatment. In the
medical examination careful inspection for vermin is made and those
found infested are shaved and treated and required to again thor-
oughly bathe and report back for reexamination. Those having
skin diseases or any special interesting pathological condition are
photographed.
II. UNITED STATES ARMY AMBULANCE SERVICE WITH THE
FRENCH ARMY.
The Sanitary Squad Unit Sections.
It is banal to say that the war which has just closed has had the
character of an industrial and commercial battle, sustained on one
side by enormous amounts of money and machinery, on the other by
the plan and organization of a nation determined to win, never mind
under what conditions or strain. Modern warfare has been an ex-
ample of one great modern invention : Speed. In America, in France,
in Germany, and in England, rapid transit is used to such a ^reat ex-
tent that, except for the poor and overworked, the vast majority of
pojndations are moving awa}' from the centers.
At the front, just back of the line, the one admonition which ap-
peared on every side was : " Move this stuff up quicker I " Just as in
the Medical Department. " Get those men back as soon as possible! "
The Sanitary Squad Unit sections, as they are known in France,
both to American and French troops, were planned for speed. The
very inception of the service fi'om the earlier days, when it was a
volunteer service, until the thue that it had come out as a regidar
g
1410 REPORT OF THE SURGEON GENERAL OF THE ARMY.
branch of the Army, has been that of rapid mobility and highly or-
ganized evacuations. During the Battle of the Argonne one sec-
tion commander planned an evacuation through a town constantly
shelled, in which it was felt that no transport could live for an hour.
His argument was that they did not have to live an hour; that he
would get the wounded out so quickly that there would be no danger
either to the wounded men or to the drivers. The fact that this was
accomplished with only two men being wounded and with the result
that many others were saved shows to what extent the evacuation
was perfected.
2. The Efficiency of Training.
The United States Army ambulance service, planned as it is both
for open warfare as well as trench warfare, owes most of its efficiency
to its training. How this was gone about; how these men were taken
from civilian life and made soldiers and efficient conducteurs; how
the officers were made and trained ; how headquarters was organized ;
the general work of the service, etc., is the story which this report
will unfold. It has been checked up until the work represents the
truth of the service as it has existed. It represents its accomplish-
ments ; its deeds of daring ; and with a natural sense of pride, the re-
wards that have come to it from time to time.
In reading this report one must remember, however, that it is pre-
ared in France, during the actual occupation of German territory
jy American troops and before a final stabilization has occurrecl.
The remarks made herein, the observations on the technical construc-
tion of the transportation and the general organization, has to do
with the fighting in France, on the western front, where the United
States Army ambulance service has performed its duty since the
early part of 1917. In Italy, or in Russia, or even closer to the
United States, in Mexico, the same observations about the use of
transportation would naturally not avail.
The general organization of the service can be taken as a model.
It has been founded upon the practical experience of several years,
both of actual management of ambulance companies under the most
difficult situations and the pooling of the experience gained in the
present war. Up until the last moment, the chief of service was de-
sirous of keeping the organization in the flux, remedying the defects
when found and applying new methods when pointed out, so at the
signing of the armistice, this service had become an organization
which implies the byword of efficiency, particularly among those
divisions with which the sanitary squad unit sections have served.
These articles have been prepared for the nontechnician, but at the
same time they are prepared with all of the carefulness in checking
up on results of documents which are to become records. They are
records, written in a way that the average reader will be able to un-
derstand, and at the same time, it is hoped, enjoy.
How this service started, how the idea came and to whom we owe
the incentive, is the story of the beginning of the service. The vol-
unteer ambulance service, prior to its being taken over by the United
States Army ambulance service, very rightly deserved the publicity
it received up until our declaration of war against Germany. It
represented a spirit of the American public, which was afterwards
A. E. F. — AMBULANCE SEKVICE. 1411
justified. It has not been the purpose of the United States Army
ambulance service to subdue in any way this spirit. It has to the
contrary taken advantage of the " esprit de corps " inherited, to
effect a central, well-organized service, which could never have been
done without the cooperation of each and every member. The earlier
days, however, were by no means easy going : they were days of con-
fusion and misunderstanding, which were only conquered after much
tact and deliberation.
3. Field Service and Red Cross Organizations.
Before the United States declared war against Germany, there
existed in France several American volunteer units serving with the
French Army. Among these units, all of which were afterwards
taken over by the United States Government, were the American
field service, the Lafayette esquadrille, and the American Eed Cross
ambulance service. It was from the reorganization of the American
field service and the Eed Cross ambulance service that a certain por-
tion of the United States Army ambulance service sections were
formed.
The organization of headquarters, to manage and prepare for the
arrival of sections trained in Allentown, had to take into consider-
ation the inexperience of many of the sections actually serving in
the field. Thus one finds numerous simplifications of army paper
work, which have been done after careful experimentation. Head-
<|uarters became used to adapting itself, retaining many of the direct
principles of business administration of the field service, and at the
same time organizing along lines that would best be understood by
the amateur soldier, a system of reporting and instruction by head-
quarters circulars that is a model of adaptation and cooperation.
In all of this work, the assistance of officers who had been con-
I nected with the volunteer service was of immense value.
I By degrees the service developed from a conglomeration of ill-
r organized and poorly liaisoned sections to a smooth, highly organ-
ized machine. But the earlier months are remembered as months
i of controversy and confusions. Just as the American Expeditionary
Forces had to build up its organization from nothing, the ITnited
States Army ambulance service had likewise to construct all the
machinery necessary for the running of its organization.
One remark must be made, however, about the discipline of the
volunteer sections. At no time did they bother the chief of service
* with lack of discipline. A great many of these sections were not
complete. Due to the fact that the recruiting of the service was done
on a purely volunteer plan, many of the individual members wish-
ing to return to the States refused to join. Those that did enlist,
however, in every way supported the new order of things. The ac-
complishment is remarkable in the swiftness of its execution.
The officers of the service at AllentoAvn were for the most part
medical men. Some time after the passing of the bill establishing
the ambulance service, officers were raised from the ranks. In this
way a considerable number of the field service and the Red Cross men
received commissions. These men were judged from the experience
in the field and their general fitness as officers. Most of them had
graduated from the center instruction automobile at Meaux, which
142367— 19— VOL 2 28
1412 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
is discussed elsewhere, or had had special instruction from some mili-
tary school or camp in the United States. They have in every way
justified their appointment.
Looking back to the earlier days, when confusion caused by the
establishment in a matter of nine months of an immense army, the
taking over of the field service and Red Cross organizations went
reasonably well. In some few cases trouble arose, due more to a
misunderstandinof of military conditions than to any unwillingness
on the part of the men concerned. The field service and the Red
Cross furnished the nucleus for 25 sections, which were recruited
up to full strength from Allentown men. All automobile equipment
and organization material was likewise turned over.
4, Type or Service.
The sections undergo an extreme danger, as they evacuate over
roads constantly under shell fire and at night, sometimes within a
few hundred yards of the front line trenches or, if in open warfare,
the actual line. From the very beginning men who are to become
drivers are trained for this highly specialized work. Each man is
given an opportunity to develop initiative and resource, and the offi-
cer is instructed to keep his men constantly employed in the rear
areas, learning new ways to perform this work. Several unique
and highly satisfactory methods of evacuation have been developed
from this system.
The fact that the duties of this service are always with combatant
troops must be remembered in reading over this report. Adaptation
and cooperation were everywhere the keynote, as typified generally
by the American Army in France. The chief of service kept in mind
the spirit that prompted Gen. Pershing to offer his army to the
French during the German attack in the spring of 1918. The service
gained a reputation among the French that was not slow to spread
universally in France. To ask a favor on the part of the United
States Armj' ambulance service was to have it immediatel}' accorded.
This cooperation from the French made the task, at times gigantic in
its problems, one comparatively easy to solve. Briefly, the United
States Army ambulance service is a development of an experience in
the ambulance service of the American and French Armies. The
best of both services have been taken, and just how this has been gone
about and just to what extent it has succeeded is the essence of this
report.
The service performed by the section serving with the French
Arm}' is very definite in its work and organization. In the advanced
zone one section is assigned to each division of 10,000 fighting men.
This section remains with the division while in line and goes with it
when it c omes out on repose. In no case is it detached, as was often
done in the American Army, but, if applied for through the proper
channels, could be loaned for an engagement to another division.
The decision as to the disposition of the section remained in all cases
with the director service automobile, who consulted the use to which
it was to be put and whether it was fitted to go into another action.
5. French Evacuation and Aivierican.
The difference between the French organization of evacuation and
that of the American Army lies in the divorcing of the litter-bearing
A. E. F. — AMBULANCE SERVICE. 1413
and medical department from the transportation department. The
evacuation of Ayounded with the French is a transportation problem
and not a medical one. To this whole end the organization of the
medical department of a French division is plannecl.
The litter bearers or branchardiers carry the patient from the place
of injury to the poste de secours, generally by means of a wheel
litter, though oftentimes only the plain hand litter is used. They
take the most concealed route, through boyaus or trenches, during a
lull in the firing, or after night has fallen. There are four litter
bearers to each company, four companies to a battalion, and three
battalions to a regiment. The band also functions during an action
in this capacity. In so far as this is carried out in increased num-
bers in the American divisions, the organizations are practically the
same. But in adclition to these litter bearers, a French division lias a
group branchardier divisionnaire.
6. DmsiON Litter Bearers.
The G. B. D. of a division in the French Army is the sum of all
the branchardiers of the division who are not attached to some defi-
nite organization. They would resemble an organization in the
American Army made up of all the litter bearers of the ambulance
companies, as the G. B. D, is a division organization, just as the
ambulance company, being attached to the sanitary train, is likewise
divisional in its relations. The G. B. D. number at least a hundred,
and sometimes many more, depending upon the service to be ren-
dered. They are under the immediate command during an action of
the chief medical officer of the division — le medecin divisionnaire.
They are organized with administrative officers, who receive their in-
structions from the divisionnaire. These soldiers, when not empoyed
as litter bearers, are attached to general headquarters of the division
and jDerform such duties as making coffins, crosses for graves, repair-
ing helmets, gas masks, stretchers, etc. They are generally, in the
French Army, older men and are not, as American litter bearers, en-
listed in the Medical Corps, though during an action they wear the
brassard of the medical department.
7. The G. B. D. in Action.
During an action, or immediately following an advance, the bran-
chardiers of the G. B. D., supplied with wheel litters, sweep the fields
for wounded. A poste cle secours having been established, the
wounded are brought to this central place, generall}^ situated on a
road and easily accessible to ambulances, from whence they are taken
liy the ambulance section to a hospital. The work, because it is con-
centrated and under the immediate supervision of officers of the line,
is done quickly and is esjjecially valuable during heavy fighting,
where the number of wounded far outnumber the means put at the
disposition of the medical department. Every man trained at
bandaging is needed for that work. The actual conveying can be
left to others. However, if the front is not an active one and only a
few casualties occur during the day, the regimental litter bearers do
the actual work and the ambulance section functions with only a part
of its personnel.
1414 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The (t. B. D. innnediately upon completing its duty returns to
camp. The actual organization is similar to that of an Infantry
company and is at all times uiobile and independent, having its own
transportation and its own method of supply.
8. British Army Evacuatiox.
The British Army has organized its medical department and evac-
uation on the same plan as that of the American Expeditionary
Forces. It differs from the French in that the sorting stations and
ambulance companies are not independent units, but depend pri-
marily upon the sanitary train for transportation and supply. The
transportation of wounded by ambulance convoy has been highly
developed by them. Sections of this service have been attached at
diti'erent times to English and Scottish divisions. The adaptation
of the section was such that no embarrassment occurred, though on
one occasion the section was assigned to serve a Scottish division
only a few hours before it was to attack.
In the ideal, the section has been planned to be used by any fighting
troops. It is so organized that a number of additional men can be
detached as guides, which means rapid education, in road conditions
and unusual terrain of new sectors. The protection that is furnished
by observation is an adaptation from the British Army, and has
been developed to such an extent that, though constantly driving
under fire and over roads directly in sight of the enemy, compara-
tively few casualties to the drivers have occurred.
9. The United States Army Ambulance Service in the Battle
OF THE ArGONNE.
Introduction. — In the Battle of the Argonne, beginning on Sep-
tember 2G, there were nine American divisions in line between
Yienne-le-Chateau and Verdun. Attached to these nine divisions
were as many as 15 sections of the United States Army ambulance
service serving in different capacities. These sections were out of
their normal position and unaccustomed to the conditions which
existed in the American Army, but nevertheless proved of excellent
efficiency value. The terrain over which they were working was for
the most part familiar territory. In the Argonne, along the Cotes
de Meuse, they had worked Avith French divisions for the past year.
The officers were all experienced men both in the evacuation of
wounded and in making reconnaissance.
A study of the movements of these sections following the days of
the beginning of the Battle of the Argonne with the specific example
of one section will give in a general way the functioning of a section
during the days of attack. How they moved up, how they were sup-
plied, and how they kept in liaison is a story which the foregoing
chapters have attempted to unfold in a nontechnical manner. The
emergencies met, the intense fighting and bombardment through
which the armies passed will show to what extent the service was
of value to the American Army. This plan is taken instead of
sketching the action of this service in a French attack, because it is
felt that the terrain, as well as the action, will be more familiar to
the reader.
A. E. F. AMBULANCE SERVICE. 1415
- Preparation. — As early as September 1, before the actual Argonne
offensive had probably been planned, the pare at Bar-le-Duc had
been warned that something probably " would happen." The com-
mander of the pare, immediately scenting an attack, either by the
French, or by the Americans, who were coming into his army in
ever increasing numbers, got out his maps and marked off the bounds
of his actual sector for the purpose of estimating the number of
sections to prepare for in case the emergency actually arose. His
estimate was made for 30 sections attached to divisions with a defi-
nite attack program. The motor supply depot in Paris was notified
that spare parts to accommodate 30 sections were needed and should
be forwarcled at once. This was done between September 1 and
September 20. The American Army during this time had ap-
proached the chief of service through the chief surgeon requesting
that a number of sections of this service be loaned to the American
Army for work with its divisions. These were accordingly assigned
to divisions and corps and a notification of this departure sent to
All pare commanders. The pare commander at Bar-le-Duc, through
whom liaison with the American Army was conducted by special
orders from the chief of service, was acquainted with the conditions
actuallj^ existing at the front. The arrival in his army of a number
of sections of this service attached to American troops warned him
of the approaching attack b}^ Americans. By this time he was in
a position to meet the full demands of sections attached both to the
American Army and if necessary to the Fourth French Army to the
left of the American sector.
The attacl'. — A section of this service was attached to the 35th
Division on the 25th of September, the day before the attack oc-
curred. This section, thoroughly equipped with litters and blan-
kets, reported for duty at 5 o'clock the afternoon before the attack
and was at the front at Neuvilly at 4.30 the next morning, an hour
before the actual attack began. The barrage had started and every
precaution was made for the evacuation of large numbers of wounded
in view of the difficult ground over which the 35th Division had
to pass. The main road between Neuvilly and Varennes had been
closed to traffic until it was repaired by the engineers. This neces-
sitated the use of byroads over which only Fords equipped with
chains could pass.
By 6 o'clock in the afternoon of September 26 the 35th Division
had passed by Varennes and Cheppy and held a line just back of
Charpentry. Wounded in great numbers lay between Varennes,
Cheppy, and Charpentry, which fell as part of the task of this sec-
tion to evacuate. An ambulance company equipped with G. M. C.'s
was also a part of the sanitary train of this division. Through
a natural adaptation the plan for evacuation had been arranged for
the Fords in the forward area and the G. M. C.'s in the rear. It
was not, however, until two days later that the G. M. C. ambulance
section was able to pass over the road between Xeuvilly and Varennes.
The Ford cars, however, being light and requiring little road space,
were easily pushed around the crater existing between Bourailles
and Neuvilly and began functioning between Varennes, Cheppy,
and Very in the late afternoon of the 26th, making an average
evacuation of 1,500 cases daily.
1416 EEPOET OF THE SURGEON GENER.'UL. OF THE ARMY.
The in()rnin<^ of September 27 the division again attacked, sweep-
ing by Chiupentry just to the rear of the heights of Baulny. Here,
ho'\vever, desperate resistance was met and the line stopped until
the next morning. Numerous wounded were found between Baulny
and Charpentry, where the Ford cars ran almost into the line held
by American troops.
The divhion relieved. — On the 28th the division again attacked,
this time taking Baulnj' and going forward nearly a kilometer and a
half to the hills to the right of Exermont. The flank, however, held
by the 2Sth Division and the 77th, was slightly exposed to cross-fire,
alid considerable difficulty was encountered on the roads because of
direct observntion from the Argonne heights. The section con-
tinued, however, to evacuate over these roads to the triage which had
been moved from Neuville to Cheppy and in spite of the confused
situation to make a high percentage of evacuations. The G. M. C's.
attached to the ambulance company of the division were used to
evacuate from Cheppy back to Xeuville because of their greater
capacity. The line of the 3oth Division remained stationary from
September 28 to September 30, when the division was relieved by the
1st American Division. The section was then detached from the 35th
Division and attached to the 1st, with a definite forward evacuation
progress.
The 1st Division remained from October 1 to October 4 on the line
taken over from the 35th. During this time the division was sub-
jected to a continuous gas bombarclment which caused a great many
casualties among its regiments. On October 4 it was ordered to
attack in the early morning and succeeded in taking Fleville and
passing through the woods north of Exermont, where it encountered
a great many machine-gun nests, particularly on hill 369. The
evacuation of this sector was extremely difficult, due to the fact that
Exermont was under continuous bombardment until the division
was relieved on October 11. More than at any other time the ability
of the United States Army ambulance service section showed itself,
especially in its cooperation Avith the ambulance companies in the
1st Division. The daily evacuations made directly from regimental
aid stations to dressing stations averaged 600. To the right of Ex-
ermont a dee]i ravine interfered with the direct evacuation along
the road from Exermont to the main road, and it was only through
the sending of Ford ambulances over paths used by ration carts that
this portion of the sector was successfully evacuated. It had rained
and the ground was unusually slippery, but the Fords succeeded in
making this trip continuously and without the use of chains. The
continual bombardment which kept on from day to day, consider-
ably strained the nerves of the drivers who from early morning until
late at night, and sometimes all through the night, were continually
on duty.
The 1st Division made another attack on October 9, and then each
morning through a series of attacks cleared foot by foot the woods
north of Exermont. taking Sommerance and advancing to within
half a kilometer of St. Georges. Here it stopped and was relieved
by the 42d Division, the section going out of action with the division.
Thus for 16 days the United States Army ambulance service section
had served continually under fire and over roads encumbered by
A. E. F. AMBULANCE SERVICE. 1417
massed traffic, evacuating over 8,000 wounded. During this time
constant liaison with the pare at Bar-le-duc was maintained in spite
of the fact that the roads had been blocked for miles and miles be-
hind Neuyille for days. Spare parts, extra cars to replace those
destroyed in action, and materials were furnished through the supply
system of the service and the section had a continuous mail service
throughout the whole action, reports being made to headquarters
regularly.
The second and last fixates. — After being relieved, the section,
still attached to the 1st Division, was ordered to the echelon at
Nancy where it was completely repaired and readv for action within
a week. The first phase of the battle of the Argonne by this time
had boen completed and the 1st Division, to wliich the section was
attached permanently, was not ordered to dutv again until October
28, when it moved up by the same roads over which it had advanced
before to Epinonville, where it backed up the S9th Division, which
attacked on the 1st of November, in liaison witli the rest of the First
Army. The advance now became extremely rapid, several kilo-
meters being taken each day. By November 5 the division was at
Sommauthe and was ordered to attack through the woods in the di-
rection of Beaumont, a town guarded by heavy entrenchments.
However, before this could be accomplished the 2d Division had
taken Beaumont and had reached the Meuse at this point. On the
6th the 1st Division was ordered to attack at Yonck. to seize a cross-
ing at Mouzon. and to hold the line of the river. This was accom-
plished with exceedingly small losses.
On November 6 the division attacked at 5.30 in the morning.
Yonck was occupied at 7 30 and by 11.45 the heights overlooking the
Meuse were reached. The casualties were extremely light, but the
difficulty of evacuating those that did occur was exceedingly gi"eat
owing to an almost impassable barrier of mud. The guns barely got
through with the assistance of large tractors. The United States
Army ambulance service section, consisting entirely of Fords, was
alone able to reach the road between Beaumont and Stonne before
the attack. The cantonment of the section was at Beaumont, and
the cars ran between Yonck, JSIouzon. and Autreville, evacuating
back as far as Sommauthe in spite of the impassable roads, assisted
in the worst places by gun tractors specially put there for that pur-
pose.
The 1st Division, after an advance of approximately 8 kilometers
against machine-gun and scattering artillery fire, which came from
the front and heights east of the INIeuse, left Mouzon at 11.45. About
2 p. m, on November 6 the division was ordered to march at once on
Sedan with a mission of attacking and seizing the city by verbal
orders of the commanding general of the 5th Army Corps. This
attack was to be made in five columns each by a different road, but
all converging at Saelin. The mission of the United States Army
ambulance service section attached to the division was to keep in
liaison with these five moving columns and at the same time evacu-
ate any wounded they might happen to find to the back area. It
was practically impossible for so small a unit to fulfill the needs
required of it, but tlie section proceeded to perform the orders given
it, leaving Beaumont early in the morning of the 7th with the pur-
pose of proceeding by the main route to Sedan. Wounded were en-
1418 REPORT OF THE SURGEON GENEEiVL OF THE ARMY.
countered and evacuated. Before the section had penetrated tx) any
^reat distance an order countermanding the march to Sedan re-
turned the section to its base, which ^Yas then east of Chickadee, on
the road from Beaumont to Stonne. It remained here from Novem-
ber 7 until the 11th. when the armistice was signed, assisting in the
evacuation of the 2d Division.
Sectmns^ service. — During the time while this section was pro-
gressing with the 35th and 1st Divisions the other sections of the
service in the Battle of the Argonne were also functioning equally
as successfully, often passing each other or being on the same runs.
It was the duty of the pare commander to maintain liaison with all
of these sections, to furnish them with spare parts, to make adjust-
ments in personnel, and to see that the sections functioned properly.
This was accomplished only by continual visits to the front, which
meant hours away from the actual operations of his pare and more
or less slowing up of the process of furnishing supplies, because of
the extreme advances made by most of the divisions to which the
sections were attached. An additional Ford echelon was established
at Verrennes in order to furnish gasoline, tires, tubes, and spare
parts to sections serving in this stock.
Meanwhile a great many of the drivers of these sections were
wounded or gassed and had been evacuated to rear areas, from where
they were forwarded to Red Cross Hospital Nos. 1 and 2 in Paris,
there coming under the immediate care of the attending surgeon of
this service. After becoming convalescent they were forwarded to
base camp, where they were completely outfitted again. From here
they were sent either back to their own section or to another section
as replacements, passing through the Paris headquarters. Inspectoi-s
of the service inspected practically every section in the Argonne
drive while the fight was in progress, making reports to the chief of
service upon the success of the service in this new field. Simulta-
neous with this attack sections were in service with French divisions
attacking in other parts of the front, especially in the Fourth Army,
which was attacking to the left of the First American Army. In
no case has a report been made of any of these sections failing to
efficiently evacuate wounded. With the signing of the armistice
practically every section of the United States Army ambulance serv-
ice found itself within sound of the guns.
The march to Germany. — Then came the march from the old front
across Belgium, Luxemburg, Alsace, and Lorraine to the Rhine, with
its continuous daily moves. This advance was very similar to that
of open warfare, and in no case was a complaint made by a division
of the failure of a section to adequately take care of its evacuation
during this period of advance. The iS sections serving with the
American Army had been relieved the week following the signing
of the armistice and were assigned to French divisions that same
week and proceeded to the Rhine attached to these organizations.
The efficacy of the evacuation made by these sections under the un-
usual strain of continuous advance showed the value of both the
personnel and material as well as the organization back of them.
The experience of advancing with an army making rapid attacks
subjects all roads immediately behind the army to an immense en-
cumberment of material and impediments. It" was not only at the
front that difficulty was experienced in keeping in touch with the
A. E. F. — AMBULANCE SERVICE. 1419
supply units of fighting forces; the rear areas were just as difficult
to supply and maintain as the forward ones. Special arrangements
had to be made to supply pares as well as sections advancing with
the general forward movement of the armies on the western fi-ont.
The casualties of the service continued to be high as long as the
Germans were not actually on the run due to the fact that in all
advances the back areas are continually bombed and the roads
shelled. The section serving with the 35th and 1st Divisions had as
many as 11 casualties out of 45 men, and this in spite of the fact
that all precautions were taken to prevent men from running into
either gas or shell fire without warning. The Germans used in this
attack great numbers of gas shells which necessitated the putting
on of masks by drivers.
The average trip of the ambulance driver is not as casual as it
may seem. He starts out from his cantonment with general direc-
tions as to how to reach a spot where wounded are collected. It is
dark, the roads are encumbered with moving artillery and munition
caissons, all without lights and with the constant habit of pulling
up on the wrong side of the road. He must drive through this
swiftly without endangering either himself or the animals drawing
the guns. He reaches the danger zone where the sharp flashes of
the guns nearly blind him and the continuous roar makes it impos-
sible for him to hear the traffic in front of him. He must go as
swiftly as possible under the conditions. He runs through a town
filled with the smoke and gas of exploded shells and stops at a little
outpost where a few huddled men begin slowly to load his car with
wounded. Perhaps a gas shell has fallen and it is necessary for him
to put on his gas mask. This prevents him from seeing 10 feet in
front of him and he must feel his way slowly on with the cries of
the wounded constantly in his ears and a constant reminder in the
shape of shells tliat there is danger ahead. He gets back to the hos-
pital with his back aching and his eyes bloodshot with the strain,
and then has to do it all over again. It is this idea of going by one-
self, in overcoming all obstacles in reaching the destination where
tlie wounded are collected that requires trained men for the job.
The ambulance service is a service of individuals which owes to its
e-'^prit de corps^ its success, its organization, its rewards.
10. Recommendations for the AMBtrLANCE Service of the Ameri-
can Expeditionary Forces.
The experience gained in the use of automobile transportation
of evacuation of wounded led the chief of service in August, 1918, to
make certain recommendations through the chief surgeon to the
Commander in Chief for changing the ambulance service of the
.\inerican Expeditionary Forces. These recommendations were not
made with the view of bringing under this service the entire evacua-
tion of the American Expeditionary Forces, but merely as an adapta-
tion, during a period of emergency, of the United States Army
Ambulance Service to fill a gap in the transportation of the
wounded of the American Expeditionary Forces. They were as
follows:
The ambulance service provided for in the manual of the ISIedical
Department and the recent changes in the tables of organization do
1420 REPORT OF THE SURGEON GENERAL OF THE ARMY.
not meet the needs for the evacuation of wounded and sick under
the conditions prevailing in France. The following changes are
suggested. These changes may be temporarily made, and if they
prove more eifeotive than our system the necessary steps can be
taken to incorporate them as regulations. It might be well to try
this plan as an experiment with one complete division which has
used the materials provided for by our table of organization, in
order to get an unbiased comparison as to the results of the two
methods.
The system of evacuation used in the French Army has been tested
by four years' experience and is satisfactory. In order to obviate
the creation of an entirely new system, or to apply our untried sys-
tem to the new conditions confronting us at this time, it is urgently
recommended that the ambulance forces and material pertaining to
the American Expeditionary Forces be transformed as nearly as
possible upon the model now being used by the United States Army
ambulance service with the French Army, certainly for front-line
work, reducing the personnel of each motor ambulance unit to 1
officer and 45 men, and distributing the excess personnel thereby
gained in part among the regiments to augment the number of
bearers and in part to reinforce the field and evacuation hospitals,
keeping the remainder at some central point, outlined below as a
reserve of litter bearers and medical auxiliaries to be used in any
part of the line. The medical officers gained by the above change
to be returned to the American Expeclitionary Forces for profes-
sional work ; the replacing officer to be chosen from noncommissioned
officers who have seen a year or more of service at the front in this
work, and who have graduated from the automobile officers training
school of the French service, and who have a good knowledge of
French. If this change is deemed too radical such officers as the
chief surgeon may direct may be left with the ambulance service in
such capacities as the occasion may warrant.
To each division will be assigned three sections of Ford cars, 1
officer and 45 men and 20 cars (duplicate of the sections of this
service) to the section; and an additional section of 20 cars of the
larger type now used in the American service for evacuation farther
back, the whole to form part of the sanitary train. Under the new
arrangements there exists now a commander of trains with the rank
of lieutenant colonel, who will supervise the entire train, both field
hospitals and ambulances are immediately under command. That
part of the train pertaining to the ambulances under the director of
ambulances is only considered in this tentative scheme. There should
be two officers under the director of ambulances, one in charge of all
motor transportation with the rank of captain in the ambulance
service, the other a medical officer in charge of the divisional stretcher
bearers. The divisional reserve of stretcher bearers should be kept
at some central point available for call, undergoing such instruction
and performing such routine as may be required.
The present system of the French in regard to the relation of the
division surgeon and the ambulance service is followed in the pro-
posed scheme; that is, the division surgeon through his assistant to
control the location of ambulance posts, to control the number of
cars to operate said post, to control the roads over which said posts
are to be reached and the wounded to be evacuated, to control the
A. E. F.; — AMBULANCE SERVICE. 1421
destination of the wounded in his zone, to be responsible through
his subordinates for tlie billetino; of the units assigned to his forces,
to insure at all times a thorough linking of all the units with his
commander of trains, in order that he may be kept posted at all times
as to the availability of his transportation.
The supply and maintenance to be similar to that in vogue with
the United States Army ambulance service with the French Armv,
except that the pares for the repair of the larger cars will be Ameri-
can Army pares operated by the Motor Transport Service. Repair
pares for the United States Army ambulance service for the Fords
are already installed in each of the French armies, being organized
to serve the sections of all divisions of an army. The 20 large
G. M. C. ambulances will of necessity depend upon American Army
pares for repairs and ambulances, but the pares might be located
at the same point. These cars are for evacuation farther back and
the proportions should be 20 for each division with a reasonable
number for replacement.
The director of ambulances will be in a position to execute such
orders as may be transmitted from the chief surgeon through the
commander of trains. According to the schematic plan herewith
illustrated, the director of ambulances will ha^-e under his charge
three Ford ambulance sections and one section of heavier ambulanc^es
and, in addition, a group of litter bearers, who may be used in any
capacity that the chief surgeon sees fit during such time as their
services are not required for actual stretcher work.
The motor ambulance sections should under ordinary conditions,
remain with and operate for their respective units, as they (sections)
are essentially divisional units. Matters of administration of the
section proper should be left to the section commander. Where his
persoimel and material is assigned indiscriminately, discipline is
seriously interfered with. The matter of using available transpor-
tation not actually employed for evacuation in the army zones, in-
cluding the advance sections of the lines of communication, must be
determined by the commander of trains. The system of evacuation
should be so elastic that there can be no hitch between the front line
trenches and the rail head. It is disastrous to allow the transporta-
tion to stand idle when it should be used to advantage elsewhere,
under certain reasonable restrictions. There are matters of detail
and can very well be worked out when the principle is accepted.
In view of the short hauls on the western front, which ordinarily
are accomplished within an hour and rarely exceed two hours by
motor, it is not believed that the so-called dressing station equip-
ment provided in our Manual of Medical Department is applicable
to the ambulance units for front-line work. This equipment maj'
well be eliminated or placed to better advantage by augmenting
equipment of regiments and field hospitals.
In the light of service experiment within the last year, the chief of
service is firmly convinced that the Ford ambulance as used in this
service is the proper, if not the only car for the front-line work,
to be augmented occasionally by heavier cars provided with seats.
It must be borne in mind that a large percentage of the evacuation
is done by night. This in itself is a strong argument in favor of
the Ford car. as it is light, easy and simple to operate, takes up little
road space, and if broken does not block transportation. The fact
1422 REPORT OF THE SURGEON GENER.VL OF THE ARMY.
mu^it not be lost sight of that any system adapted to the evacuation
of sick and Avoimded must consider the possibility of sudden and
long advances, as Tvell as retreats. There should be always available
in the division certain cars for assisting the regimental surgeon in
case his allotted transportation is not sufficient to move his equip-
ment. Othewise the regimental surgeon may be forced to abandon
his equipment which is A'ital to his proper function.
In regard to the wisdom of using more than one type of machine
in an organization (section), the chief of service firmly believes that
it should not be done. It will inevitabh' result in interminable trouble
and confusion, as the very axis of the automobile service is one of
replacement and spare parts. Using one type in the organization will
also serve to obviate the necessity of having replacement troops versed
in the use of both types. No matter how well a soldier may drive a
Ford car. it will take time for him to acquire a knowledge of driving
and maintaining in good order a gear shift car. This same statement
applies to mechanics, duplicate sets of mechanical tools, spare parts,
maintenance of two different parts, etc. On the spur of the moment
one is likely to be misled with the apparent and alleged advantages
of using two types of cars in one section. These advantages, how-
ever, are upon analysis purely imaginary.
In this connection, the chief of service wishes to state that he is
unalterably opposed to the use of animal transportation for front-
line work. The principal objections are untrained personnel, diffi-
culties in procuring forage, loss of time b}' caring for animals, un-
trained animals, insufficient number of animals, a larger part of
evacuation done at night, heavy and cumbersome type of animal-
drawn ambulances, difficulty in keeping the command together, slow-
ness of operation, and other objections ad infinitum. This opinion
is based upon hard practical experience. The chief of service has
organized, equipped, and operated three animal-drawn ambulance
companies and knows whereof he speaks, besides having a fair knowl-
edge of horses and mules.
The superstructure of motor ambulance built in the United States
for service in France is defective, especially the Ford ambulances
operated by this service, whose superstructure is composed of compo-
sition material, in reality papier mache. ^ATien these are struck by
shells they break like glass, and are very difficult to repair. The same
applies to many of the G. M. C.'s coming from the United States for
service with the American Army, and some measure should be im-
mediately instituted to correct this defect. This service has let a con-
tract which is being delivered now for 600 wooden bodies of a more
durable nature. Another defect which is serious in the American
type of ambidance is that the sides and tops are one layer of canvas.
While this is tolerable in summer, it would be unbearable for winter
work in France. By way of suggestion it may be that this defect
could be remedied by using some metal, if available, or if nothing
better could be found, duplicate and triplicate layers of canvas,
heavily painted, would serve to keep out the rain and wind. It is
noticed that some of these cars coming from America are also pro-
vided with heaters, which depend upon exhaust gases for their heat.
This, as experience has shown, is a dangerous contrivance and should
not be used under anv condition.
A. E. F. — AMBULANCE SERVICE. 1423
To operate successfully aii}^ transportation, whether animal or
motor, it is essential that we have trained men. To turn over to un-
trained and undisciplined soldiers motor transportation is next to
criminal and is inviting disaster. Without exception, every soldier
should have at least six weeks of intensive instruction before he is
allowed to join an ambulance section. If this is necessary in every
branch of the service, it needs no argument in this case.
If the chief surgeon will direct, the experiment as outlined above
ran be put into force at an early date, and if it proves satisfactory'',
this organization can be expanded to any reasonable degree even
evacuating the entire zone des armees and the advance section of the
line of communications. Whatever system is adopted, or tried out,
ample authority is necessary for its successful execution.
It must be borne in mind that a certain amount of motor transpor-
tation is essential to the operation of hospitals. This can be arranged
by as^gning the necessary vehicles and drivers from the general pool
to these hospitals, after consultation with the respective chiefs. The
• control of this feature of ambulance service, however, is not at all
contemplated, but is mentioned as a measure, the importance of which
should not be lost sight of.
II. Demobilization.
Within five months after the signing of the armistice over one-half
of the United States Army ambulance service had been demobilized,
and plans for the complete demobilization perfected. The work of the
sections did not by any means end on November 11, 1918. Many of
the units moved far into Germany, and some crossed the Ehine, with
the French army of occupation. But within a few months, it be-
came possible to call in the sections that had been attached to the
French divisions that did move into Germany, and the sections
in Germany were replaced by the new sections which arrived in
I France late in November. Hence, it w-as so arranged that all the sec-
i tions which had seen war service were assured of a speedy return to
' America. The plans were further worked out with the French so
that the new sections were relieved by French regular army units
later in the spring, allowing even the sections which had come over
after the armistice to return before midsummer.
The plans for demobilization of the service were worked out with
such care that all preparations for transport to America and for
discharge were made within the service itself. The base camp proved
to be ideally fitted for demobilization purposes, and it w^as there
that the sections from the front were prepared for discharge. The
ambulances were turned into the Motor Transport Corps of the
American Expeditionary Forces, which took over all the transporta-
tion of the service.
Sections, cleared of their automobile equipment, arrived at the
base camp with only personal property and section records. Here
the men were put through the "delousing" process and issued stan-
dard Medical Department equipment.
All individual records and section records were straightened out
at the base camp at the same time that the men were being put
through the various stages prescribed for all units previous to em-
1424 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
barkation. When the sections left the camp, they did so with a
" clean bill of health " and with all section funds and records fully
attended to. This efficient care of sections was in a great measure
resi^onsible for the smoothness with which the service's demobiliza-
tion worked out in conjunction with the American Expeditionary
Forces embarkation service. The ambulance contingents left the
base camp all prepared to step on board ship at Brest and hence
avoided all the work and delay encountered b}' other services at the
ports of embarkation.
On January 30, 1919, it was announced that 10 sections would be
sent home in February, and 20 sections each month thereafter until
the whole service had been demobilized. Ten sections left in Febru-
ary, but before the end of March 46 more sections had either gone
through the base camp homeward bound or were ready and awaiting
transportation at Brest. Demol/ilization was speeded up ver}!- largely
because it was seen that the sections at the front ceased as soon as
the French demobilized their temporary divisions and were thus
enabled to handle to a much greater extent all their own evacuation
transportation problems. After the middle of April, no units re-
mained in the field that had seen service at the front previous to the
signing of the armistice. The new sections continuect to serve until
May, and was largely located with the French divisions along the
Rhine. The nature of the work changed after the armistice, sickness
being the one cause for evacuation.
This lessening of the work alloAved, in some cases, the combining of
the work of two divisions for one ambulance section. The withdrawal
from service with the French Army was carefully done and in nO'
case was there an interruption of service throughout the demobiliza-
tion period.
Many of the men who entered the service of the United States
Army in France took advantage of a general order which permitted
them to be discharged in Europe. These men were sent from the base
camp with their completed records to the St. Aignan discharge camp.
,The old volunteer sections all had a limited number of their original
personnel still in the service when they arrived at the base camp
and many of these men desired to stay in Europe. More men in the
United States Army ambulance service were affected by the order
permitting discharge in Europe than was the case in an}^ other unit of
the American Expeditionary Forces.
The first contingent to leave the service en route for America sailed
from Brest on March 15. Ten sections, five of them from the first
Allentown contingent, and five more from the old volunteer service
were included. They were: S. S. U. 501, S. S. U. 509, S. S. U. 546,
S. S. U. 586, S. S. U. 594, S. S. U. 627, S. S. U. 629, S. S. U. 631,
S. S. U 635, and S S. U. 642.
The second returning contingent, composed of the following 10
sections, left Brest only five days later, on March 20: S. S. U. 517,
S. S. U. 523, S. S. U. 539, S. S. U. 551, S. S. U. 558, S. S. U. 592,
S. S. U. 593, S S. U. 628, S. S. U. 630, and S. S. U. 641.
On March 26, a contingent composed of the following 14 sections
left the same port : S. S. U. 504, S. S. U. 510, S. S. U. 512, S. S. U.
525, S. S. U. 552, S. S. U. 553, S. S. U. 625, S. S. U. 626, S. S. U.
632, S. S. U. 633, S. S. U. 634, S. S. U. 636, S. S. U. 638, and S. S. U.
646.
A. E. F. — I]SrSPECTION. 1425
The remainder of the veteran sections sailed in contingents vary-
ing in size from 10 to 22 sections, and were all out of France before
the end of April.
III. GENERAL MEDICAL INSPECTION IN THE AMERICAN EXPE-
DITIONARY FORCES.
Under date of January 31, 1918, the chief surgeon addressed the
following statements to the comander in chief, American Expedi-
tionary Forces :
The question of general medical inspectors has never yet been presented for
C'onsidei-ation because the proper officers were not available for this dutj-. It,
hnwever, must be brought to the commander in chief's attention in a few days,
as suitable officers are now on their way to France to perform this most im-
portant duty. These officers should be general inspectors and should occupy
the same status that the general medical inspectors occupied during mobiliza-
tion on the border in 1916. The same inspectors are functioning under orders
from the War Department in different divisions of the United States at the
present time. These officers I consider most important to the successful meet-
ing of the demands of the American Expeditionary Forces on the chief sur-
geon. While the administration of all sanitary units, except those attached
to combatant troops, rests with the commander in chief, line of communi-
cations, the chief surgeon of the American Expeditionax-y Forces, must have, to
carry out his obligations, general inspectors clothed with proper authority and
under the control of these headquarters who will investigate sanitary conditions,
epidemics, the care of property, hospital administration, conservation of food
and property, and many other important subjects of similar nature.
It is equally necessary that experienced sanitary officers from this office shall
be authorized to inspect in the zone of the division occupying a sector of the
front. In no other way can the chief surgeon know that proper disposition of
sanitary personnel and sanitarj' units have been made and the required med-
ical material provided. It may be considered that this duty should devolve
upon the corps surgeon, but recent information indicates that the corps sur-
geon's sphere of activity does not comprise supervision of the work of the sani-
tary personnel of the division. If, however, the chief surgeon, American Ex-
peditionary Forces, is to be held responsible for the proper care of sick and
wounded in the zone of the advance then it would seem that he should have the
necessary authority to either visit in person or send his representative to ascer-
tain whether or not proper provision has been made for the care of wounded in
advance sanitary formations and their evacuation to line of communications
units.
The chief surgeon feels that the time has arrived when the question of his
responsibility for the care of battle casualties should be defined. There are
troops at the present time at the front holding a sector of the line. The dis-
position of sanitary formations and the arrangements for the care and evacua-
tion of possibly a large nimiber of woiuided appeal's to rest almost entirely with
the division surgeon. Neither the corps surgeon or the chief surgeon, line
of communications, can advise or assist this officer, and the same restriction ap-
parently applies to this office. The chief surgeon is of the opinion that inas-
much as the responsibility for the successful accomplishment of the duty of the
Medical Department rests upon him he must be permitted a close advisory
relation with subordinates.
It is recommended that general medical inspectors whose sphere shall cover
the entire field of Medical Department activities in France be authorized.
These officers should be attached to this office and their duties should not
only include those commonly assigned to medical inspectors but in addition
they should be authorized to advise and cooperate with the division and corps
surgeons in the organization of the means for the care and evacuation of battle
casualties. Therefore they should be experienced and capable officers, familiar
with the latest developments in the highly complex problem of so organizing
a sector that the high standard set by our allies in care and evacuation of
wounded may be realized.
The principle and necessity for general medical inspectors was
accepted.
1426 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Effort was made that the inspection visits should establish liaison
between the chief surgeon's office and the unit inspected. In addi-
tion to the investigation of existing conditions, information from
headquarters, and that gained as the result of experience, was im-
parted and all possible endeavor made to be helpful to the more
or less inexperienced organizations of our newly created Army. De-
fects noted were pointed out, discussed, and as far as possible steps
were taken to have them corrected on the spot. The needs of the
medical officers were ascertained and the inspector attempted to
have them supplied by personal endeavor upon his return to head-
quarters. Defects were reported and those that could not be cor-
rected locally were taken up with higher authority. A full Avritten
report of each inspection was submitted to the chief surgeon that
he might be familiar with conditions.
In the earl}' months of 1918 and while our Army in France was
still small general inspections were made, including base hospitals
divisions at the front, and in billeting areas, and investigation of
unusual prevalence of disease.
In March the chief surgeon's office was moved from Chaumont to
Tours. The American forces soon rapidly expanded to enormous
proportions, the divisions being collected and organized into corps
and armies. The chief surgeon felt that the work of inspection, as
of all other lines, must be decentralized and that the corps and armies
must be held responsible for conditions and results within their own
areas.
The chief surgeon himself visited the armies. The organization
of the means for the care and evacuation of battle casualties was-
handled through the medical representatives upon G~4: of the general
staif. The medical consultants, each in his own specialt}^, super-
vised and inspected along the line of his specialty. Epidemic dis-
eases were investigated by special epidemiologists connected with the
corps or armies or from the central and base laboratories.
It was then considered that the general medical inspector could
be fully occupied with the various services of supply formations,
reporting directly to the chief surgeon's office. These included the
base sections, the increasing number of hospital centers and base
hospitals scattered all over France, the depot and replacement di-
visions. In addition from time to time came complaints from various
sources and directions from higher authority for investigations upon
sanitary subjects.
IV. THE SANITATION OF A FIELD ARMY.
1. Orga>;ization.
A body of troops is a community in which, in addition to or-
ganization for combat, provision must be made for all of the needs
of a civilian community, for supply of food and water, for shelter
and warmth, for refuse disposal, for personal cleanliness and laun-
dry, for care of the sick, and for all of the other innumerable de-
tails that arise where human beings live in crowded places. The
military sanitarian has some advantages over his civilian colleague.
He has his community under more rigid control than the latter, and
the individuals comprising it are young and hardy. Those, how-,
ever, are his only advantages. To effect this, he is confronted with
A. E. F. FIELD SANITATION. 1427
the difficulties that arise from the housing of iiianj^ men in ban^acks,
from the exposure and hard work that form the daily routine of
their lives, and most important of all. from the fact that all of his
arrangements must be made with the clear recognition that there
will be times when all considerations of health must become sub-
ordinate to the purposes for Avhich his community has been formed,
namely, the training for combat and battle.
In training areas and base sections, the problems of military sani-
tation are very similar to those of civilian Avork. In case of an
army occupying a front-line sector, the conditions are modified by
t]ie many factors that active warfare involves. It is these latter
problems that we wish to consider more particularly.
The organization of divisions is based upon the necessity for
mobility. A division is a spear which must be thrust and with-
drawn as military needs indicate. It must be complete in itself and
(jury within its organization the elements of all the parts neces-
sary for independent functioning. Often a gain in mobility in-
volves an inevitable loss of efficiency, and the sanitary organizations
of divisions therefore must necessarily do without many of the
ni langements that are possible only in a permanently organized ter-
ritory with extensive laboratory facilities, bathing and disinfection
apparatus, and all the other devices Avhich are perfectly arranged
only when more or less ]5ermanent o cupation of an area is pos-
sible.
Divisions are gathered in corps, and the corps occupies an area.
But as warfare was developing just before the armistice was signed,
the corps was a tactical unit and its headquarters were changing
almost as frequenth^ as divisional stations. Consequently corps areas
were shifting to meet the ra]iidly changing necessities of strategy.
It is in the field army only in Avhich Ave can. for the present, count
upon the occupation of an area for a reasonably definite period;
long enough, at least, to justify the undertaking of extensive or-
ganization and construction, with relation to territory occupied;
and it is only in the army organization, therefore, in Avhich we can
formulate a system of sanitation based on area, Avhich can so re-
enforce the divisional organizations as to fill in the defects existing
in the latter by reason of their greater mobility.
An Army sanitary organization under conditions of warfare such
as those Avhich, until recently, prevailed in France, should be so
constructed that it combines careful sanitary scrutiny and control,
with sufficient mobility to adapt itself to advances, to the shifting
of flanks, contractions and expansions of the occupied territory.
When the British armies first entered the battle fields of Flanders,
they had sanitary squads or detachments attached to diA'isions just
as Ave had thorn in the old tables of organization. It soon developed
that an army area is a section throughout which a continuous shift-
ing and rearrangement of the composing element must take place.
Divisions moA^e foinvard into the line, remain in position for A'arying
periods, and are AvithdraAvn for replacements and rest. Other divi-
sions move forAvard from reserve positions to take their places. Ar-
tillery changes its emplacements. Supply and ammunition trains,
engineering detachments, and labor troops moAe about wherever
needed.
142367— 19— voT, 2— 2n
1428 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Witliin the more or less constant limits of the army area a con-
tinuous circulation of units takes place, a shifting of troops to and
fro, an active wandering about like that of ants in a hill. It is ap-
parent that there is much wasted energy and loss of efficiency if
every division is required to organize its sanitary arrangements
de novo whenever it is moved. The knowledge gained and the work
done by one division is lost to the one that moves into its place, and
a new investigation of water sources, billets, dumps, latrines, baths^
and everything bearing upon the control of disease becomes necessary
whenever divisions change locations. It has been found, in conse-
quence, that some form of constant central supervision by the Army
itself will remove these obvious defects. This is the principle which
underlies the British Army sanitary organization and it is this sys-
tem, in its esentials, that we have found worthy of emulation. We
have borrowed from the British system certain essential elements,
but have attempted to adapt these to the more mobile conditions^
which prevailed on all parts of the front during the latter part of
the war. The following outline describes briefly the plan instituted
in the Second Field Army, American Expeditionary Forces, with the
official approval of the commanding general. The plan is similar in
most of its details to that conceived and carried out for the super-
vision of the advance section, American Expeditionary Forces, by the
chief surgeon of that section, but differs from this in the attempts
made to remain prepared for sudden extension forward of the Army
area, and the rapid organization of conquered territory.
2. OuTLiXE OF Plan for Area Sanitation, Second Army.
A. SANITARY SECTIONS.
The Army area is divided into administrative subdivisions to be
known as sanitary sections. The area as at present constituted will
be divided into three such sanitary sections, and in the future ex-
pansion or change in the territory occupied by the Second Army
can be easily adapted to corresponding changes in the subdivisions.
In a central point in each sanitary section there will be stationed
one commissioned officer, lieutenant or captain. Medical or Sanitary
Corps, chosen for his training in practical sanitaiy methods.
Each sanitary section will be again subdivided into 8 to 12 sub-
areas. These will be so outlined as to be small enough to be patrolled
on foot, this obviating the necessity of additional transportation.
Into each subarea will be placed two or three enlisted men and non-
commissioned officers chosen for their general intelligence and train-
ing in sanitary inspection. Further training will be given these
men by the commissioned officer commanding the squads in eacli
sanitary section.
It seems likely that a number of sanitaiy squads so selected can at
present time be obtained from personnel or divisional sanitary squads
now assigned to the services of supply.
1. Duties of the conmiissioned officer in charge of the squad. The
commissioned officer assigned to each area will —
(1) Maintain in the town of his station a sanitary school for the
instruction of noncommissioned officers and enlisted men of sanitary
squads and a shop for the construction of sanitary appliances, such
as latrine seats, etc.
A. E. F. FIELD SANITATION. 1429
(2) He will select and distribute men of his squad to the 8 to 12
siibareas in the section. He will direct and advise the work of the
men in the siibareas bj- receiving reports and keeping in constant
touch Avitli them by circulating in his area.
(3) He will keep in touch with all matters of sanitary importance
in his section and furnish all such information to zone majors, med-
ical officers, and commanding officers of all units that enter the area.
(1) He will keep in constant touch with corps and division sur-
geons in his area, furnishing them all information at his disposal.
(5) He will be directly responsible to the chief surgeon of the
Second Army through his sanitary inspector, reporting all matters
that in his opinion need correction.
B. SANITARY SQUADS.
2. Sanitary squads will be divided into groups of about 15 to 20
men who will work at the station of the squad commander, in the
>liop, and in the sanitary school.
The remainder will be assigned in groups of two or three in each
of the small subareas.
The place in each subarea at which they are stationed will be so
chosen chat from it they can patrol the entire area on foot. These
men under the direction of a commissioned officer will —
(1) Keep detail maps of the subarea. showing everything of a
sanitary importance — water sources, latrines, urinals, stables, cess-
pools, dumps, baths, lavoirs, kitchens, billets, barracks, camps, etc.
(2) They will inspect and keep in repair permanent sanitary ap-
pliances located in their subareas, such as latrine seats, baths, kitch-
ens, etc., drawing upon the sanitary shop of the section for labor
and materials.
(3) They will keep in touch with the engineer water personnel'
working in the subarea.
(4:) They will, as well as possible, keep themselves informed of
infectious diseases occurring in the civilian population in the sub-
area and see that such disease is promptly reported to the proper
medical authorities.
(5) They will furnish all information gathered hj them to town
majors and commanding officers of incoming troops as soon as they
enter the area.
(6) They will report all sanitary defects which require attention
to squad commanders of section.
(7) They will plan improvements of permanent sanitary installa-
tions and confer with the squad commander regarding them.
(8) They will report upon the condition of subarea or parts of it
whenever troops leave this area.
(9) They will exercise no administrative or other authority, their
functions being those of inspection.
(10) Their maps will be kept up to date and copies furnished in-
coming troops and others whose health depend upon such knowledge.
(11) It should be understood that the enlisted men of sanitarv
squads are not labor troops; i. e., they do not police or care for
grounds, billets, and areas, or dispose of refuse. They function as
assistants to the sanitary inspector of the Second Army.
1430 REPORT OF THE SURGEOTsr GENERAL OF THE ARMY.
Tlu'sc arrangements provide an adequate sanitary supervision,
which serves the important purposes of keopimr constant guard
over the area occupied by the army, facilitating tlie tasks of incom-
ing troo]is. obviating the ne<'essity of frequent and useless repetition
of sanitai'v surveys of tlie same territory and keeping the anny
authorities constantly informed of ])i'evailing coulitions and needs.
By constant cooperation with billeting majors and with otlicei's and
men of the water service of the Engineering Dejiartment. moreover,
these squads form a coordinating link which serves to convey neces-
sary information from one service to the other.
When the Army area changes by advance or lateral shifting it is
relatively easy matter for the squad conmiander, whose area is adja-
cent to the newl}' acquired territory to extend his work into this. If
complete change in the location of the Army takes place, the squad
commanders concentrate their men at a central point, move them for-
ward, and after a rapid survey on their motorcycles, in consultation
with their billeting officers of G-1, redistribute personnel. Such a
shift should not require more than three or four daj^s at the most,
and as a matter of fact, when the system has once been thoroughly
established and the personnel trained, the survey of a new area can
be carried out with increasingly greater speed.
When the Army is engaged in active combat it is best to exclude
from the above srheme of organization a strip of territory about 4
kilometers deep, immediately behind the trench lines. This area is
subjected to shellfire, and any kind of constructive activity of a
permanent nature is renderecl difficult. In this area it is best to
leave sanitary work entirely to divisional authorities, in direct consul-
tation with the Army sanitary inspector, who should keep in close
personal touch with the divisions in the line.
C. RELATIONS or THE ARMY SANITARY OFFICE TO THE SANITARY INSPEC-
TORS or DIVISIONS.
The Army sanitary organization should not interfere in the slight-
est with the sanitary organization of the several divisions of the
Army. The routine sanitary supervision of divisional troops in all
matters pertaining to health should, be left as hitherto, in the hands
of division surgeons and division sanitary inspe;tors. It is the duty
of the Army sanitary inspector, however, to reinforce the divisional
facilities, to advise the responsible divisional officers, and to place at
their disposal the experience and knowledge he may have gathered
by reason of his intimate acquaintance with the area. The Army
sanitary inspector should be a man, not only trained in field sanita-
tion but one who by experience in laboratory and epidemiological
work, can reinforce the divisional facilities whenever infectious
disease of any kind occurs. Whenever infectious disease is reported
from divisions in more than isolated, unrelated cases, the Army sani-
tary inspector should confer with the divisional sanitarj- inspector,
examine the prevailing conditions, and advise. It is he, who either
in person or through trained assistants, should make ejiidemiological
studies and laboratory studies whenever these seem indicated for the
purpose of arresting the spread of contagion. He should be the ad-
visor of the chief surgeon of the Army in matters of sanitary policy,
in circulation of information, and in the meeting of any emergency.
i A. E. F. FIELD SAjSTITATION, 1431
It ib his duty to organize the area supervision and the transmission
of information concerning the areas to incoming divisions. It is his
function to establish and maintain liaison between the divisional
authorities, and other services of the Army which have bearing on
sanitary problems such as the water service of the engineer depart-
ment, and the bathing and disinfestation activities of the Quarter-
master Department.
To carry out these functions he must have, first, transportation,
H'((jnd. assistants and personnel for area organization, third, a sys-
Riii of report whereby he can keep records of the dail}' occurrence of
communical)le diseases in all units of the Army.
His functi(ms thus defined, do not in any sense curtail the authority
or diminish the responsibilities of the divisional medical authorities.
The question of the jjroper personnel of the Army sanitary organi-
zation will be tabulated below.
Reports. — It is necessary for the sanitary inspector of an Army to
keep constanrly informed concerning the prevalence of communicable
diseases in all troop- of tlie Army, botli those in divisions and those
designated as Army troops. For this purpose he must maintain in
his office some kind of a reporting system whereby he can constantly
keep his hand on the pulse of the sick rat€. In w^orking out a system
of reporting for active army organizations it should be borne in mind
that unit commanders and medical officers are often overburdened
•with paper work and that the multiplication of such duties may inter-
fere seriously with their more important function, namely, the actual
execution of the duties they are asked to report upon. For this
reason whenever outlining a system of report one should scrutinize
each report demanded as to whether it is actually one wliich will fur-
nish information on a basis of which action can be taken. Provision
is already made in Army Regulations for routine reports of many
kinds and the routine information which is really needed is con-
stantly passing through the proper sources automatically. What the
Army sanitary inspector needs to know is whether contagious dis-
eases are occurring, when and where, and in which company units.
The company unit is important because it indicates occurrence in
groups which are eating and living together, and therefore this re-
I port gives information as to contact. Knowledge of the place where
f the disease occurs is very important when troops are stationary, less
' important when they are constantly moving about in an Army area.
But nevertheless even here the place is of value since the occurrence
, of a considerable number of cases in one and the same place within
a limited period may point to faulty condition of barracks, billets, or
! water supply. The system which has been worked out and is in use
in the Second Army is simple anel gives the necessary information.
(&) &'pot map. — A wall map of the entire Arm}- area is kept and
when an infectious disease occurs a pin is stuck into the location from
which the disease is reported, pins with a variety of colored heads
used for different disease. Each pin is thrust through a little square
of paper on which is written the date and unit. "When the area is
one of an Army activelj^ engaged in combat, in which units are
moving to and fro with great rapidity, the knowledge of the place
from whicli the case is reported loses value by virtue of the fact that
the disease was probably not contracted in the place from which the
report comes, and from the fact that by the time the patient has
1432 REPORT OF THE SURGEON GENERAL OF THE ARMY.
boon in hospital two or three days, this unit may have moved to
another location. However, the spot map can be nevertheless made
of value by the following procedure: At the end of each week the
information found on the spot map is entered in a book. In this
way there is constructed a record of all phices in which infectious
diseases have occurred during the week. When this information has
been entered in the book for the past week the pins are taken out
and replaced with common pins (without colored heads) , which are
left to form accumulated evidence of all infectious diseases that have
occurred in each place. When a large number of such pins accumu-
late in any single space, it is simply by going back to the book in
which the diseases are kept by places to find out which particular
variety of disease occurred there. Beginning with the new week, the
colored pins are again entered as before. The map, thus, at all times,
shows not only the nature and location of the diseases occurring
within the week, but also indicates by the massing of the common pins
Avhether or not these places have been frequent sources of disease.
After awhile it is of value to study the movements of units in which
infectious diseases have occurred and draw lines across the map with
red or blue pencil along the paths of movements followed by these
units. This can easily be done by reference to the inform^ition in the
"unit" and "place" record, and it may occasionally be found that lines
drawn for infected units may intersect at places at which a consider-
able number of infectious diseases occurred. By putting in dates
it may sometimes be discovered that a unit which has reported com-
municable diseases has passed through places from which similar
cases were removed from other units, within periods representing
incubation times.
As implied in the above, a further record, arranged by places,
is kept in an ordinary ledger in such a way that there is a page for
every town in which a communicable disease has occurred and all
cases reported from these towns are entered on this page.
To summarize, we then have a cross-indexing of record as follows:
1. Record b}^ units from which contact studies can be made.
2. Map record of places, as described above.
3. A ledger in which the occurrence of diseases is recorded by
place of occurrence.
4. A week book in which weeklj' records of the map are preserved
after the renewal of pins.
In addition to these records constant contact should be kept with
divisional surgeons and sanitary inspectors and medical officers of
Army troops, who are requested to communicate directly with the
sanitary inspector of the Army when they wish advice on any sani-
tary matters, or when any of the units under their care show the
occurrence of infectious disease which they regard as warranting
remedial action. Such an arrangement, especially if the sanitary
inspector has the confidence of the officers involved, forms an in-
dispensable check on the records described above and makes it pos-
sible also to keep in touch with the occurrence of diseases which
it is unwise to designate as " reportable." Such, for instance, would
be influenza. When a few isolated cases of so-called influenza occur
they have very little sanitary importance, and reporting them would
needlessly encumber the paper work. When influenza occurs as
an epidemic the cases are usually so numerous that telegraphic re-
* A. E. F. FIELD SANITATION. 1433
ports are not feasible. In this disease and a few others, therefore.
we must rely on the direct information by contact with the officers
in charge, with whose cooperation intensive study of the situation
must be made when epidemic conditions prevail.
The activities of an Army sanitary department are, in other words,
analogous to those of the combat branches. A routine of reliable
information must be established, on the basis of which the needs
of ordinary times can be attended to, but this organization must be
sufficiently elastic and possess sufficient reserve margin to detect
promptly and to be capable of reacting b}" special efforts to emer-
gencies or sudden changes that may occur.
D. LAB0!?AT0RY AND EPIDE.MIOLOGICAL SERVICE.
Just as the laboratory is of partial efficiency only in hospitals if
the bacteriologist is unfamiliar with the cases in the wards, so in
armies the laboratory service can not be entirely efficient unless the
laboratory officer is trained and in touch with the epidemiological
data. For this reason the sanitaiy inspector of the Army, who
should be capable of acting as an adviser to medical officers and
sanitary inspectors of the several troop units, should be a man not
only trained in practical sanitation, but one who at the same time
is familiar with the facts of epidemiology', the methods of making
epidemiological surveys, and can handle a laboratory for the control
of communicable diseases as an important tool of his profession".
The laboratory organization of a field army when the Army is
holding a definite sector should consist of a stationary mobile lab-
oratory within reasonable proximity to Army headquarters. This
main. Army laboratory should be equipped for all cultural work and
have a personnel consisting of at least two or three commissioned
officers and five enlisted men, three of whom are trained technicians.
Attached to this Army laboratory there should be one to two mobile
laboratory cars equipped as are those now in the American Expe-
ditionary Forces or those designed by the British for army use.
When the Army is moving as in a rapid advance or is changing its
areas for other reasons the two mobile laboratories may suffice. Each
mobile laboratory should have as personnel one bacteriologist, one
driver, and one trained technician. There should be with it a motor-
cycle, which can be used for the collection of specimens and for epi-
demiological studies. The stationary Army laboratory should also
be a supply laboratory for the mobile laboratories which proceed
from it as a base on special trips.
It is doubtful, at the present time, whether the divisional labora-
tories as formerly organized and equipped should be continued.
When divisions are reasonably stationary, such laboratories can be
of great value for the performance of clinical pathological work for
field hospitals and can materially aid in the speedy detection of
communicable diseases, more particularly meningitis, diphtheria,
amoebic dj^sentery, malaria, and tuberculosis. It should never be
attempted to equip such a laboratory for extensive laboratory work,
for when divisions are moving or actually engaged in combat in-
superable transportation difficulties invariably arise. Moreover,
under such circumstances patients who are sick for more than a few
days are evacuated to hospitals where laboratory facilities are avail-
1434 ItEPOKT OF THE SURGEON GENERAL OF THE ARMY.
able and the laigest epidemiolo<rical problems can best be handled
under any circumstances by the m()I)ile army laboratories described
above. The bacterioloo-ist in charjLre of these cars can be trained by
the Army sanitary inspector to n ake epidemiolooical studies and
thus utilized can independently attend to the rapid ctmtact and car-
rier studies which should be made in direct coordination with the
actual laboratory work. It is our belief that a thorough laboratory
traininjr is essential to work in epidemioloo;y. The divisional lab-
oratory man should be utilized in the same way as special assistant
to the divisional sanitary inspector.
In discussing laboratory work in field armies it should always be
borne in mind that an army engaged in combat or holding a sector is
not the place for research. The laboratory should be an instrument
in the hands of sanitary authorities for the prompt detection and
arrest of communicable diseases. For these reasons it is of great
importance that we should considei* briefly the extent of laboratory
"work which it is wise to carry out in active field armies.
The most practical solution of the clinical pathological problems
for divisions would seem to me to maintain a number of such organi-
zations for assignment to divisions when circumstances are such that
the laboratory can functionate to advantage. These laboratory units
organized as at present could remain under the control of the director
of laboratories of the Army and assigned to divisions for indefiiiite,
temporary duty when the respective divisions are at rest, assigned at
the request of the division surgeon, and withdrawn and reassigned
wherever needed when the particular division is in combat or
moving.
. It goes without saying that mobile laboratories and all purely
diagnostic laboratories which are connected with an army organiza-
tion should at all times be carefidly supervised in order that the
promptness of diagnosis Avhich gives the clue to epidemiological
investigation and control shall be efficiently carried out.
One of the fundamental principles underlying successful epidemio-
logical laboratory work is to restrict it to the amount which can be
accurately done. We are entirely out of symi^athy with the exten-
sive carrier examination which were instituted in the camps of the
United States for the control of meningitis upon the occurrence of a
single case. Our own observations have not given us the impression
that this work has had much effect upon the reduction of the disease
incidence and we are absolutely sure that the technical inaccuracies
inevitable in such wholesale bacteriology largely defeat the purpose
of the work.
It is, in our opinion, more important to restrict the laboratory work
at first to rapid and accurate diagnosis, and to abstain from extensive
carrier work until a number of cases have occurred in one and the
same imit. The principles of prevention of most of the diseases of
imjDortance for Army sanitary control are fairly well understood,
and after the discovery of a single case in a unit it is more important,
as a rule, to concentrate speedily upon the correction of general
sanitary defects for the control of the particular disease. Most all
of the important military epidemics are either of respiratory, diges-
tive, or of insect transmission.
A. E. F. CASUALTIES. 1435
i:. PliOBI.K.Al OF KEFLACEMENT DIVISIONS.
One of the most important sources of admission of infectious dis-
ease to divisions of an acti^•e army is the replacement division. A
replacement division is usually located somewhere in the reserve
area of an army and through it pass a large number of casual
troops, which after some training and, perhaps, reclassification and
equipment, are sent out to divisions in groups varying from a frac-
tion of a platoon to a i^latoon and larger units. The division, there-
fore, represents the small end of a funnel through which all kinds
of contacts of communicable diseases pass from the services of supply
into the Army. Also troops that ^re held for some time in the re-
placement camp may there be exposed to disease which may subse-
quently be scattered by their different units throughout the Army
area.
The replacement division, there I'ore, is one of the focal points
which should have the especial attention of the Army sanitary in-
spector. This division should establish a reception camp in which
new arrivals are held until their medical examination can be made
before they are turned into the main camp. The sanitar}^ inspector
of the replacement division should have special sanitary squads at
his own disposal and the laboratory of the the replacement division
should be more extensive, both in equipment and personnel, than that
of a mobile division. Cultural works of all kinds should be possible.
When cases of infectious disease occur in a replacement division
prompt epidemiological surveys should be made and measures taken
to prevent contacts from being sent to other divisions until the ex-
piration of the incubation time. When cases of infectious disease
occur in the Arm}^ itself an endeavor should always be made to find
out whether the patient or his contacts have been recently added to
the unit from the replacement division. In this way it may often
be found that the origin of the disease is in the replacement division
and that the point of approach for sanitary measures lies in that
division rather than in the unit in which the case developed. The
sanitary inspector of the Army should keep in constant and im-
mediate touch Avith the office of the chief surgeon of this division.
V. CASUALTIES, MEDICAL OFFICERS, AMERICAN EXPEDITIONARY
FORCES.
Names of deceased medical officers, American Expeditionary Forces, Apr. 6,
1917, to Sept. 25, 1919, both dates inclusive.
KILLED IN ACTION.
Name. , Rank. \ Organization. Date.
____i ! I
Amberlang, Lisle P First lieutenant I Dental Corps ! Aug. 6,1918
Arneit. John D ; do i Meaiccl Corps i Apr. 16,1918
Barber, Timothy L I Captsin do Oct. 10, 1918
Beaslev, Slwdworth O ! Major I do Oct. 14,1918
Brown, Arthur S : First lieutenant ' do Oct. 9,1918
Brown. Tresley R i do i do July 1,1918
Bull, William S do I do Oct. 11, 1918
Cassell, Lee S i do ' do Nov. 19, 1918
Clair, Fre lerick David I Captcin I do May 10, 1918
Cox^Jame-^C Second lieutenrnt Veterinrry Corps I Oct. 23,1918
Craisr, William F i I irst lieutenant Medical Corps I Sept. 26,1918
Daniels, Iloddie W 1 Captain I do I July 19, 1918
Desmond, Walter P ' First lieutenant ' do ■ Oct. 6, 1918
1436 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
Names of deceased medical officers, American Expeditionary Forces, Apr. 6,
1917, io Sept. 25, 1919, both date^ inclusive — Continued.
KILLED IN ACTION— Continued.
Name.
Organizatirn.
Medical Corps ,
do
Dudenhiefer, Joseph E I Captain
Pinkelberp, Morris ' First lieutenant
Gaston, Terry S ' do
Gochnaur. Orlando M do
Han en, David T Cnptain
Herringion, William G First lieutenant
Howe, G. P do
Hudson, William B i Capfain
Je't, Rioh'rd L do
King, Emil First lieutenant
Lemird, Jernme M • do
Lineh, Halbrd C do
Lone, Chrrle^ R do
MpQuillrn. J^mes C I Captain
Miller, Melvin A ' First lieutenant
Morgan, Harold S '• do
Morrii^ey, Howard H do
Murdock, Robert H do
Ogle;by, K. G do
Parson ;, Jo-eph H do
Post, Dam C do
Ran^nn, G. Damey do
Reed, Stephen J. H G^ptrin
Renner , John W First lieutenant
Saim^er-i. Alnnzo W do
Sheid.Clyc'eE i do
Sherwood . Robert A ; do
St een , John H do
Stone. I e-'er A do Dental Corps...
Summers, Da ■'id K do Me linal C'^rps. .
LTm-i'eid, Rolla P do i Sanitary Corps.
Web-^er, Harri-on B Major Medical Corps..
Wheeler. r)a vid E ' First lieutenant do
White, Winfield March do i do
..do
..do
..do
■ do
do
do
do
do
do
do
; do
I do
do
do ....
I Dental Corps. .
I Medical Corps.
i do
Dental Corps..
Medical Corps.
do.........
' do
do
do
do
do
do
Date.
Sept.
Sept.
Apr.
Nov.
Oct.
Jime
Sept.
Aug.
Apr.
Sept.
Nov.
Sept.
Apr.
Oct.
Sept.
Apr.
Nov.
Sept.
Aug.
Oct.
Aug.
Sept.
Oct.
Nov.
Oct.
Oct,
Sept.
Aug.
Oct.
Mar.
Oct.
Oct.
July
Nov.
, 1918
,1918
, 1918
,1917
., 1918
,1918
, 1917
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
.1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
, 1918
,1918
,1918
,1918
,1918
,1918
WOUNDS RECEIVED IN ACTION.
Augus*ein, Melvin M
Bass, Urbane F
Bell, Howard W
Betowski, Paul E
Bur-e^«, Wi'li-m G
Burrell, Gu'hrie O
Cox, Boaz B
Davis, Ree e
Elli>:, Jay G,, ir
Fi'z^imm^n-, William T
Frazier, Frmcis V
Furlon<', Jt eph A
Goss, Paul L
Henry, Howard R
Hole'nn, .\rthur John. . .
Humphreys, Richard W.
Jovce, W'liitnev H
Klin en, O erf M
Lie er, Willi-m .\
McFarl^nd, Jame'
McQu-nl, Ar'hur F
Marowi'^z, M, J
Marlin. W. W
Mead. TheidoreF
Mooney. E. L
Ostein, Matthew F
Pinku'!, Ir' in<' .Tames
Powers, Ralph E
Ray, John E
Rosenwald, John P
Sage. A. P, H
C-iptrin ! Dental Corps..
First lieutenant , Medical Corps.
Maior ! do
C-iptain I do
First lieutenant ' do
.do.
.do.
.do.
Captain
First lieutenant .
do
do
do
Captain
First lieutenant.
do
do
do
do
do
do
do
do
Captain.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
First lieutenant do
do do
do do
do do
Captain do
First lieutenant do
^af,sr. -T.. i . ii ■ do do
Sanaers, Frank B do do
Sioeker, Delman H i do Dental Corps...
Tinsman, Joseph Atley do Sanitary Corps.
Vermilyea, Sidney C do Medical Corps..
1 Oct.
16,
Oct.
7,
July
20,
July
2,
Nov.
1,
1 Sept
26,
Mav
19,
Sept
30,
July
2,
Sept
4,
Mar.
24,
Oct.
10,
Oct.
6.
Feb.
12,
Dee.
21,
Nov,
1,
May
17,
Oct.
16,
Oct.
5,
Oct.
24,
Oct.
13,
Sept
1,
Dec.
4,
Oct.
30,
Mar.
26,
July
9,
.■\ug.
30,
Jan.
22,
Oct.
S.
Mav
fi,
Mav
30,
July
24,
Oct.
3,
Nov.
17,
Oct.
31,
,1918
,1918
,1918
,1918
,1918
,1918
,1919
, 1918
, 1918
,1918
,1918
, 1918
,1918
,1919
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
,1918
1918
, 1919
, 1918
,1918
,1918
,1918
,1918
,1918
,1918
A. E. F. — CASUALTIES.
1437
2^ames of deceased medical officers, American Expeditionary Forces, Apr. 6,
1917, to Sept. 25, 1919, hoth dates inclusive — Continued.
DISEASE.
Name.
Organization.
Date.
Adams, Henry G First lieutenant Medical Corps
j^nderson, Lionel A | Captain I do
Ballow, Joseph R First lieutenant Veterinary Corps.
Baris, Alexander D do | Dental Corps
Bedinger.John Van D Captain Medical Corps
Bissing, Albert G i Major do
Blanchard, Kennith L First lieutenant Sanitary Corps...
Bliss, Vance W do Dental Corps
Booth, James Lofton Captain Medical (^orps
Bradley, Burton P First lieutenant.
Burkhalter, Francis M do
Burro'.vs, Lorenzo, jr Captain
Caro, Heiman do
Costen, Fred C First lieutenant...
Cowper, William L do
Demmett, PaulC do
Evans, Arthur M do
Evans, George R Second lieutenant.
Faulds, Winfleld S First lieutenant...
Tletcher, Francis D Captain
Eox, Walter Henry do
Gallagher, CharlesH do
Gates, William C do
Gayden, Hugh D First lieutenant. ..
Gibson, Robert M Captain
Glascock, Alfred do
Goldwaithe, Robert do
Guilfovle, William r.,jr ^ do
Ha 11 , William L First lieutenant . . .
Hanbridge, Francis F do
Hand, Jesse D do
Harwcod, William E , Captain
Hawes, Stephen J First lieutenant. ..
Hawley , Franklin M do
Henderson, George E Captain
Henry, Edward G First lieutenant. ..
Hicks, John R Major.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
.do.
Medical Corps.
do
do
do
do
do
Sanitary Corps
Medical Corps.
do
do
do
do
do
do
do
do
do
do
.do.
Hill, Armstrong First lieutenant Veterinary Corps.
Hobbs, Austin L do Medical Corps
Hockett, George H Captain do
Holman, Joseph D Second lieutenant Sanitary Corps —
Hoverton, Clarence E First lieutenant do
Hoyt, R. Francis do MedicalCorps
Hudson, Carl B do do
Huff, BurrellR do Sanitary Corps —
Johnson, Thomas P do MedicalCorps —
Jones, Alexander H do Dental Corps
Jones, Earl P Captain do
Kalaher, Leonard M First lieutenant MedicalCorps
Kantner, William C do do
Karpas, Morris J Major do
Kitchens, Lewis AV First lieutenant do
Knapp, Lee H do do
Knight, Frank H Captain do
Kuykendall,Jolm E do i do
Larson, Albert M First lieutenant do
Lavelle, Harry M Captam do
Lee, Jeptha D" First lieutenant Veterinary Corps.
Leonard, Frank S do Dental Corps
Lowndes, Andrew J Captain
McCauley, Lawrence L Second Lieutenant ] Sanitary Corps...
McCurdy , Asa C Major j Medicnl Corps
McNeil, Herbert L First heutenant do
Magnussen, Arthur H Second lieutenant I Sanitary Corps...
Manns, George W Captain do
Martin, William Joline First lieutenant Medical Corps
Mattcx, George W do i Denial Corps
Mauney, Samuel M Captam ' MedicalCorps
MiddlekauC; Casper L First heutenant do
Miller, William L do ' do
Morton, William T do do
Xeal, Max Captain Dental Corps.
Nolan, Martin F First lieutenant.
Palmer, Thomas J I do
I 'ei'bler, Raymond E ; do
I'helan, E. F | Captain
Phillip.';, Lester J 1 First lieutenant.
Price, Grover C do
Prudden, Clyde E Major
Medical Corps.
-do
.do
.do
.do
.do
•do
Sept. 23
Feb. IS
Feb. 20
Feb. 28
Get. %)
Oct. 21
Dec. 15
Oct. 12
Sept. 26
Oct. 16
Oct. s
Sept. 17
fan. 22
Mar. 21
Mar. 9
Oct. 28
Oct. 5
Dec. 10
Oct. 1.1
July 30
Feb. 22
Aug. 2^
Feb. 21
Dec. 13
Oct. 3
Oct. 8
Sept. 30
Sept. 2
Feb. 10
Jan. 31
Nov. 24
Feb. 4
Oct. 20
Oct. 4
Feb. 12
Nov. 11
Jan. 3
Dec. 2.T
Sept. 26
Dec. 1
Oct. 20
Do.
Dec. 28
Oct. 2
Jan. 12
Oct. 8
Oct. 1
Mar 3
Feb. 9
Sept. IS
July 4
Oct. 30
Mav 22
Oct. 2S
Feb. 22
Oct. 13
Mav 29
Mar. 1
Jan. 13
Oct. 17
Oct. 6
Mar. 24
Nov. 3
Feb. 14
Oct. 6
July 21
Oct. 15
Nov. 1
Oct. 8
Mav 28
July 21
leb. 1
Oct. 9
Oct. 28
Oct. 20
Dec. 9
Oct. 13
Oct. 30
Oct.
1919
1919
1919
1919
1918
1918
1918
1918
1918
1918
1918
1918
1919
1919
1919
1918
1918
1918
1918
1918
1919
1918
1919
1918
1918
1918
1918
1918
1919
1918
1918
1918
1918
1918
1919
1918
1919
1918
1918
1918
1918
1918
1918
1919
1918
19)8
1919
1919
1918
1918
1918
1918
1918
1919
1918
1919
1919
1919
1918
1918
1918
1918
1919
1918
1918
1918
teis
1918
1918
1918
1919
1918
1918
1918
1918
1918
1918
1918
1438
EEPOKT OF THE SURGEON GENERAL OF THE ARMY.
Nanus of ilccciisrd medical officers, American E-viicditinnarii Fonus, Ajir. 6.
1917, to Sept. '25, 1919, both daie.^ inelmire—Conimwea.
DISEASE— Continued.
Name.
Rank.
Organization.
Date.
Reed. Clinton V
First lieutenant .
Oct 7,1918
Roborl.son, Charles A
do
do
Nov. 14,1918
Rogor.<. Alton
Captain
First lieutenant
do
do
Jan. 2,1919
Russi'll. Donald G
do
Dec. 21,1918
Shannon, Samui-l D
dn
Nov. 5, 1918
Shrver, Julius L
Nov. 4, 1918
Smi(h,C.irlC
Feb. 17,1919
Sn vder. Edward .T
Oct. 27,1918
July 14,1918
Spioselherg, Sidney J
Squires. Tamos W
Captain
First lieutenant
Captain
First lieutenant
do '
Dec. 16,1918
Svrop, Edward F
do
Oct. 27,1918
Thorpe, Han-ey L
do ...
Nov. 4,1918
Trock, Michael .T
do
Julv 2,3,1918
Underwood, Robert B
Captain
do ...
Nov. 13,1918
Walters. Edward H
First lieutenant .
Sept. 25,1918
Dec. 10,1918
Washington. Fa v V
Captain
Weaver. William I
Nov. 10,1918
Dec. 9,1918
Weilepp. Harry Ors'ille
White. Clarence H
Captain.
Medical Corps
do
Nov. 2,1918
Williams, John E
First lieutenant
Sept. 3,1918
Apr. 19,1919
Sept. 18, 1918
Williamson, Rvan M
Wils, Lester H".
RESULT OF ACCIDENT.
Hunt, Harr>^ F
Lebron, Leo R
Vaughan, Victor C., jr. .
Williams, Alexander W.
Second lieutenant.
Captain
Major
Lietenant colonel..
SUICIDE.
Veterinary Corps.
Medical Corps
do
do
Feb. 6, 1919
Feb. 5, 1918
June 4, 1919
Oct. 5, 1918
Coble, Paul B
Cocke, Paul L
Fields, Knight W.
Hilgard, George E
Oren, Samuel.....
Major
Captain
First lieutenant.
Major
First lieutenant.
Medical Corps.
do
do
do
do
May 11,1919
July 18,1918
Oct. 7,1918
June 13,1918
Oct. 9, 1918
Nature of casualty.
Medical
Corps.
Dental
Corps.
Sanitary
Corps.
Veteri-
nary
Corps.
Designa-
tion un-
known.
Total.
Killed in action
41
32
76
3
5
4
2
7
1
1
10
1
47
Died of wounds
35
6
1
2
101
Died, accident
4
Died, suicide
5
Total
157
13
12
8 2
192
Sources of information.
Casualty cablegrams.
Personnel, Surgeon General's Office.
Division of Records, Surgeon General's Office.
•Demobilized Records, The Adjutant GeneraTs Office.
Officers Division, The Adjutant General's Office.
A. E. F. CIRCULAR. 1439
VI. CmCULAIl, CHIEF SURGEON'S OFFICE.
1. Memorandu.ai to Commanding Officer, Services of Supply,
May 29. 1919.
Herewith is forwarded a copy of report made to the commanding
general, Services of Supply, in accordance with memorandum of
February 19, and other data asked for in letter of May 29.
The following suggestions are made in connection with the sub-
ject (e), Special Order 141:
1. It is thought that the Medical Departiueiit lias suffered in this war
tlirough the tendency to legard it as one of the supply departments, instead
of a great technical and administrative department which has at the front
very important tactical prohlems and in the Services of Supply complex ad-
ministrative proiilems entirely different from those of the supply departments.
The personnel of the IMedical Department of the American Expeditionary
Forces numbered at the time of the armistice: 15,279 officers, 121,040 enlisted
men, 7,937 luu-ses, and 3S6 civilians, a total of 140,642. It had. in addition, at
the time of the armistice 193,000 sick and wounded for whose feeding, cloth-
ing, shelter, discipline, pay, service and medical rt<'<trds, and disposition it was
responsible. These great and arduous re.'jponsibilities suggest the necessity for
a closer connection with the General Staff by a representation ujion certain
of its sections, as the first and fourth.
2. Some of the organizations under the exclusive control of the Medical
Department have been of a size unprecedented in former wars. The strength
of the command at the hospital center at Mesves on November 16, 1918, was
20,180 patients and 8,642 medical personnel, a total of 28,828. This great
organization, equal in numbers to a Division of Infantry, was under the com-
mand of a colonel of the Medical Department. It is evident that the adminis-
trative problems of such a command would be numerous and complex and that
they could not be successfully met without the as.sistance of a full administra-
tive staff. This fact was recognized by most of the staff departments, who
willingly gave representatives to serve on such a staff: but the Engineer De-
partment at no time was willing to place an officer of its department on the
ho.spital center staff, and many difficulties in connection with the construction
and repair of roads, bridges, sewers, water mains, etc., occurred which would
have been obviated if this department had also been willing to " play the
game." It is also obvious that if the commanding officers of these hospital
centers had been general officers of tlie Medical Department it would have been
of administrative advantage and more fitting for their responsibilities.
3. The earlier development of convalescent camps in connection with hospital
centers would have assisted the administration of the hospitals and have
favored a return of the sick and wounded to the front more promptly and in
better physical and moral condition. The first recommendation for conva-
lescent camps was made on February 27, 1918, and the first convalescent camp
was authorized on .June 9, 1918 and started operating on July 26, 1918.
Provision should therefore be made in tables of organization for hospital
centers, and a convalescent camp should be a necessary constituent part of each
center.
4. Camp hospitals — Perhaps the greatest source of embarrassment, confusion,
and ill administration which the Medical Department experienced in the first
year of the American Expeditionary Forces was due to the deci.<ion that no
allowance of persoimel should be given for camp hospitals, but that they should
he administered I)y the persomiel attached to line organizations present at the
camps. This personnel is sufficient only for emergency treatment and does not
conf.iin the various specialists which are necessary at a camp hosi)ital, often
of considerable size, where cases of all kinds are received and given definite
treatment. Also usually there was an interval between the time of the moving
out of one organization and its replacement by another, so that a choice would
have to be made whether the sick would be abandoned or the line organizations
would start off without their medical personnel. As there was no casual per-
sonnel available for these important hospitals, the chief surgeon had to dis-
member the base hospitals as they arrived and scatter their personnel to all
parts of France to supply the camp hospitals. He had also to establish a sys-
tem of barter by which l>ase hospitals and evacuation hospitals which were on
1440 EEPOKT OF THE SURGEON GENERAL OF THE ARMY.
the priority schedule were exchanged for casual medical personnel. This
enabled the Medical Department to meet its responsibilities for the troops in
training areas, but caused a serious shortage in base hospitals and evacuation
hospitals when the American divisions went into the line of battle, and especially
when the great offensive began on the ISth of July, 191S.
It is obvious, therefore, that camj) hospitals should be provided on tables of
org.uiizatiou in sufficient number for the demands of training areas, and after-
wards for the still greater demands of camp hospitals in the occupation of
conquered territory.
5. Medical supplies — The most serious difficulty encountered in the medical
administration of the American Expeditionary Forces arose from the fact
that when base hospitals, evacuation hospitals, and other medical imits were
sent t)ver it was impossible to secure the shipment of their equipment on the-
same .ship, although in many cases it was piled upon the dock ready for ship-
ment. Also, when shipped it was often divided up between ships which in some
cases landed parts at different ports. Therefore, these large units, when they
arrived in France, were in many cases compelled to wait weeks before a new
medical equipment could be assembled and furnished them. If our Army had
been required to go into conflict with the enemy and suffer serious casualties-
within a few weeks after landing, the operation of the Medical Department
would under this lack of system have been entirely paralyzed, because it would
not have been possible to organize a supply depot which could issue the great
numl^er of articles required to equip a large hospital.
The best solution of this difficulty is hospital ships, which under the Geneva
convention observed in war guarantees the safety of medical personnel and
equipment and prevents the dispersion of the latter.
6. With reference to the data called for in the letter of the president of the
board of May 29, 1919, it may be said that this is asked for in terms of a supply
department and can not be applied exactly or literally to the Medical Depai't-
ment, which renders professional service and has not plants producing mate-
rial things. The nearest approximation to the data asked for under (o) and
(ft) would be to furnish tables of organization, with a statement of the number
and location of the various hospitals, laboratc^ries, dispensaries, offices, etc., of
the Medical Department. It is believed that this board does not desire to go-
into the matter of tables of organization, which, however, was fully con-
sidered by a board convened by Special Orders, No. 175, general headquarters,
1918, and which furnished to general headquarters a full, elaborate scheme of
organization of every medical activity. It is believed that these tables of or-
ganization are now being considered by the Dickman board at general head-
quarters. (A copy of the order for this board is appended.) The organization
of medical units therefore will be, in a future war, presumably such as may be
approved by that board, and not such as have been in operation in the Services
of Supply, which have been subject to variations to fit local conditions and in-
dividual ideas of development. The number and location of medical units is
shown in the report of hospitalization for December 1, 1918, which gives these
units at the period of their greatest number and expansion. Inclosed also are
ground plans of base hospitals of types A and B, the types constructed at most of
the hospital centers. A scheme of the oi'ganization of this office is also in-
closed. It is believed that the data when used with the tables of organization
will give the essential information asked for under (a) and (b) of the letter
of I\Iay 29, when taken with the memorandum attached.
The information asked for under (c) is attached, marked with that letter.
Walter D. McCaw,
Brigadier General, M. D., United States Army,
Chief Surgeon.
JIEDICAL DEPAKTMENT OKGAXIZATION.
(a) The authorized strength of the Medical Department can not be fully
stated in tables of organization, but for officers is a numerical proportion of
the strength of the Army.
Upon the declaration of war, the Medical Corps was expanded by calling
in the reserve. The enlisted strength was fixed by the Secretary at 10 per cent
of the Ai-my, exclusive of the Medical Department. Tables of organization
prescribed the medical units for a division, and allowed four base hospitals
of 500 beds each and two evacuation hospitals of 450 beds for each division.
Both of these were line of communications units, but in June, 1918, the evacua-
tion hospitals were transferred to the armies. It was also found advisable
A. E. F. — CIRCULAK. 1441
in the interest of economy of personnel to increase these units to 1,000 beds
each^ with a small increase of personnel. During the Argonne-Meuse offensive
many base liospitals liad an emergency expansion to 2,000 or more patients.
Besides tlie units prescribed in tables of organization, numerous others are
necessary, which are created as needed from tlie casual personnel provided by
a proportional allowance, which, being a field organization, has great advantages.
The general statf. American Expeditionary Forces, however, from the first was.,
inclined to adhere rigidly to tables of organization, with consequences which
were most severely felt in the Services of Supply, and whicli are stated fully
under personnel in the report to the commanding general.
(?>)Tlie important Services of Supply medical units were:
Camp hospitals. — Located wlierever bodies of troops were in fixed camps>
and varying in size from 50 to 500 beds, according to the needs of the com-
mand. There were 5G of these in operation on November 11, 1918.
Base hospitals of 1,000 lieds. with a personnel of 35 officers. 100 nurses, and
200 enlisted men, were the most important medical organizations in the Serv-
ices of Supply. There were 153 in operation at the time of the armistice,
located as shown in the liospitalization report attached.
Hospital centers were groups of two to nine base hospitals under a center
commanding officer with complete autonomous military or,ganization. A con-
valescent camp is a part of each center. A laboratory is located at each hos-
pital center or separate base hospital. Camp hospitals are, of course, under tlie
local commanders, their medical superior being the section chief surgeon,
while base hospitals and hospital centers depend on the chief surgeon's office.
(c) Procedure of Silpply Division, Medical Department, called for in letter
dated May 29, 1919:
Class I. Received at base ports from vessels. — The procedure of handling
supplies at base ports was modified by the facilities for storage at the port.
At St. Nazaix-e, I5ordeaux, and Marseilles there were facilities for storage.
Representatives of the Medical Department were stationed at the docks to as-
sist in segregating medical property from other classes of incoming supplies.
In general, all supplies were loaded into cars and shipped to the storage sta-
tions as rapidly as received on the docks. When received at the base storage
station they wei"e separated into two classes, one class placed in stora.ge and
termed " controlled stores," the other class, of miscellaneous supplies in mixed
boxes and of small volume, shipped direct to the intermediate depots. The
storage stations entered on warehouse receipts all supplies in controlled stores,
and copies of these receipts were sent out daily to the chief surgeon. Services
of Supply, where stock records of all storage stations were kept.
Supplies were also received at Le Havre, Clierbourg. Brest, Los Sables, La
Rochelle, La Pallice, and Rochefort, where the Medical Department had no.
stora.ce facilities. INIedical representatives assisted in segi-egating medical
supplies from other stores and they were all shipped to the intermediate depot
at Gievres, as rapidly as cars or barges could be obtained.
Class II. Purchases in Etirope. — Purchases in Europe were made by the
medical member of the general purchasing board, which was located in Paris,
such purchases being made by direction of the chief surgeon. Services of Supply.
These supplies were at times shipped direct from the place of purchase to the
hospital or depot requiring them, but in general purchases in France and
Eii.gland were shipped to the intermediate depot and there placed in stock for
distribution in connection with other supplies.
Snpply to combat troops. — The supply of combat troops in the Army area
was controlled by the armies and was entirely independent of the chief sur-
geon's office. The responsibility of maintaining adequate supplies at the
Army dumps rested with the chief surgeon of the Army who made requisition
to the chief surgeon. Services of Supply, for supplies as he deemed necessary.
All requisitions received in the office of the chief surgeon. Services of Sup-
ply, were disposed of according to the quantities required. When items were
sufficiently large to make a carload they were exti-acted upon shipping notices
to the base storage station for direct shipment, thus obviating rehandling at
the issue depots. When less than carload lots or miscellaneous items of less
than original packages were called for the requisition was forwarded to the
nearest issue depot. Issue depots were established at Cosne, Gievres. Is-sur-
Tille, St. Nazaire, and St. Sulpice. Requisitions from small hospitals were
forwarded to the nearest issue depot after modification and approval by the
section surgeon.
1442 REPORT OF THE SURGEOlSr GENERAL OF THE ARMY.
VII. ACTIVITIES OF GENERAL STAFF.
As the supervision now exercised hy (t-4 o\'er hospitalization and
(evacuation Avas not clearly defined before, and the medical group of
G-4 did not come into existence until the publication of (leneral
Order 31 on February 16, 1918, no report on the status of hospitaliza-
tion and evacuation of the American Expeditionary Forces as it
existed upon the cessation of hostilities on Xovember 11. 1918, would
be complete without briefly revieAviiio- these subjects from their
inception.
In this narrative, criticisra of a constructive character has ])een
freely introduced. Should we fail to ])rofit by and avoid in the
future the mistaken policies that have liitherto been followed, all
the lessons learned in this war would prove useless. Under every
subject discussed herein will be found certain recommendations for
improvement. These conclusive recommendations are ])roposed as
jiolicies on which any future organization plans should ho liased.
The important giiideposts or factors leading up to or facilitating
the establishment of our hospitalization and evacuation service on a
substantial basis were as follows:
1. ]\!a.v 26. 1917: ('renliou of the A. E. F. witli an adiiiiiiistrarive sinff aiid
headquarters at Paris. ((4. (). 1, 1917. A. E. F.)
2. July .5. 1917 : De^;nition of staff duties. Tlie coordination of policies for
the A. E. F. placed under general staff control. Evacuation of sick and wounded
••supervised by the administrative section, (later G-1), of the general staff, and
procui'enient of hospitals, particularly construction, supervised by tlie co-
ordination section (later G-4), general staff. (G. O. 8, 1917, A. E. F. I
3. Julv 20, 1917: Red Cross hospitalization under military control recognized.
(G. O. 17, 1917. A. E. F.)
4. Jidy 21, 1917 : As an evacuation measure, authority was granted to pur-
chase standard vestibuled hospital trains in England for use of the A. E. F.
5. July 23, 1917 : Chief surgeon, A. E. F., subnntted to the chief of staff an
estimate of sanitary personnel required for the Medical Department, A. E. F.,
including all grades and other services functioning under the INIedical De-
partment, representing a total of 14.5 per cent of the eutire A. E. F. strength in
.Europe. As finally approved by the General Staff, A. E. F.. this ratio was re-
duced to 7.65 per cent. (Memoranda. See Exhibit "A.")
6. August 2, 1917 : Chief surgeon, A. E. F., recommended steps be immediately
talcen to provide 12-5,000 beds to meet needs of 500,000 men in France, and thut
barrack hospital constiaiction of our own be inaugurated. (Letter.)
7. August 13, 1917: General staff, A. E. F., authorized establishment of
73,000 Iieds on the then lines of conmuinication, to meet needs of 300.000 men.
(Letter A. G. O., A. E. F.)
8. August 13, 1917: Organization of the lines of communication effected;
headquarters at Paris; linuts of advance, intermediate and base sections out-
lined. (G. O. 20, 1917, A. E. F.)
9. September 1, 1917: Separation between G. H. Q. and headquarters,
L. O. C. ; the f<u"mer moving to Chaumout.
10. September 17, 1917 : Chief surgeon, A. E. F., submitted approved plan of
type A base hospital luiit, prepai-ed in his office; this to provide a barrack
hospital of our own construction, with a normal capacity of 1,0(X) beds, and a
crisis capacity in emergency of 2,000 l)etls by use of tentage.
11. September 30, 1917: Chief surgeon, A. E. F., submitted approved plan
of type B camp hospital unit, tu-epared in his office; this to provide a barrack
hospital of our own construction, with a normal capacity of 300 beds, and a
crisis capacity in emergency of 500 beds by use of tentage. This hospital was
particularly designed for training areas and to meet local needs of isolated
conmiands.
12. October 10, 1917 : Scarcity of construction material necessitated curtail-
uient of resources and assignment of definite allowances of floor space in
hospitals, etc. (G. O. 46, 1917, A. E. F.)
A. E. F. CIRCULAR. 1443
13. October 16, 1917 : Administrative section of general staff materially i-e-
diiced our hospitalization allowances and placed them on a "phase" basis.
For normal hospitalization there was allowed 10 per cent on all troops, and to
provide for combat conditions an additional 10 per cent on the strictly com-
batant troops. (Memorandum.)
14. October 20, 1917 : Joint France-American conference at French mission
attached to these headquarters, in which methods to be followed in procuring
hospital accommodations for the A. E. F. were prescribed.
l.'i. December 18, 1917 : Joint France-American conference held in office of
French minister of war, Paris, in . which agreement was mutually adopted
whereby in emergencies American patients would be received in French hos-
pjfnls, and vice versa French patients in American hospitals.
10. January 15, 1918 : Headquarters, L. O. C, moved from Paris to Tours.
17. February 16. 1918: Xew em. — Reorganization of A. E. F. general staff
divided into five sections; G-4 supervising all ho.spitalization and evacuation
matters. Provision for Medical Department representation in various sections
of the general staff. Assignment of medical officers to G-4. Transfer of chiefs
of administrative and technical staff services to headquarters. S. O. S.. Tours,
leaving behind here representatives on the general staff, with authority of
deputy. (G. O. 31, 1918, A. E. F.) Under this reorganization scheme supervi-
sion of lied Cross activities was left under G-1.
18. May 6, 1918: Adoption by the A. E. F. of mobile hospitals and mobile
surgical units; new departures in our organizations. (G. O. 70, 1918. A. E. F.)
19. June 1, 1918 : Hospitalization placed on a new basis. Medical Department
authorized to maintain an actual current bed status aggregating 15 per cent of
total troops in Europe. This allowance to concern tixed hospitalization only.
To overcome delays in acquirement incident to construction, additional credits
also authorized. (Letter G-4.)
20. June 4. 1918 : Joint France-American conference held at the office of the
French minister of war, Paris, at which arrangements were perfected for the
interchange of statistical data regarding American patients in American
hospital.
21. August 29, 1918: Promulgation of regulations concerning operation of
hospital trains. (Circular letter, G-4.)
1. General Staff Supervision, Medical Department.
Before proceeding with a discussion of hospitalization and evacu-
ation, the functions of Gr-4 in relation thereto must be described.
G-4, general headquarters, exercises supervision over matters re-
lating chiefly, but not exclusively to procurement and location of
hosiDitalization and evacuation resources, and their coordination with
other activities. G-4 directs policies, the Services of Supply or
other agencies execute them. Under our present scheme of organiza-
tion at these headquarters, it has become the custom to refer all
Medical Department matters presented to any subdivision of the
general staff to this section for study and recommendation.
Prior to February 16, 1918. when' General Orders 31. these head-
quarters, became operative, representatives of the chief surgeon's
office took up directly with the various sections of the general staff
concerned all Medical Department matters requiring their execution
or coordination. As the chief surgeon was then at these headquarters
and in close liason with the general staff and other administrative
and technical services, the more important policies were usually
placed on record and then verbally discussed with those concerned.
Accordingly, the hospitalization section of the chief surgeon's office
since the organization of the American Expeditionary Forces had
been dealing directly with G-4 in matters relating to the pro.ure-
ment of hospitals. When the chief surgeon removed to Tours, he
left behind as his representatives with G-4 two medical officers who
• 142367— 19— VOL 2 30
1444 REPORT OF THE SURGEOIiT GENERAL OF THE ARMY.
had been associated with the hospitalization projiram from its in-
ception. Under the new reorganization, the assistant chief of staff,
G-4, proceeded to establish the medical, or "B" group, of G-4, and
it immediately began to function as an integral part of the section
under the chief of that section. The chief surgeon also left a repre-
sentative with G-1 to handle the tonnage and supply matters arising
in that section, and another representative in G-5 who handled
training matters.
"With the separation of the chief surgeon's office from headquarters,
American Expeditionary Forces, his relations with the combat forces
virtually ceased, and as his deputy, his senior medical officer in
G-4-B supervised all the combat activities of the Medical Depart-
ment in the zone of the armies. The demands upon the medical
group of G-4 constant]}' grew, and from the beginning of our Ameri-
can Expeditionary Forces combat activities it was called upon to
meet the daily emergencies of battle conditions as the}' arose.
The composition of the group varied according to circumstances
but on the average included four medical officers of field rank, and
two officers of the Sanitary Corps for office management, with a large
clerical force. Two of these officers were eventually detailed on the
general staff. Two officers were almost constantly in the field, repre-
senting G-4 in the coordination of hospitalization and evacuation.
In addition to the Medical Department personnel composing B
group of G-4, one medical officer was attached to G-1. In actual
jDractice this officer functioned as a member of this group but was
placed with G-1 to handle certain specific duties. Such a detail was
found to be necessary for the reason that all questions of ocean ton-
nage were treated in the latter section of the general staff. It was
essential, therefore, that there should be a medical officer on the gen-
eral staff thoroughly conversant Avith the Medical Department sup-
ply problem and the method of getting these supplies shipped to
France.
With the growth of the organization, the group soon became the
center to which all matters affecting the Medical Department arising
at these headquarters were referred for recommendation or suitable
action. No important questions of policy were decided without first
submitting the pro])osition to this group. All actions initiated in
the group were of course executed over the signature of the assistant
chief of staff of the section, G-4. This system was followed even
with questions involving another section. In this case a memoran-
dum was usually prepared for the other section of the general staff
involved and transmitted to it through the assistant chief of
staff, G-1.
Aside from the many questions which arose and involved hospi-
talization and evacuation policies in the Services of Supply, the
greater part of the time of this group was taken up with questions
concerning operations and policies connected with combat activities
at the front. The chief of section kept the members of this group
informed as to impending combat plans and through advance notice
so furnished, the medical group was able to keep in touch with
the chief surgeons of the various armies, corps, and divisions con-
cerned, as to their facilities for meeting forthcoming obligations,
and permitted prompt assistance Avhen and where it was needed.
A. E. F. CIECULAE. 1445
The chief surgeon was granted the privilege of having a medical
representative on each section of the general staff. At the time no
officer was detailed to G-2 (intelligence) or G-3 (oiDerations), largely
because of the very great shortage of Medical Department personnel.
It soon became evident that a medical representative on G-2 was
unnecessary, but as to G-3 it appeared •desirable that there should be
such representation in order that ]Medical Department plans might
be coordinated with combat operations in general.
As events developed and American troops began actual participa-
tion in the war is was soon apparent that no military operations
could be planned or undertaken without consultation and fullest co-
operation with the assistant chief of staff, G-4. It has been a policy
of this officer to consistently take the medical representative of his
section into his confidence. The wisdom of so doing has been amply
demonstrated: it has been equallj- as well demonstrated that with-
out this harmonious cooperation the Medical Department would have
been doomed to failure. Gen. 's stand in this matter is
particularly to be remarked for the reason that a number of officers
of high rank were convinced that the Medical Department should not
be advised in advance of impending combat activities. It is believed
that in the light of the experience of the recent past the most skep-
tical has been convinced that military objects can be attained only
by considering the military machine as composed of numerous recip-
rocating parts, each striving toward a common end.
Prior to the creation of American Expeditionary Forces Army and
corps formations, there devolved upon this group the necessity of
functioning in the dual capacity of an Army or corps surgeon, as
there was at that time no other agency through which the higher co-
ordinative functions could be exercised.
Until the chief surgeon. First Army, was designated in July,
1918. the duties of the chief surgeon of our divisions in combat, in-
cluding all of the early military activities of the American Ex-
peditionary Forces, were discharged by this group. This, of course,
was not contemplated in the organization of the general staff, but
through force of necessity it became a duty which was. and could be,
discharged in no other way. This placed a very heavy burden of
responsibilty on this group, which its organization had not provided
for and which it was not contemplated should be provided for. With
the appointment of corps and Armv surgeons, in the summer of 1918,
the group was relieved of this part of its duties. Even after the
formation of corps and armies, very careful supervision was exer-
cised by this group over Medical Department activities at the front.
The hospitalization and evacuation plans for the St. Mihiel and
Argonne-Meuse offensives, as far as procurement and evacuation
were concerned, were largely prepared in this section and placed into
effective operation through personal consultation with the chief
surgeons of the First and Second Armies. The battle casualties to
be cared for were carefully estimated and every available resource
drawn upon to properh' meet them. Owing to the limited resources,
it frequently became necessary to move sanitary formations and re-
sources from one place to another. As a part of G-4, controlling all
transportation resources, the affiliation materially assisted in these
movements. All changes of station of Army units were accom-
plished on order issued by G-3, based on recommendations prepared
1446 REPORT OF THE SURGEON GENERAL OF THE ARMY.
in this group for the signature of the assistant cliief of staff. G-4.
Therefore, from a practical standpoint, (t-4-B made battle disposi-
tion of sanitary units as dictated by military necessity and thus dis-
charge the superlative functions of a chief surgeon of a group of
armies.
The oeographical location of general headquarters permitted of
maintaining close and immediate contact with division, corps, and
Army headquarters. It was not only possible for a member of this
group to rapidly reach almost any part of the front oc -upied by
American troops, but a splendid system of telephone and telegraph
communication enabled the office to know exactly the conditions to
be met at any and all times. It was due largely to this fact that the
]\Iedical Department was able to meet the daily problems created by
the lack of authorized personnel, sanitary units, and equipment. By
means of this rapid system of communication casual personnel, oper-
ating teams and sanitary units (ambulance companies, field, evacu-
ation, and mobile hospitals) were moved on orders initiated by this
group from one sector of the front to another. Without this ma-
chinery for coordination of effort and consolidation of resources,
failure to care for, evacuate, and hospitalize battle casualties would
have been certain.
In retrospect, the members of the group believe that without this
elasticity of control as reflected in the authority of the assistant
chief of staff, G-4, serious embarrassment to the Medical Department
would surely have resulted. This elasticity permitted us to utilize
our limited resources to a maximum degree of advantage.
The present method of providing for Medical Department repre-
sentations on and with the general staff is ideal, and is favored over
all other previous propositions. Medical Department representation
on the general staff as conceived by the assistant chief of staff, G-4,
more nearly approaches the ideal of organization than any other
plan which has been proposed. It is hoped that the policy inaugu-
rated by the chief of this section in this respect will have demon-
strated its value, and will be perpetuated in any future reorganiza-
tion of the general staff. It is also hoped that the results obtained
by this section of the general staff have amply demonstrated the
wisdom of having adequate Medical Department representation on
the general staff.
Shortly afterwards, as mentioned above, permission was granted
to assign an officer to each section. However, at about the same time,
General Order 31, 1918, was issued which separated all the so-called
services, including the Medical Department, as represented by the
chief surgeon, American Exj^editionary Forces, from these head-
quarters and established the Services of Supply at Tours. Under
this organization the chief surgeon's office became merely an agency
for the procurement and distribution of supplies and personnel and
was completely separated from the Medical Department activities
connected with tlie zone of active operations. No mechanism of the
control, direction, and super\dsion of such activities in the zone of
operations was substituted. Consequently, as the only representative
at general headquarters of the chief surgeon, the two medical officers
comprising originally the medical group of G-i found themselves
charged with these duties and all the heavy responsibilities implied
thereb}^
A. E. F. CIRCULAK. 1447
The classification of the Medical Department among the siippl}'
services is questionable. Its functions are so intimately connected
Avith- combat activities that it becomes a very difficult matter to ad-
minister this branch of the service if placed on the same basis as the
purely supply departments.
In providing the necessary medical supplies for an army only one
of the comparatively unimportant functions of the Medical Depart-
ment has been fulfilled. The demands made upon the Medical De-
partment by combat activities can not be satisfied if the prevailing
conception of that Department as a supply department is adhered to.
The organization of headquarters, general headquarters, Ameri-
can Expeditionary Forces, as first outlined in General Order 8, 1917,
followed very closely that in operation in the French Army at the
time, except that for the latter army generous provision was made in
the way of Medical Department representation on the fourth bureau
of the general staff and none was provided for ours. As stated above,
this defect was corrected some months later, after representations
had been again made by the chief surgeon.
In the meantime a reorganization of the French general staff went
into effect March, 1918. This change created an additional or fifth
bureau of the general staff which was made up entirely of medical
officers and was known as the Medical Department bureau. The
senior officer of the section was a major general, with the title of
assistant chief of staff, with the same responsibilities and privileges
as his brother officers of the line of the other bureaus of the general
staff.
A short time before the French had published this change in staff
organization in this report. The above has been outlined as of pos-
sible interest to the student and historian. It is of interest, how-
ever, to note that gradually there has developed at these headquarters
an organization to coordinate Medical Department activities which
had been disapproved when submitted as an academic proposition
and which up to the pre.-ent time has never been authorized by orders
or regulations. It will also prove of interest to observe if in the
future the lessons learned during this war are to be forgotten and
the War Department is to be broken up into a number of separate
and uncoordinated agencies as was the condition when war was
declared.
The opinion has been expressed about that the present organiza-
tion as tested by the actual experience of war. under trying circum-
stances, is ideal. It would be difficult to devise a more satisfactory
organization or one better calculated to meet the emergencies of
warfare. This expression of opinion should, however, be qualified
by the statement that without the sympathy, broad judgment, good
common sense of Gen. , and the constant assistance fur-
nished by his wide knowledge of military problems and organiza-
tion, the verdict might well have been different. In other words,
results can be more confidently expected under the organization now
existing than by the provision of a separate Medical Department
section of the general staff, provided only that the assistant chief of
staff, G-4, is willing to consider the medical members of his section
as part of his official family and worthy to be entrusted with his
confidence. Under such conditions the Medical Department is in-
1448 EEPOET OF THE SUKGEOlSr GENERAL OF THE AEMY.
finitely better prepared to discharge its responsibilities either in
peace or war than has ever been the case before. Lacking such condi-
tions, failure can be confidently predicted.
2. Hospitalization.
This subject must be discussed under two headings: (1) Fixed
establishments; (2) Mobile sanitary formations accompanying the
armies in the field.
FIXED ESTABLISHHENTS.
These included: (l)Base hospitals, (2) camp hospitals, (3) con-
valescent camps, (4) American Red Cross military hospitals, (5)
American Red Cross hospitals, and (6) American Red Cross con-
valescent homes.
G-4 controlled the allowances, decided on the location of hospital-
ization on the line of communications, ordered new construction, and
coordinated these projects with other activities.
Base and camy hospitals. — The first American Expeditionary
Force troops to arrive in France in any considerable number landed
at St. Nazaire in June. 1917. Hospitalization obligations at that
time, and for several months thereafter, were confined solely to
meeting the local needs of our troops in a fairlj^ restricted area.
Obviously, it was impossible to construct hospitals in time to meet
the immediate needs; therefore, the French were called upon and
willingl}" relinquished to us hospital accommodations such as they
had. wherever they were needed.
This process of acquiring hospitals from the French, or through
their agency of obtaining buildings suitable for hospital purposes,
continued over a period of many months. As our needs increased
and our troops became located over a gi^adually expanding area, it
became necessary, even in meeting normal needs, to increase these
demands on the French. The hospitalization acquired through these
means comprised schools, and even stables. AVhen the training areas
selected for our troops in the foothills of the Vosges were designated,
we were confronted with a new problem, as the French did not have
in those areas sufficient hospitalization available to meet our needs.
This made necessary the immediate construction of our own hos-
pitals, the needs being met by the establisliment of one of our type
B, 300-bed camp hospitals in each of those areas where hospitaliza-
tion did not exist. Thus was born our first construction program.
Coincident with the monthly arrival of large numbers of troops
from the United States, the acquisition of existing buildings for hos-
pital purposes was pushed to the utmost. Many of these when taken
over required alterations, additions, and repairs to render them
suitable for occupancy as hospitals. However, it was realized that
a limit soon would be reached beyond which the French could not
safely go without seriously jeopardizing the sufficienc}' of their own
hospital service.
In this connection it is well to direct attention to the fact that the
available buildings in France at this time which would answer the
purpose of providing hospital facilities were very limited. The
French Government had had first choice in the early days of the
A. E. F. — GENERAL STATE.
1449
war Later tlie British, Belgian, and Italian Governments had es-
tablished hospitals in France, and there were also a large number ot
hospitals maintained bv volunteer aid societies from different parts
of the Avoi-ld. The result was that at the time the Lnited States
embarked on its hospitalization program the available i-esourcesm
this direction had been almost completely exhausted. Those^ biiild-
ino-s which were obtained were generally of a most nnsatistactory
character very expensive to maintain, difficult to acbnmister, and
usually required an excessive number of personnel to properly op-
erate them. - ^11, Til
School buildings were among the first placed at our disposal by
the French Government. These were almost invariably unsatis-
factory Few of them had running water, sewer connections, or
toilet facilities. Under French law when school buildings are i-e-
quisitioned for military purposes the teaching personnel must be
allowed to retain their living quarters in the school. 1 he result
was that in the same buildings there would be wards for patients,
quarters for personnel, and living quarters for French civilians.
The first American military hospital established in France was
located in a school building in St. Xazaire. Under one roof here
was an American Expeditionary Forces hospital, a school for bo^s,
and living quarters for the American medical personnel and the
French teaching staff with their families. All were hope essly inter-
mingled, and at one time there was under treatment m this hospital
mealies, mumps, scarlet fever, and cerebrospinal meningitis. Proper
isolation of these contagious cases became a difficult matter.
In this comment there is no criticism either intended or implied.
The French o-ave freelv and jrenerously of the best of their hospitals.
While the F'l-ench had to submit to the same conditions regarding
the use of schools they were not confronted by the barrier of lan-
guage between hospital and school personnel, nor the countless petty
misunderstandings engendered thereby. i -i r „
In utilizing hotels as hospitals the objections to these buildmgh,
while serious, rested on other grounds. As shown above, practically
all the cood buildings obtainable had been taken over by the allied
governments. Those remaining were very largely summer hotels
without heating facilities, insufficient water, and very limited plnmb-
ino- In addition, when private buildings are taken possession ot tor
military purposes the owner is allowed .by law to reserve certain
parts of the buildinirs. and the law also requires that they shall be
returned to the owner in the same condition as when taJien out ot
his control. The latter provision necessitates refurnishing such
buildings at tremendous co.st and removing all improvements or addi-
tions which may have been installed. In spite of these many disad-
vantaf^es inherent in leasing or requisitioning private buildings no
other course was open. Building was out of the question unti an
oro-anization could be secured and personnel and equipment, includ-
ing sawmills, transported to France. As the avadable supply ot
biuldings, unsuitable and expensive as they were, was soon exhausted
it became necessary to institute a building program on a large scale.
A type A 1.000-bed barrack unit was adopted as the model for this
prot^ram Our first large venture on the construction of these base
hospital types was located at Bazoilles-sur-:Meuse, centering on our
trainino- area, and ideally situated as regards lines of communication
1450
EEPOET OF THE SUEGEOX GENERAL OF THE AEMY,
and prospective combat activities. Five units, or a total of 5.000
beds normal capacitv, were authorized for that place in September,
1917.
Up to the fall of 1917 no definite policy had been announced as to
what sector of the fiohting front the Anierican troops would even-
tually occupy. The absence of this definite information rendered it
extremely difficult to map out a comprehensive hospitalization pro-
gram. However, as we were expecting combat activity, and delay
could not be countenanced, it was necessary to proceed on the as-
sumption that our principal bases mu^-t be St. Xazaire and Bordeaux,
and our sector in the proximity of the training areas in which we
were already placing our troops. This afforded us a fairly well-
defined line of connnunication. and, as events later proved, our early
conjectures as to the sector on which our maximum combat efforts
would be put forth proved to be reliable.
The decision was soon reached to hospitalize along those lines of
communication, adhering as far as possible to a distribution of hos-
pital facilities which would approximately provide for 15 per cent
of our total beds in the advance section, 60 per cent in the inter-
mediate section, and 25 per cent in the base sections. Every possible
means of acquiring existing buildings, in order that accommodations
for meeting the needs of incoming troops could be assured, were
made, and at the time construction programs looking far ahead into
the future were pushed to the limit of our capabilities. Following
our initial effort at Bazoilles, sites were early selected and construc-
tion ordered at the following places: Eimauc'ourt. Bordeaux, Beaune,
Allerey, Mars, Mesves, Limoges, Perigueux, Xates, etc., on a pro-
gressive scale. The monthly status of total beds made available for
the year 1918, and during the height of our combat activities, are
shown in the following table :
Total beds.
Normal.
Emerg-
ency.'
Total
patients in
hospital.
Approxi-
mate
strength
A. E. F.
Jan. 31
1918.
9 377
Feb. 28
lo' 694
Mar. 31 .
22' 1''5
Apr.30
28' 090
MavSl
33' 077
June 30
39 713
Julv 31
58' 687
90,204
110,953
166, 534
171,830
Aug. 31
Sept. 30
Oct. 31
Nov. 11
37,086
42,815
75,793
102, 144
148, 596
221,421
233,092
5,091
4,960
10, 723
11,115
15,336
22,905
42,470
54,485
79,580
163, 767
169,235
315,788
251,889
318,621
439,659
651,284
873,691
1,169,072
1,415,128
1,705,392
1,807,143
1,870,257
1 Emergency includes normal.
The distribution and scope of hospitalization as they existed upon
the cessation of hostilities November 11, 1918, were approximately as
shown in the attached hospitalization pamphlets (Exhibit B).
A. TITE PROCESS OF REALIZING A CONSTRUCTION PROGRAM.
_ A suitable site was selec ted either by a member of the hospitaliza-
tion section of the chief surgeon's office, or the Fremh military
A. E. F. GEXERAL STAFF. 1451
authorities were requested to indicate where a hospital group might
be constructed in a given location. Through the French mission at-
tached to these headquarters, or the headquarters of the fourth French
bureau at Paris, we informed the French authorities of the size and
location of the hospital project. This was necessary because the
duty of coordination devolved primarily on the French, sometimes
tAvo or three activities seeking the same site. A conference was then
arranged between the American and French representatives, who in-
spected the site and submitted recommendations as to whether it
should be accepted or rejected. The American representation usually
comprised a member of the hospitalization section of the chief sur-
geon's office, a member of the general staff, G— i, a water and sewage
expert of the Engineer Corps, and a railroad transportation expert.
The French representatives practically^ represented the same services.
Upon the conclusion of this conference the French sent to the com-
numder in cliief, American Expeditionary Forces, their formal ap-
proval, or disapproval as the case may have been, of the project. As
a rule, our propositions met with approval, but m some instances,
where we were particidarly anxious to estal^lish extensive hospitaliza-
tion, notably in the Paris region and at Dijon, our applications were
disapproved.
With the approval of the French at hand for the construction of
a project, on the recommendation of the chief surgeon, American
Expeditionary Forces, the assistant chief of section 0-4, in usual
letter form, directed the comnumding general, Services of Supply,
to proceed with construction of so many units at a certain place.
The Engineer Corps, having been furnished a set of plans of types
A and B hospitals by the chief surgeon, American Expeditionary
Forces, then proceeded with the construction.
The chief engineer turned over considerable of this construction
to civilian contractors.
The sites on which hospitalization was establishd were leased by
tlie chief cjuartermaster. The acquisition of these sites was made
through andcable agreement with the tenants. Usually the land
involved was divided into five classes, depending upon the average
revenue derived from each class of land. As there were sometimes
hundreds of owners involved in accomplishing a lease for a single
hospital site, duplication of effort, payments, and records was
avoided by encouraging the tenants to give the local mayor, or his
representative, a power of attorney for all the land desired by the
American Expeditionary Forces. The cadastral holdings were then
grouped and leased from the ma^or, or his representative, in one
transaction. This greatlj' simplified our acquisition and seemed to
be particularly acceptable to the French tenants.
The above describes briefly the method which was gradually
evolved for initiating a building program in any given locality.
This procedure resulted from a joint Franco- American conference
held at the French mission in October, 1918, in which representatives
of the French and American general headquarters participated.
The French took a very immediate and active interest in the prose-
cution of our hospitalization program.
The acquisition of schools, hotels, and other buildings not previ-
ously occupied as hospitals was accomplished through leases ob-
tained generally through the intervention of a local representative
1452 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
of the French Army. Karely was it necessary to resort to military
requisition, althon<ih in a few isolated cases this had to be done.
Hotels. — Due to the inability to construct hospitals rapidly enough
to meet our needs, it became necessary to lease a considerable num-
ber of hotels for hospital purposes. These buildings generally Avere
very expensive, not onlv because of the high rate of rental, but
because of the necessity of replacing them in the condition in which
they were taken over, when no longer needed b}- the American Ex-
j)editionary Forces. The acquisition of this class of property was
postponed as long as possible, and was resorted to only as a measure
of absolute necessity. Seldom was a hotel found which could be
utilized in its present condition for hospital purposes. Removal
of many partitions, and modifications in plumbing, sewage, etc., to
render it habitable as a hospital necessitated not only the original
monetary outlay. Init a second outlay in restoring the Iniilding to
its original condition when evacuated for the purpose of returning
it to the owner. A considerable number of these hotels were built
for summer use only. It was necessary, of course, to use them dur-
ing the winter, and this entailed a certain additional expense through
the absence of heating appliances and the constant freezing of
plumbing.
Strategic fixed hospitalization. — In locating hospital centers, the
guiding principle should be establishment on or immediately oil the
main arteries of railway traffic, and preferably radiating from a
regulating station serving the forces at the front. In the advance
section our hospitalization was well located with reference to the
regulating stations of Is-sur-Tille and St. Dizier.
Unexpected combat activities of American troops on the Paris
front found us facing a difficult evacuation and hospitalization prob-
lem. This was due not only to the fact that we had insufficient hos-
pital facilities on the lines radiating from the regulation stations es-
tablished there, but to the necessity of cutting across the lines of
communication serving allied armies, in order that our hospital trains
might be sent to places where we had adequate American Expedi-
tionary Forces hospitalization. Despite the recommendation of the
Medical Department, hospitalization in the Paris region, except for
the Eed Cross military hospitals in the city of Paris itself, was de-
nied the American Expeditionary Forces. To evacuate to our avail-
able hospitalization from the regulating stations established at Le
Bourget and Creil during the Marne operations necessitated con-
siderable cross movements on railroad lines, that slowed up our
evacuation and serious interfered with the trains supplying and
evacuating other armies. In future operations tentative regulating
stations in the theater of operations should early be indicated by the
general staff, G-4, and the hospitalization for the forces mapped out
on lines in the rear, radiating from those stations. Without this
provision, an excessive number of hospital trains will always be
needed and unwarranted congestion of traffic lines result.
In locating base hospitals, from a railroad standpoint, it is as
stated above preferable to establish them on a branch line, slightly
off the main line of traffic. However, our hospital trains were so
large that this factor had to be taken into consideration in selecting
sites. Instances arose where an excellent site was available but could
A. E. F. — GEXERAL. STAFF. 1453
not be utilized because a bridge on the branch line to it did not pos-
sess sufficient strength to sustain a heavily loaded train.
From a strategic standpoint, the geographical location of base hos-
pitals in France was not "always ideal. The demands for hospital
accommodations were constantly so pressing that it became necessary
to accept any facilities that were available. This accounts for the
fact that a fairly good proportion of our hospitalization was estab-
lished in remote regions, yet still accessible to the uiain lines of
traffic, by long haids for hospital trains over branch lines.
AMierever hospitals^ can not be ideally located from the strategic
standpoint, the onl}' remed}' lies in the provision of a sufficient num-
ber of well equipped vestibuled hospital trains to permit of wounded
receiving every necessary care en route over the long hauls involved.
During the latter part of our combat activities properly equipped
hospital trains to meet all the needs were not available, but by \ising
American trains for the long hauls and the more seriously wounded,
and borrowing from the French some of their trains for the short
hauls and the moderately wounded, the situation was met in a fairly
satisfactor}' manner.
Bane hospital allowances. — The accepted shipping schedule called
for the dispatch to France of four base hospitals for each division in
France. Those first to arrive were organized and equipped in the
United States on a 500-bed basis. It soon became evident that this
was not an economical organization with which to meet the problem
presented in caring for the large number of sick and wounded cer-
tain to arise among our troops. Accordingly, recommendation was
made early to the War Department that they be organized and
equipped on a 1,000-bed basis. After the lapse of several months, this
increase in size was adopted for all incoming units. For some reason
not yet explained, our shij^ping schedule for base hospitals did not
progress smoothh'. Units failed to arrive, frequently being displaced
by combat troops, and often when they did arrive their equipment
was not received for many months afterwards. This created a very
serious situation, as at no time was our hospitalization maintained on
a safe margin. Our depots in France had been depleted and during
our final combat operations there were over 20 base hospitals in
France with complete personnel, but no equipment for them. Re-
peated cablegrams to the War Department, during the entire period
of our operations here, failed to bring about the desired result of
placing us on a safe hospitalization basis.
As a matter of muih interest, and to preserve historical accuracy,
it should be pointed out that had hostilities continued much longer
and casualties occurred at the same rate as in the concluding weeks of
our activities, the American Expeditionary Forces would have been
confronted Avith a situation of having on its hands more patients
than could possibly have been hospitalized.
This was due to a number of causes, the most important of which
were :
First, the original estimate of sanitary personnel requirements
was placed by the general staff, American Expeditionary Forces, at
a figure far below the actual needs. Second, failure to get to France
the limited authorized personnel and equipment provided for in ship-
l)ing schedule. Third, our own construction projects had been per-
1454 REPORT OF TH1-: SURGEON GENERAL OF THE -ARMY.
mitted to progress too slowly, and some of the work on them was of
such a makeshift character that the buildings could be utilized only
tem])orarily and would have become uninhabitable during the winter
months.
As it was, it became necessary to shelter thousands of our wounded
in unfloored and unheated tents. The general situation, from the
standpoint of hospital accommodations in the fall of 1918, was
fraught with great anxiety to those responsible for providing ade-
quate accommodations for our constantly increasing battle casualties.
The above is not offered in a spirit of criticism, but merely as a
plain statement of fact, and for future guidance.
H. EVOLUTION OF PLANS, SPECIFICATIONS, AND LAYOUTS FOR AMERICAN
EXPEDITIONARY FORCES HOSPITALS.
In the formative period of the organization of these forces it was
plainly apparent, as above stated, that if adequate hospitalization
facilities were to be proA'ided for our troops, a comprehensive, broad
construction program should be inaugurated at once.
To standardize and simplify constiuction, the liospital units were
designed on the principle of using only the 20 by 100 foot portable
huts, or any hut approximately those dimensions, obtainable in
Europe. These huts, frequently called barracks, had been in use by
the various armies in France, had proved satisfactory, and became
the backbone of our hospital construction program. A general de-
scription of one of the types of huts so utilized is given below.
In order to preserve symmetry and facilitate their assembly, it
was prescribed that huts, as far as possible, should all be of similar
design and dimensions in any one imit. The demand for these
gradually became so great that it was necessary to comb Qvevy avail-
able European market for them. As a result, a half-dozen different
types of hospital huts eventually came into use. Where local re-
sources permitted, and particularly in those units constructed by
French or English contractors, tile, brick and concrete material were
frequentty used, following the same design prescribed when the
wooden portable huts were utilized.
Eecognizing the shortage in material, and the great difficulty ot
obtaining in appreciable quantities many of the essential articles re-
quired in a great construction project of this nature, every conceiv-
able refinement was eliminated from these hospital units. Porches
were not included. Owing to the incessant inclement weather in
France, particularly in the territory in which we were required to
hospitalize, it was believed that overhead protection in the form of
covered passageways along the fronts of the ward entrances and con-
necting up the central group of clinical and mess buildings should
be provided. They were prescribed in the plans as finally adopted,
but were never installed in any of the units, owing to alleged scarcity
of lumber. In recognition also of the fact that adequate plumbing
material could not be obtained, the system of disposing of fecal mat-
ter by means of the i^ail method and incineration was also adopted.
To conserve the wear and tear on personnel and facilitate closer-
administrative control, the area to be covered by these hospital units
was reduced to a minimum consistent with safety.
A. E. F.— GEXERAL STAFF. 1455
To economize in heating, lighting, structural material, etc., and to
centralize and standardize the units, only 20 feet of space was allowed
between most of the buildings.
From an administrative and clinical standpoint this concentration
proved preferable, rather than objectionable. It increased the fire
risk, but, with suitable precautions, it should be stated that not a
single fire occurred in any of these units throughout France.
As eventually completed, the plans of both of our American Expe-
ditionary Forces hospitals were far from ideal, yet they possessed all
the practical features necessary to operate an efficient hospital and
perform in them as good work as could be done in institutions in the
homeland. In operation they met all requirements and as far as
known not a single criticism on their design was registered against
them.
When the plans were completed the general staff called for and
carefully examined them. After considerable difficulty and discus-
sion, they were approved and adopted by the general staff, Ameri-
can Expeditionary Forces, as originally prepared in the chief sur-
geon's office.
The approved plans were then furnished the chief engineer (Sept.
17, 1917), and from then on, to inaugurate a construction project, it
was onl}' nece.'^sary to send the commanding general. Services of Sup-
p\y, a letter prescribing the construction of so many type A or type
B units, as the case might have been, at a certain place (Exhibit E).
In this way all the hospitals constructed by us in France were of
a standard design. Soon after starting our construction program, the
general staff faced the prospect of being unable to have transported
to France, or to obtain here, sufficient building material to carry on
the many construction projects confi'onting these forces. Accord'
ingly, among others, and in an effort to retrench, the hospital plans,
the requirements of which, as above stated, we had already reduced
to the safest minimum, again came up for inspection by the general
stajff.
THE AJIERICAN EXPEDITIONARY FORCES TYPE B CAMP HOSPITAL UNIT.
Development of the plans for this hospital was accomplished in a
manner similar to that in the above-described type A unit. However,
us this type provided only the barest necessities from a hospitaliza-
tion standpoint, the plans remained unchanged, as further pruning
was not deemed by anyone as permissible. In general features, the
layout was similar to the type A unit. For typical layout see Exhibit
H. Our specifications required that a space 600 feet front and 600
feet depth should be reserved for these units. These were never
grouped, being located throughout France' wherever required to meet
the local needs of large commands, or large needs of small commands.
On the day the armistice was signed, November 11, 1918, there
were 66 camp hospitals in operation.
C. DEVELOPMENT OF HOSPITAL CENTERS.
The geometrical layout of the individual unit admirably fitted in
with any grouping scheme. For a typical hospital center layout see
Exhibit I. When a site capable of accommodating a number of the
1456 EEPOET or THE SURGEON GEXERjM, OF THE AEMY.
lype A units Avas selected, an initial survey, with particular refer-
ence to contours, was made b}' the Engineer Corps, and the grouping:
eventually adopted with reference to the most adaptable conforma-
tion to these contour lines. By doing this and bearing in mind that
the majority of the buildings were but 20 feet wide, a considerable
saving in ])iering material or excavation work was effected. The
location of the units, moreover, was nuide with a view to harmonizing
the administration of the center.
In consultation with those in charge of construction, representa-
tives of the chief surgeon's office worked out and adopted an ajipro-
priate laj'out for each center. The primary requisite was the de; ision
as to the location and adequacy of railroad sidings, all of which had
to be newly installed, and the frontage of units on these sidings.
The requirements for the administration and supply of these centers
were made by providing suitable systems; garages, storehouses, etc.,
also had to be installed. In fact, the larger centers, in some of which
we had projected a capacity of 20.000 beds, approximated the creation
of a veritable city with all its necessary requirements.
CONVALESCENT CAMPS.
"With the speeding up of troop movements, early in the summer of
1918. it was soon realized that fixed hospitalization, as its acquisition
was then progressing, could not keep pace with the arrival of troops.
To meet this situation it was decided to provide convalescent camps
in the vir inity of and as part of large hospital centers to which men
not yet fit for duty, but who no longer required careful hospital treat-
ment, could be sent pending their fitness for return to duty. In these
camps they were provided with shelter, with limited bed space, but
good food, and given a certain amount of work and exercise to fit
them for their forthcoming duty. G^, in a letter dated June 1, 1918,
authorized the construction or establishment of tentage of these con-
valescent camps, on the ratio of 20 per cent of our total bed capacity.
Many of these camps were in operation upon the conclusion of hostili-
ties on Xovember 11. 1918. and it was through their operation only
that we were able to provide accommodations for the battle casualties
occurring during the summer and fall of 1918.
Aside from the necessitj' of providing in these convalescent camps
adequate shelter, food, etc., the essential points to be borne in. mind in
establishing them are :
First, the}^ must be Medical Department units. Second, the neces-
sity of removing men who are almost well and face early return to
combat duty from the atmosphere of the hospital at the earliest pos-
sible moment. Third, the most careful selection of medical officers
qualified to carry on mental and physical reconstruction of men who
have once been subject to the nervous shock and physical damage
wrought by combat. Fourth, there unquestionably l^eing a psycho-
logical element in the reconstruction of these men, the assignment of
bands and other means of providing music and entertainment at
these convalescent camps must be recognized. It has been the experi-
ence of our Allies, extending over a much longer period than our
own. that a good band is of the first importance in restoring the
moral fiber in a man who has been shaken bj' the ordeal of battle.
A. E. F. GEXEEAL STAFF. 1457
D. AMERICAX RED CROSS MILITARY HOSPITALS.
The establishment of these hospitals might properly be character-
ized as " camouflage " American Expeditionary Forces hospitaliza-
tion. The designation of these hospitals was one of necessity. During
our operations in France there were certain regions where hospital-
ization was absolutely essential, from a strategical standpoint. In
these areas we were denied by the French authorities the privilege
of establishing American Expeditionary Forces hospitalization, but
on account of its affiliation with and the great assistance rendered by
it to the French nation, the American Eed Cross was given this
privilege.
AJXERICAX RED CROSS HOSPITAI.S AND CONVALESCENT HOMES.
These facilities provided by the Red Cross were an asset in the
hospitalization scheme of the American Expeditionary Forces and
were operated on our recommendation. They provided for civilian
hospitalization, and at the same time wherever located were avail-
able to us for emergency military hospitalization. The convalescent
homes Avere established in watering places and mountain resorts.
To them we were able to send our convalescents for recuperation,
thus greatly expediting their return to class A combat condition.
They served a ver}^ useful purpose and, as a military asset, their
establishment should always be encouraged,
DETAILED NARKATI\^ OF AMET{ICAN RED CROSS HOSPITALIZATION AND RELATED
ACTRITIES OF THAT SOCIETY IN THE AMERICAN EXPEDITIONARY FORCES.
During the earh' period of the development of the American Ex-
peditionary Forces American Eed Cross hospitals played a very im-
portant part in the care of our sick and wounded. For that reason,
and also that there may be a record of the very valuable assistance
rendered by the Red Cross, this subject is treated below in some
detail.
From the beginning of the war the American Red Cross had ren-
dered vital aid to the French War Department. The scope of its
work became very greatly augmented upon the entrance of the
United States into the war.
One of its first endeavors at this time was the taking over of the
American ambulance. As has been explained elsewhere, this insti-
tution was organized by the American colony in Paris shortly after
the beginning of the war. The French Government furnished the
building, a partially completed school located at Neuilly, a suburb of-
Paris. The equipment and maintenance of this ambulance (or hos-
pital) was assured by voluntary contributions from the American
people. The professional personnel was composed of eminent Ameri-
can surgeons who served without compensation. The hospital
developed into a splendid institution, capable of accommodating
1,000 patients. It received only French wounded. Without doubt,
there was not a better institution of its kind in Europe at the time
the headquarters of the American Expeditionary Forces arrived in
France. The hospital was not onlv perfectly equipped, but it had
provided in addition an efficient ambulance service and the most
complete hospital train at the service of the French Government,
1458 REPORT OF THE SURGEON GENERAL OF THE ARMY. "
In July, 1917, the Eed Cross beoan negotiations for the taking
over of the snpi)ort and nianagenient of the hospital. On July 20,
1917, General Order 17, American Expeditionary Forces, accepted
the hospital from the Red Cross and its designation became Ameri-
can Red Cross J^Iilitary Hospital No. 1. It had, however, been stipu-
lated in this transfer of control that it should continue to receive only
French soldiers. The hospital was placed under command of an
officer of the Medical Corps of the Army and graduall}^ the volunteer
personnel was replaced, very largely by officers, nurses, and enlisted
men of the Army.
In preparing a hospitalization program for the American Expe-
ditionary Forces the chief surgeon was instructed by the commander
in chief that no American Expeditionary Forces hospitals should be
located in Paris. This was apparently due to the desire of the com-
mander in chief to reduce the number of Americans in Paris to the
absolute minimum, and also to the belief that the American sector
of the line would be so far to the east that hospitals in Paris would
not be needed. In spite of the intention to maintain only a very
small garrison in and about Paris, it early became evident that a
very considerable number of men would always be stationed there.
At first arrangements were made with the French to hospitalize our
sick in French military hospitals. The differences, in standards of
hospital care, the barrier of language, and the inability to get accu-
rate records of cases admitted produced a most unsatisfactory situa-
tion. Owing to the prohibition mentioned above no American Ex-
peditionary Forces hospitals could be established in Paris and it,
therefore, became necessary to appeal to the Red Cross to provide
additional hospital facilities. This was done and a number of so-
called Red Cross military hospitals were opened under that designa-
tion, although the personnel of the various staffs was almost entirely
furnished by the Army.
In the meantime the provision of American Expeditionary Forces
hospitals progressed according to the approved program. These
hospitals were located at the base ports, along the lines of com-
munication, and in the advance area in the general vicinity of the
Toul and Verdun sectors.
Early in the spring of 1918 the 26th Division was sent into the
trenches in the Soissons area. This part of the front was so far
removed from that which it was considered would become the Ameri-
can sector that it became necessary to make provision for the hos-
pitalization of our sick and wounded in an area where no xVmerican
Expeditionary Forces hospitals existed. In this emergency the
French were appealed to and permission was given by them to send
our patients to Red Cross Military Hospital No. 1, in Paris. This
was a most generous act on the part of the French inasmuch as it
closed to them the best-equipped hospital in France. It ^also relieA'ed
the American Expeditionary Forces and the Red Cross of the ob-
ligation entered into with the French of maintaining this hospital
exclusively for French patients. The French service de Sante took
the broad ground that inasmuch as the 26th Division was going into
the line as part of a French corps it was their duty to provide the
necessary hospitalization. While this was made as a temporary ar-
rangement, it may be noted that this hospital from this time on, to
the close of the war, received almost exclusively xA.merican patients.
A. E. F. GENERAL. STAFF. 1459
The German offensive of March 21, 1918. had mdirectlj' a far-
reaching influence on the hospitalization program of the American
Expeditionary Forces. Following this offensive, the American di-
visions available were placed by the conmiander in chief at the dis-
position of the French. In the next few months, American Expedi-
tionary Forces divisions were serving with French armies all along
the western front. The French had agreed to assume the care of all
battle casualties. The American Expeditionary Forces divisional
sanitaiy formations under this agreement were to evacuate directly
to French evacuation hospitals, from which evacuation would be
made by French hospital trains to French hospitals in the zone of
the interior.
It fell to the lot of the 1st Division to operate first under this
agreement. In April. 1918, this division was moved from the eastern
part of the line to Chaumont-en-Yixen. A little later it went into
line north of Beauvais and northwest of Montdidier, and on May
28, 1918, the successful operation known as the Cantigny fight took
place. During this operation the divisional field hospitals were well
installed and well equipped and fulfilled their functions in an ex-
cellent manner. From that point on difficulties began to occur. The
wounded were very much dissatisfied with the care received in
French hospitals. The difference in language caused friction, and
evacuation in the wretchedly equipped French hospital trains caused
further hardship. A very serious administrative difficulty arose
through the fact that French hospital trains were distributing
American patients to French hospitals from one end of the country
to the other. These patients were lost sight of for months at a time.
Deaths occurred which were not reported for excessively long periods
of time. Nothing but an emergency of the gravest nature could
justify the continuance of such a method.
With a view to remedying this condition, permission was requested
of the French to install an American Exj^editionary Forces evacuation
hospital at Beauvais. The American Expeditionary Forces had no
such hospital available at this time. Instead of having the two per
division allowed by tables of organization (A. E. F. ) there was less
than one-quarter of one such hospital for each division in France.
However, more such units were expected daily from the United
States and it was hoped one or more would arrive in time to meet
our needs. Temporarily, the whole question was taken out of our
hands by the French decision that no American Expeditionary Forces
hospital could be established in the rear of this (the 1st) Division.
At the time, this decision appeared to be arbitrary and unfair. In-
vestigation showed, however, that it was an unavoidable conclusion
on the part of the French. It was purely a question of railroad
transportation. An evacuation hospital at Beauvais would have
meant American hospital trains for moving patients from that hos-
pital to the base hos[)itals in the interior. Such trains would have
-ct up cross currents of travel and would have required practically
a separate line of communication for the service of a single division,
comprising only a single element of a French Army. This was
clearly impossible. The French made a counter proposition to per-
mit the Eed Cross to establish a hospital in Beauvais, this hospital
to receive only American patients, but to have a French officer in
142367— 19— VOL 2 31
14G0 EEPOKT OF THE SURGEOX GENERAL OF THE ARMY.
conimund and to be evacuated by French hospital trains. This prop-
osition was accepted as otferiD<r the only possible solution. While
it did not permit tlie collection of American patients in American
base hospitals, it did insure that the first suraical care was obtained
in an American hospital with American personnel. Later an agree-
ment was made Avhereln- all French hosj)ital trains with American
Expeditionary Forces patients were stopped near Paris and these
patients removed and transported b}'^ ambulance to our Paris hos-
pitals.
Ihis militarized Bed Cross hospital at Beauvais was the first
institution of the kind established in the zone of the Army. Its
personnel was very largely made up of officers and enlisted men
of the Medical Department. It served to fill a very urgent need,
and did splendid work. Because the establishment of so-called Red
Cross hospitals in the zone of the Army was a radical departure from
the generally accepted sphere of usefulness of such institutions the
cii'cumstances surrounding the inauguration of such a policy have
been given at some length. As has been shown, the two impelling
motives for adopting this solution were, first, that the French rail-
way transportation lines would not permit of 1 aving two parallel
sj^stems of evacuation going on over the same railway line, partic-
ularly on an active front, and second, the failure of arrival in France
of the authorized evacuation hospitals, and the shortage of personnel
and material caused thereby. (It may be added here that never up
to the time of the armistice was there more than '25 per cent of the
authorized allowance of these units.)
The end of JNIarch and the months of April and May were dark
daj's for the allied cause. The German lines were steadily nearing
Paris. American divisions were being concentrated both to the north
and east of Paris, but the larger number to the northeast of that
city. This was a cause of grave uneasiness, for the reason as stated
above that no hospitals had been provided in Paris except the mili-
tarized Red Cross ones. As early as April 8, 1918, a member of this
section went to Paris and assembled the commanding officers of these
hosi^itals in conference with Maj. , Quartermaster Corps,
Reel Cross commissioner for Europe, and pointed out to these officers
the possibility that the Paris hospitals might have to serve as evacua-
tion hospitals, in which case they would receive wounded directly
from the battle field by ambulance.
Insti-uctions were given to expand each hospital to its maximum
or crisis capacit}', and to so organize it that it could receive, operate,
and evacuate up to the limit of its possibilities.
The Red Cross was also asked to put up a large tent hospital on
the Auteuil race course, in the Bois. Paris. This was agreed to by
Maj. and work was commenced as soon as the necessary
permission to occupy the ground could be obtained from the French
authorities.
On the 30th of May. 1918, the 2d Division was being assembled at
Chaumont-en-Vixen, northwest of Paris, and received orders on that
day to be prepared to move into line the next day, ostensibly to re-
lieve the 1st Division at Cantigny. In the meantime, the situation
created by the German advance to the Marne at Chateau-Thierry
produced a most critical situation. The orders of the 2d Division
were hastily changed on that day, directed this division to proceed
A. E. F. GENERAL STAFF. 1461
with all haste to Meaiix, to the east of Paris, and to take position
across the Chateaii-Thierry-Meaiix road. By the 2d of June this
division was heavily engaged and casualties were occurring in large
numbers. The French, who under the agreement referred to above
were to hospitalize and evacuate our wounded, found that the}" were
in no position to do .so. Their army in that sector had been forced
back and the finest evacuation hosjjitals they possessed, totaling some
45,000 beds, had fallen into the hands of the enemy. Evacuation
by hospital train was out of the question because of the congested
condition of the railways, incident to supplying the forces engaged.
The result was that evacuation by ambulances into the city of Paris
offered the only possibility of clearing the battle field.
Fortunately, there was a small hcspital at Juilh^, about halfway
between Paris and the front. This hospital had been organized and
supported by of Xew York, and functioned only for
French j)atients. In our extremity, it was taken possession of and
the I\ed Cross were appealed to to enlarge by means of tents as
rapidly as possible. A limited amount of additional personnel was
provided and this formation was designated for the reception of
the niofet seriously wounded. Its personnel performed prodigies in
the next few days, but not more than 25 per cent of the number
needed could be furnished.
Ambulances were very scarce. Ever}' available vehicle in the
American Expeditionary Forces, including trucks, were put to work.
All the Red Cross ambulances in Paris were secured, and a few
French, and for a week these vehicles were running night and day
between the front and Paris in the effort to keep the battle field
cleared. The distance involved in the round trip was about eight
miles. Half of the distance was over rough cobbled roads. These
hospitals in Paris were poorlv adapted to meet this emergency, yet in
some way each convoy of wounded was absorbed, operated, and
rapidh' evacuated by hospital trains into the interior. Medical of-
ficers, nurses, and enlisted men worked continuously for 72 hours
without sleep, and with but very little food. All in all, it was one
of the most remarkable achievements of the war. There was no
doubt but that the wounded lacked in some respects the care which
they should have received. Also, there is no doubt that the long
ami)ulance trip from the front destroyed or reduced the chances of
recovery in some of the more serious eases. It could not have been
otherwise when the lack of personnel and equipment (ambulances
and evacuation hospitals) is considered. The point to be emphasized
at this time is that the only hospitals which could be reached were the
Red Cross hospitals of Paris. Without them, it is difficult to con-
ceive how the situation could have been handled.
AVhile the 2nd Division was first holding the enemy, and later on
in this first week of June, driving him back foot l)v foot toward
Chateau-Thierry, other American Expeditionary Forces divisions
were being brought into this sector. It was absolutely essential that
hospitalizations should be provided in this area. There were not
siiffifient evacration hospitals available in France to meet the needs
of this and other sectors, so again the Red Cross was called upon,
and again hel]) was obtained. A French hospital at J()uy-sur-]Morin,
south of Chateau-Thierrv. was o])tained and bv the addition of
1462 rp:port of the surgeon general of the army.
tentrtge a veiy complete and well equipped unit was rapidly installed.
The personnel was mixed; that is, botii Army and lied Cross. As
was the case in all these hospitals of this type, an officer of the Army
Medical Corps was in connnand and all of the connnissioned per-
sonnel were of the Medical Corps. This particular hospital was first
called Militarized Red Cross Hospital No. Ill, and later, with prac-
tically the same personnel and equipment, became Evacuation Hos-
pitalXo. 114.
Fortunately, about this time a few evacuation hospitals arrived
from the United States. The first to reach this sector was ]So. 7.
A site for it on the grounds of a chateau in the outskirts of Coulom-
miers was secured and with the addition of Mobile Hospital ^o. 1,
also just become available, began to receive patients about the 13th
of June. In the next six weeks these two units, combined and func-
tioning as one, handled and evacuated 27,000 casualties, an achieve-
ment probably not surpassed by any similar unit during the war.
Later or during the latter part of July, one more militarized Red
Cross hospital for the advanced area was organized in this same
sector. This hospital Avas laiown as No. 110. Both of these units
were later moved to the west, one participating in both the St. Mihiel
and Argonne-Meuse offensives, and the other in the latter. Both
functioned as evacuation hospitals and both did most excellent
work.
As more and more American Expeditionary Forces divisions
became engaged the problem of adequate hospitalization and evacua-
tion became increasingly difficult. Evacuation hospitals, while never
adequate, began to arrive and ever}' effort was made to provide units
of this kind for duty with the different divisions engaged.
The American Expeditionary Forces divisions placed at the dis-
position of the French were moved here and there with little or no
advance notice furnished these headquarters. The necessity of
secrecy was also a factor in complicating the problem of providing
adequate evacuation hospital facilities. This was particularly true
of the allied offensive beginning July 18, 1918, when surprise was
depended upon to play a most important part. Neither the French,
nor the American Expeditionary Forces medical service was pre-
pared to meet the situation created at this time.
Criticisms were many regarding the lack of proper care of
wounded, and slowness in evacuation. There was no doubt as to
the truth of these charges but a thorough investigation made by the
inspector general's department showed conclusively that this condi-
tion was not due to Medical Department failure, but to other causes
entirely outside of its control or power to remedy. The principal
factor in contributing to the creation of this situation was the lack
of advance information from the French as to the movements of the
American Expeditionary Forces divisions. After the experience
mentioned above, attending the resumption of the offensive by the
Allies on July 18, serious Medical Department breakdown was nar-
rowly averted on several occasions and this by good luck rather than
by good coordination.
This situation had become so acute that under date of August 21
the commander in chief informed the French by letter that in the
future he must be furnished information regarding the movements
of American Expeditionary Forces divisions, in order that suitable
A. E. F. GENERAL STAEF. 1463
arrangements for the care of, and evacuation of, battle casualties
might be insured. From this time on the care and evacuation of our
wounded was very good and worked smoothly. While a little later
the American Expeditionary Forces was given a definite sector, a
number of divisions continued to operate exclusively with our Allies.
Because of the Aery great shortage of personnel and evacuatipn hos-
pitals, this distribution of American Expeditionary Forces divisions
along the whole western front very seriously complicated the problem
of this section. Nevertheless, the situation was met and with a very
considerable degree of success.
In the zone of the interior the Red Cross organized a very con-
siderable number of hospitals, convalescent homes, homes for nurses
on sick or convalescent leave, and dispensaries. In addition, large
quantities of medical supplies, consisting of drugs, instruments, hos-
pital equipment, etc., were supplied the American Expeditionary
Forces. Under an agreement made between the chief surgeon and
the Red Cross a factor}^ was established by the Red Cross which
manufactured the thousands upon thousands of splints used by the
Army, and a second factory was provided for the manufacture of
oxygen and nitrous oxide gases.
Through the acceptance by newspaper correspondents and writers
in general of the term "Red Cross" as indicating all personnel and
equipment which is employed in the care of sick and wounded, an
erroneous impression has grown up that the Red Cross Societ}^ has
had complete charge of all medical work, including hospitalization
and evacuation of battle casualties. This is to be deplored. The
work of the Red Cross had been so splendidly conceived and exe-
cuted that onlj- harm can result, through forcing upon this society
credit for lines of endeavor which were outside its sphere and
activity. It was only natural perhaps that the newspaper corre-
spondent seeing the Red Cross markings on ^Medical Department
ambulances, hospital trains, etc., should conclude that they were
agencies of the Red Cross Society'. It was unavoidable, therefore,
that adverse criticism developed. The Red Cross activities have been
of far-reaching scope and of the greatest service in alleviating the
suffering of our sick and wounded and the society should not be
humiliated by the extravagant claims of misguided publicists.
The Red Cross functioned under many difficulties, not the least of
which was the prevalent misconception of the role to be played
by this organization in time of war. The law has plainly indicated
the sphere of activity of the Red Cross and has provided that in time
of war it shall become a part of the Medical Department of the
Army. It is also specified that only through this organization can
any other volunteer societies furnish aid to the troops. That this
was not understood was shown by the fact that in organizing these
headquarters the Red Cross was classed with the Salvation Army, the
Knights of Columbus, and all other aid societies associated with the
American Expeditionary Forces. The activities of all these organi-
zations were placed under G-1, general headquarters. In spite of
frequent protests by the chief surgeon this organization persisted up
to the end of hostilities. The anomalous situation was presented of
the ]Medical Department functioning through G^, while the Red
Cross, a constituent part of the Medical Department, was required
to function through another section of the general staff which had
1464 REPORT OF THE SURGEOX GEXER.VI. OF THE ARMY.
no connection witli, or knoAvledge of, its activities. The result of this
orizanization was to delay business. It can be justified on no known
grounds of military ortranization. It is noted here as an error which
sliould never be repeated.
:M0IUI,E SAXriAKV formations ACCO>rPANYINO THK ARMIES IN THf: FIELD.
These included: (1) Field hospitals, (2) mobile hospitals, (3)
evacuation hospitals, and (4) Eed Cross hospitals.
E. FIELD HOSPITALS.
There are four (three motorized and one animal-drawn) for each
division, equipped and organized according to existing tables, as
part of the divisional sanitary train.
P^acli corps sanitary train has three motorized field hospital com-
l^anies. provided by withdrawing them from depot and replacement
divisions.
The Army sanitarj' train has four motorized companies, shipped
direct from tlie United States as Army troops.
Owing to shortage of equipment and transportation, many of the
corps and Army field hospitals did not become available for use until
the concluding phase of our combat activities.
The location of the division field hospitals devolved upon the
division surgeon, of the corps field hospitals, upon the corps surgeon
in consultation with the Army surgeon, and of the Army field hos-
pitals, the Arni}^ surgeon.
In each group of four field hospitals two of them were operated
as previously equipped. To one of the field hospitals it was neces-
sary to add extra bedding and a mobile surgical unit in order to
provide proper hospitalization for the wounded who could not, with-
out endangering their lives, withstand transportation to other for-
mations in the year. It is conservatively estimated that this pro-
vision of a division field hospital for nontransportable cases resulted
in a saving of the lives of 50 per cent of those properly belonging to
this category.
It also became necessary to meet another requirement of modern
warfare by providing the remaining field hospital in the divisional
train with material for the treatment of gas casualties. Shower
baths, new clothing, and requisite chemicals were provided for these
hospitals.
The subject of " triage " and specialization of services, as conducted
in these hospitals, is a strictly professional matter and does not re-
quire description in this report.
The efficienc}' of our field hospitals, particularly those belonging to
the corps and Army trains, was seriously impaired through lack of
motor transportation prescribed for them in the tables of organiza-
tion. The so-called method of pooling transportation resources re-
acted to the great disadvantage of the wounded, in that the Medical
Department, under it, did not ]>ossess the mobility to quickly meet
the changing conditions of combat activities. In future operations,
if it is deemed impracticable to assign to the Medical Department the
full allowance of transportation needed by it to properly function, a
minimum Medical department " pool," under its exclusive jurisdic-
A. E. F. GEXEEAL STAFF. 1465
tJon and sufficient to provide for the movement of at least one com-
plete company in a sanitary train, should be allowed.
The field hospital has justified its existence and while its equip-
ment needs some modifications in the light of our ..ecent war experi-
ence, its general organization and functions have been found to i-est
on sound military principles.
If the use of lethal gases is to be sanctioned in future wars, pro-
vision must be made for modification in the equipment of one of the
field hospitals to meet this special requirement.
The increasing use of high-explosive projectiles, and the mutilat-
ing character of the wounds produced by them, will also necessitate
the addition to the equipment of one of the field hospitals of extra
surgical material, to properly care for the stricth' nontransportable
cases.
r. :mobile hospitals.
The mobile hospital is a new type of unit in our service and wfi.^
adopted by the Medical Department as a result of the experience of
our Allies in this war. These units were designed in order that facil-
ities for competent and immediate surgical aid to the seriously
wounded might be brought to the patient close to the battle line, in-
stead of removing any chance of recovery that the nontransportable
man might have by conveying him an uncertain distance to a hos-
pital in the rear. It was moved by truck transportation, and with
its complete ecjuipment provided a modern surgical hospital of 120
beds. The operating features provided modern facilities for six
surgical teams. The special type of tentage and material needed
for the equipment of these units was obtained in France through con-
tracts ])laced with the French. It was our aim to provide these
hospitals on the ratio of one for each combat division. Upon the
conclusion of hostilities we had in operation 12 complete units.
These were Army units and utilized wherever needed bv the chief
surgeon of the Army concerned. These mobile hospitals, through the
results achieved in their operation, have fully justified their existence
and should be provided for in future tables of organization as filling
a very important role in combat hospitalization.
MOBILE SURGICAL XJXIT.
The adoption of this unit was also the outgrowth of our experience
during the present war. This formation enabled us to provide
portable sterilizing, X-ray, electric-lighting facilities, and a small
operating room for divisional, corps, or Army field hospitals, thus
enabling them to carry on their surgical operations on the nontrans-
portable wounded. They should also be retained in our equipment
manual and transportation provided for them in the tables of organi-
zation, on the basis of one per division.
G. EVACUATION HOSPITALS.
These hospitals are the backbone of all combat hospitalization.
Previous to our operations here, existing regulations prescribed that
they should be operated as lines of communication formations. This
provision was soon recognized as a tactical mistake, and under orders
1466 REPORT OF THE SURGEON GENERAL OF THE ARMY.
issued by G— t at those headquarters, they were divorced from ser\-
ices of supply control and made Armv units (composite layout of
A. E. F., E. H.).
If they are to properly function the location of these hospitals is
a matter of the utmost importance. Their primary function is indi-
cated b}' their name. Aside from the small percentage of very seri-
?usly wounded who must be hospitalized in them because they can
not withstand transportation to the rear, evacuation hosi^itals are
merely relay or clearing stations in the hospitalization and evacua-
tion chain of an army. Accordingly, they must be located on or
near standard-gauge railroad sidings readily accessible to hospital
trains. This permits of a steady stream of evacuation from them to
the base hospitals in the rear, which are designed for the definite
treatment of wounded.
In estimated total bed resources the temporary accommodations
provided in evacuation hospitals should never be included. A patient
admitted to and occupying a bed in an evacuation hospital in the
morning may, and probably will, be evacuated b}' hospital train to a
base hospital in the rear and occupy a bed there on the night of
the same day.
During extensive operations the location of evacuation hospitals
away from railheads is a tactical blunder. Even when troops are
moving forward, from a practical standpoint much more efficient
results are achieved by retaining an evacuation hospital at the rail-
head and transporting the wounded even a great distance to that hos-
pital than by moving the evacuation hospital, thus separating it
from sources of supply and necessitating evacuation of postoperative
cases to railheads by ambulance.
According to the shipping schedule these hospitals were to be auto-
matically provided at the rate of two for each division. This pro-
gram was never realized and at no time during combat activities did
we have at hand a sufficient number of these important hospitals
equipped and efficiently functioning. As prescribed by tables of
organization each provided a bed capacity of 432. To meet the vary-
ing conditions of static and mobile warfare, it was recognized early
in our operations here that they should be organized on a 1,000-bed
basis.
Anothei- factor in actuating this increase in the capacity of the
evacuation hospitals was their failure to arrive, as provided for in
the shipping schedule, and the urgent necessity of more than doub-
ling the capacity of each hospital. In no other way was it possible to
care for and evacuate battle casualties. Eventuall3% this organization
was adopted for units arriving from the United States, as a result
of cabled representations made from this side. This 1.000-bed ca-
pacity was tentatively divided into two sections, first, a mobile sec-
tion of 500-bed capacity, consisting only of the essential equipment
and providing folding cots; second, a semi-fixed section containing
beds, mattresses, and a more liberal hospitalization equipment for a
similar nimiber of beds. The mobile section was provided with tent-
age and whenever transportation was available could be quickl}^ lo-
cated wherever needed. The fixed section was usually installed in
such buildings as could be found for shelter, being moved to take
its place alongside of the tented mobile section when transportation
bv rail or truck became available.
A. E. F. GENERAL STAFF. 1467
Annexes of these evacuation hospitals were operated for special
treatment of gas, neurological, contagious, and other cases.
RED CROSS HOSPITALS.
These hospitals Nvere permitted to function in the zone of the
armies onl}' through urgent necessity. The Medical Department was
at all times so short of material that it became necessary in emer-
gencies to call upon the Eed Cross to furnish tentage, equipment, and
some personnel to meet our needs. These hospitals functioned in the
same manner as our own evacuation hospitals and under the com-
mand of an officer of the Medical Department. They rendered ex-
ceptionally efficient service. Two of them were utilized during the
Chateau-Thierry operations, and two during the St, Mihiel-Argonne
offensives.
Other Agencies, Relatixg to Hospitalization or Evacuation,
Established or Organized in the Zone or the Ar:mies for the
Service of an Army or Group of Armies.
h. medical department concentration area.
The establishment of these areas is an important link in meeting
hospitalization and evacuation demands incident to combat activities.
Under conditions existing during operations in France the Medical
Department mobile formations belonging to the arndes were landed
at base ports and dispersed to various localities in the Serxices of
Supply for the purpose of securing equipment. After being
equipped, there arose the problem of securing transportation to, and
a location for them in, the combat area. To bridge this gap we soon
faced an urgent need for the selection and designation of a place
properly located in the zone of the armies, to which incoming sanitary
formations, particularh' evacuation and mobile hospitals, ambvdance
companies, surgical teams, and other auxiliary personnel and equip-
ment for front line work could be sent for the purpose of mobiliza-
tion, equipment, training, and assignment.
Accordingly, upon our recommendation and with the approval of
the French, a Medical Department concentration area was desig-
nated and set aside at Joinville, Department of Haute Marne, for
the exclusive use of sanitary formations. This area comprised ap-
proximately 25 square miles, and contained 9 villages which afforded
billeting capacity for about 500 officers and nurses and 10,000 en-
listed men. From it good roads led to all parts of the American
front, and the distance was such that any sector could be reached
b}' motor transport in only a few hours. In addition, it Avas lo-
cated on several railroads which admirably served for the purpose
of assembling the units arriving from base ports and their distri-
bution by rail to the remote parts of the front if the need should
arise.
Prior to the establishment of our concentration area at Joinville
we lacked the means of providing for reserve units, and keeping
in close supply liaison with the armies. Xone of the sanitary forma-
tions temporarily kept there were established for the purpose of
receiving patients. It was our aim, however, to have one of each
1468 REPORT OF THE SURGEON GE^;ERi\X, OF THE ARMY.
type of unit set up from time to time in adjoining fields for pur-
poses of demonstration and training. In order that trained units
so held in reserve might be thro^vn in behind any part of the line,
as dictated by the necessity of the military situation, geographic
proximity, and good roads with adequate railroad facilities are im-
portant factors in determining the location of a concentration area
of this character.
The operation of these areas is somewhat as follows: The per-
sonnel of all Army and corps mobile sanitary formations upon
arrival at a base port are sent dire t to the area. A supply depot
is established in the area, with sufficient material on hand at all
tim&s to fully equip these units as they arrive. After equipment
has been turned over to the unit, the personnel is given a quick course
of training in the demonstration hospital established there. In
other words, they are given a working view of the equipment and
functions of the various types of hospitals they are to operate in the
field. Being established at a central but advance point immediately
behind the zone of operations, these mobile formations, by use of
truck transportation, can be quickly moved to any part of the line to
meet emergencies.
These areas also provide for '" rest periods " for the personnel of
mobile formations engaged in active operations, and afford an op-
portunity for overhauling and repair of equipment. Overworked
personnel can be sent back to the area for much needed rest, being
replaced b}' fresh personnel from the area, without requiring any
changes in transportation or equipment.
The value of these areas was so amply demonstrated, even during
the brief period in which the Joinville area was operated, that the
necessary " overhead " for their establishment in future wars should
be authorized in the tables of organization.
I. CONVALESCENT DEPOTS.
The need for these units in an army, as part of an army organiza-
tion, had long been reccgnized, but owing to the scarcity of person-
nel and material it Avas impossible to proceed with their establishment
until the concluding phase of our combat activities. When the
armistice was declared the Medical Department was in the process of
establishing one of these large depots at Rivigny for use of the First
i^rmy.
These convalescent depots must not be confused with convalescent
canips operating in conjunction with the large hospital centers in
the rear, or Services of Supply, A constant and serious strain was
thrown upon our evaluation service, as represented in hospital trains,
through the fact that in our efforts to keep sufficient beds available
in eva nation hospitals it bevame necessary to evacuate to distant
points in the rear the slishtly wounded as well as sick, even though
they showed a reasonable expectancy of returning to duty within a
few days.
In all operations, provision should be made for the hospitalization
of these classes of cases as near the front as possible, thus conserving
duty. In no other way can the combatant strength of our forces be
preserved. Experience has shown that the constant depletion of
effectives from this cause will take place much faster than these
A. E. F. — GEXEEAL STAEF. 1469
losses can be made a'ood by replacements. This is particnlarly true
when troops are operating at a distance far removed from tlieir
bases, with but few railway lines and limited rolling stock. The
situation i:)rodnced by this condition was so serious during the latter
part of the Argonne-Meuse operations as to cause the gravest con-
cern.
Slightly wounded and sick, and those cases no longer requiring
careful hospital treatment, but still needing a few days' rest before
they are fit for restoration to combat duty, must not be permitted to
occupy valuable spa^e in evacuation hospitals. On the contrary, foi-
the reasons above given, they should not be evacuated to the rear.
Therefore, the solution of this problem is the establishment of these
con^■alescent depots. One for each Army at the front should be
authorized and no restrictions as to size placed upon it. Its mini-
mum capacity should never be permitted to fall below 3.000. Shelter
should be provided by use of tents or existing buildings, or if time
will permit and the operations are of a fairly static character, by
hut construction. The essentials needed are proper sleeping accom-
modations-— which can be provided by the use of cots — and good
food, exercise, and such work as the officer in charge may prescribe.
During times of unusual combat activity, slightly wounded and
sick should be diverted as quickly as possible from " triage " to these
depots, such minor surgery as may be necessary in the form of dress-
ing, etc.. to be performed there by providing the depot with one or
more mobile surgical units.
The location of a convalescent depot is important. It should be
readily accessible from the front and the evacuation hospitals serv-
ing that front, and at the same time be in proximity to a replacement
or depot division, in order that the men freed for duty may be re-
turned to their organizations through a replacement organization for
the purpose of reequipment and coordination of records. Future
tables of organization should make pro\ision for the personnel of
these units.
J. GENERAL REVIEW OF :Nr0BIL,E (cOMBAT) HOSPITALIZATION AND
EVACUATION.
EARLY PERIOD. TRAINING IN TRENCH WARFARE.
This embraced the period of training in the trenches, with our
troops usually brigaded with the French. Because of the peculiar
geographical, tactical, and organizational conditions, the direction of
this phase of hos])italization and evacuation devolved upon G^,
through its medical group. There was gradually evolved a situation
whereby the functions of the Services of Supply (chief surgeon,
American Expeditionary Forces), with reference to the mobile sani-
tary formations operating in the zone of the armies, resolved them-
selves into those of procurement, supply, and transportation to the
forward areas.
In providing for battle casualties, main reliance was placed on
evacuation hospitals. As above stated, for each division sent to
France, the shipping schedule called for the coincident dispat -h of
two evacuation hospitals. For some reason not yet known here, and
despite repeated appeals by cable to the War Department, this auto-
1470 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
matic supply was never realized and shortage of evacuation hospital
personnel and equipment Avas one of the principal factors in creating
peri)etual and well-Avarranted anxiety as to our ability to meet the
forthcoming combat obligations,
Tn tlie early period of American P^xpeditionary P'orces activities
this shortage did not cause any grave concern. With the stage set up,
as it were, in the form of fixed hospitalization in the rear, fairly well
established, the problem of finding adequate hospitalization to
meet the needs of our forces engaged in training for trench warfare
was easily solved. Static conditions prevailed. This situation of
inunoliilization had existed sufficiently long to permit the French to
establish well organized and equipped hut evacuation hospitals be-
hind their trenches, or in lieu of complete construction, they had
taken over and altered existing buildings for these purposes. These
French formations offered every facility for carrying on the treatment
of the wounded along modern lines. Coincident with the arrival of
one of our divisions in the trenches it was arranged with the French
to have them relinquish to us on a temporary or a permanent status
one of more of these hospitals. Many of the hospitals taken over by
us from the French in tliis manner were transferred with full equip-
ment. In those cases it only became necessary to send in our medical
personnel and immediately begin functioning as an American hos-
pital and caring for our own cases. However, this verj' desirable
mutual cooperation existed only in fairly restricted sections, notably
in the Toul, Luneville, and Baccarat regions, where the greater part
of our early training in trench warfare was conducted. In the re-
moter regions, to which it was sometimes necessary to send our divi-
sions for training purposes, or to relieve French orgiinizations in
quiet sectors of the line, we were not accorded this privilege of tak-
ing over French hospitals, sick and wounded of our forces being sent
to near-by French hospitals administered with French personnel.
It is true that we still possessed and operated to a maximum degree
our divisional field hospitals, but when our sick and wounded were
admitted to the French hospitals, American personnel were seldom
permitted to enter and care for our men hospitalized therein. This
created a very unsatisfactory condition, which at times threatened to
border on the scandalous, and neces-^itated that the medical depart-
ment of the American Expeditionary Forces put forth every effort
to secure control over the treatment of our cases. Obviously, it would
be unwise in a report of this character to dwell upon the many
reasons which rendered this arrangement unacceptable. The single
item of difference in language, with frequent inability of our men to
make their simplest wants known was- in itself sufficient cause for
objection to it. Differences in methods of hospitalization and treat-
ing cases were also factors. It can be safely asserted that each army
operating in Europe believed it had in force the best methods.
Frequent changes in the designation of training sectors for our
troops rendered it impracticable for the French to always comply
with our requests for strictly American hospitalization. Events were
moving so rapidly that rarelv was it deemed expedient to become too
insistent on this subject. Sometimes the results achieved in permit-
ting the French to hospitalize our soldiers were far from satisfactory
and at times, in order to disarm criticism, it became necessary for us
to take extreme measures to explain our apparently passive attitude.
A. E. F. GENERAL. STAFF. 1471
On the contrary, we desire to go on record with the statement that in
some of the French formations the work done and the attention given
our soldiers was uniforml}' excellent, sometimes surpassing any of
the end results accomjjlished in our own formations.
The German offensive of March 21. 1918, created an entirely new
situation on all parts of the allied front. Up to that time hospitaliza-
tion had been comparatively a simple matter. This German of-
fensive caused a reversion from static or trench warfare to mobile
or open warfare. Incident to the changes daily taking place in the
surging battle lines, the stationary hutted evacuation hospital became
relatively useless and, for purposes of immediate combat hospitaliza-
tion, a thing of the past.
To maintain hospitalization abreast of the lines, the utilization of
tentage and such existing buildings as could be found and were habit-
able became necessary. Prior to this era, motor transportation played
a relatively unnnportant role. With its advent, adequate transpor-
tation facilities became a crying necessity. As is well known, so far
as the American Expeditionary Forces was concerned, these re-
sources were woefully lacking.
As the Medical Department did not have at hand the mobile hos-
pitalization provided for in the shipping schedule, this shortage,
combined with limited transportation facilities, seriously increased
our operating handicaps. Prior to the German offensive of March
21, 1918, we always knew sufficiently in advance where our divisions
were to be placed in training in the front line, and had ample time to
prepare to meet their needs. Quickly following in the train of this
offensive, the locations of our divisions on anj' part of the front were
governed solel)^ b.y existing military exigencies. This commenced our
first virtual hosi^italization and evacuation problem. In quick suc-
cessions these problems became manifold. Facing a critical shortage
in personnel, equipment, transportation, and many other essentials,
the summer of 1918 became a period pregnant with anxiety and deep
concern to the medical department of these forces. A division was
here to-da3\ away to-morrow, and thrown into the battle line next
day, perhaps on some distant front. The only local combat occurring
during this period that threw any strain upon our hospitalization re-
sources was the action at Schiesprey on April 20. In this, the 26th
Division became engaged, and confronted us with our first real evacua-
tion task. We had alread}' taken over from the French existing
hospitals in the Toul and Aulnois regions which provided hospital-
ization sufficient to permit of excellent care being given all wounded
from that action.
BATTLE OF PICARDY — OPIIBATIONS AT CANTIGNY.
The pioneer movement in our divorce from the satisfactory condi-
tions of static warfare to the anxious moments of mobile warfare de-
volved upon the 1st Division. As previously mentioned, this di-
vision was hurriedly withdrawn from the Toul sector and placed at
the disposition of the French in reserve behind the Montdidier
salient. We possessed no hospitalization in that region, short of
Paris. As the division was placed under the French the responsi-
bility^ for hospitalizing the sick and wounded devolved upon and was
assumed by the French. As above stated, this obligation was in
keeping with the ruling previously adopted during our period of
1472 REPORT OF THE SURGEON GENERAL OF THE ARMY.
troiic'li warfare instruction. In orders prejiared by the French and
(lirectiniT the dispatch of the division to the iicav front it Avas speci-
fied that all hospitalization (except that furnished by divisional
Held hospitals) anil evacuation of onr forces would l^e ])ro\ided by
them. These orders also prescribed the liaison to be established be-
tween our own field hospitals and the French formations farther to
the rear. This order Avas received by us with considerable apprehen-
sion. Facing not only a serious shortage in personnel and equipment
for Army sanitary units and the frankly stated objection of the
French to the establishment of American Expeditionary Forces eva-
cuation hospitals in the rear of divisions operating with the French,
it was, nevertheless, very early recognized that every eifort nuist be
made to provide for the hospitalization and evacuation of our own
wounded.
On May -28 the 1st Division participated in the Battle of Cantigny.
We had notice of the impending attack to be made by this division
and, preceding its execution, sent a member of this group to that
front for the purpose of arranging for the hospitalization facilities
to be provided.
Repeated efforts were made to secure permission from the French
to establish at Beauvais at least one American evacuation hospital in
the rear of that division. These requests were disapproved by the
French on the grounds that a dual hospitalization and evacuation
service in that region would, in view of. existing traffic conditions, re-
sult onl}' in confusion.
At the request of this section, the American Red Cross appealed
to the French for permission to establish a hospital at Beativais to
serve this division. The grooving dissatisfaction as to the treatment
being received by our wounded in the French formations made it
necessary to leave no eflt'ort unmade to remedy this condition. The
permission of the French to establish a Red Cross hospital was ob-
tained on condition that it should he known as a French military
hospital, Avith a French medical officer in command. Thus arose the
necessity of permitting the Red Cross to enter the zone of the armies
to assist the Medical Department in its scheme of hospitalization,
A suitable building was obtained and with a mixed Army and
Red Cross personnel the hospital was equipped and rendered ex-
cellent service. The French medical officer in connnand was in-
sisted upon by the French authorities for the reason that by keeping
it a French hospital they could control its evacuation. This was
accomplished by French hospital trains, as no permission could be
obtained to utilize American Expeditionary Force trains for this
purpose. The objections of the French were Avithout doubt well
grounded and this condition is not detailed here in a spirit of criti-
cism, but merely to set forth the difficulties surrounding the hospitali-
zation and evacuation of battle casmilties Avherever American divi-
sions Avere opei'ating under French command. While this arrange-
ment had many advantages, it was still far from perfect, for the
reason that the patients after receiving primar}^ care in the so-called
Red Cross hospitals all over France, after a long delay, attended
with many conferences and much negotiation, authority was ulti-
mately obtained to remoA'e, at a station in the vicinity of Paris, all
American patients passing through on French trains. A small
detail of sanitary personnel was placed at this station, with sufficient
A. E. F. GEXERAL STAFF. 1473
aiubiilances to eAiiciiate our battle casualties to American hospitals
in Paris. lender the conditions as outlined above, it is unavoidable
that there should have been criticism of the care oiven our wounded.
It is true, however, that no elt'ort was spared to better these condi-
tions.
It was in the operations about Canti^ny that this group first
started the system of sending out a member of the section to represent
it in all imjDortant field operations. Very effective coordination re-
sulted from this action.^ Our representative had the freedom of
action and latitude that could not otherwise have been exercised by
an officer attached to the operating forces. He kept in close touch
with this office by telephone or telegraph, and also with the officers in
charge of the hospitalization reservoirs to which he directed evacua-
tions. With hospital trains operating under (i— 1, his liaison with this
service also proved most advantageous. During quiet periods he
automatically returned to and resumed his duties in this office. The
office force itself from March on habitually worked far into the
night and was able to keep in constant touch with field operations
and its re])resentatives there.
Following the Cantigny battle, the 2d Division was also removed
from the comparativeh^ quiet Lorraine sector to a place in reserve
near Montdidier.
3. Medical Review, Second Battle or the ^^Iarne.
AVith the beginning of the Grermans' Aisne offensive, the latter part
of May, 1918, it became necessary to hurriedly throw in other Amer-
ican divisions on the enemy's front before Paris. The first American
divisions to l)e utilized in the repulse of this offensive were the 2d
and 3d. At the height of our Marne activities we had nine divisions
intermittently engaged. This created a new hospitalization problem.
As in their retreat the French had lost all of their evacuation hos-
pitals in that region, they were not in a position to assume the addi-
tional burden of caring for our casualties. Unfortunately, this con-
dition was not admitted bv the French as soon as it should have been.
For the first time, the French not only permitted, but assigned us
in every way to begin the establishment of our own chain of hos-
pitalization behind our divisions, and evacuation from them by
means of our own hospital trains to fixed American formations in
the rear. However, our initial efforts met with almost insuperable
obstacles. Behind the 2d Division the best hospitalization that we
could provide under the circumstances was established at ^leaux
and Juilh'-Dammartin. The rapid German advance had so de-
moralized the evacuation service that it was impossible to operate
hospital trains. Consequently, evacuation by ambulance, and in lieu
of ambulance by truck, from 40 to 100 kilometers into our hospitals
at Paris was at first necessary. By concentrating all our available
resources and borrowing from the French, we were able to provide
200 ambulances for the 2d Division, which were barelj^ sufficient to
meet the needs, owing to the great length of our evacuation avenue.
For the immediate evacuation of Paris, another 100 ambulances had
to be brought into service. As the other divisions in rapid succes-
sion were concentrated on the Marne, our activities upon that salient
1474 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
extended in a semicircle, of which Chateaii-Thieirv was the pivot.
All available mobile hospitalization, in the form of evacuation and
mobile hospitals, Avas concentrated on that front. As far as possible
buildings were utilized, but in this new phase of open warfare our
main reliance for shelter frequently had to be provided by the
use of tentage. The early phase of the battle found us confronted
with transportation difficulties and shortage of personnel, hospital
equipment, and ambulances. The evacuation into Paris, our nearest
hospital center, which was gradually expanded for and during the
emergency to a capacity of 10,000 beds, was continued by ambulance,
until the railroad situation permitted the use of hospital trains,
which we had garaged there to meet this emergency.
Our evacuation hospitals, which were gradually brought up, did
not possess the mobility that was necessary to meet the changing
military conditions existing at that time. The shortage of motor
transi^ortation was primarily responsible. Divisions were huri'iedly
withdrawn from one part of the line and thrown into another part
alongside of the French without advance notice to the medical repre-
sentatives in the field and at times evidently without due notice be-
ing furnished the tactical headquarters of the " Paris group, " then
established at LaPerte-Sous-Jouarre, under which title all American
divisions operating in that region functioned.
This condition of affairs created a situation on the Soissons front
that evoked considerable unjustifiable criticism of the Medical De-
partment. The 1st and 2d Divisions were thrown into battle there
without advising the American headquarters, and as we had no
hospitalization established in that sector the heavy casualties sus-
tained were not promptly and well cared for. As it developed, more-
over, the French were no better prepared to meet the hospitaliza-
tion obligations that this new situation imposed upon them. This
incident was regrettable, in that we had, packed and available for
quick transportation, a mobile and an evacuation hospital to meet an
emergency of this nature. Had we had notice of this impending
tactical change, we could have established hospitalization of our own
behind the troops engaged on the Soissons front. The French medi-
cal Department was greatly embarrassed by the large number of
wounded that flowed into their organizations from our two divisions
engaged there and while the responsibility for the care of our sick
and wounded devolved upon them, events showed that they were
woefully unprepared to receive them. The evacuation of our own
men from that sector was eventually carried out under the direction
of our G— 1 representative on our own trains, hurriedly sent up on
bis call. This situation, which is purposely dwelt upon at some
length, eventualh' rendered it necessary for these headquarters to
inform the French that thereafter, when American divisions were
brigaded with them, due notice of impending movements must be
furnished to the proper American authorities in order that Ameri-
can hospitalization and evacuation facilities could be provided for
them, and that the French designate in their battle order suitable
sites for the location of American evacuation hospitals.
"With the massing of our troops on the true Chateau-Thierry
salient we were able to utilize our limited hospitalization and evacu-
ation facilities to maximum advantage, but only by carefully hus-
A. E. F. — GENERAL STAFF. 1475
bandin<i- our ina(le(liiate ivsourcos and working- onr insufficient per-
sonnel to tlie limit of human endurance.
In marked contrast to the chaotic conditions tliat obtained on the
Soissons front were the smoothness and precision with which opera-
tions on and evacuation of thousands of American wounded flowing
into our American liospital formations from onr divisions enaag'ed
on the Chateau-Thierry front were handled. For example, on the
ninth day of the offensive and counter-offensive, opei'ations and
evacuations had carried through with a regularity that still left us
with 3,800 vacant beds in our evacuation hospital chain there. Hero
our forces were operating with the French Sixtli Arm}^, and we were
given unrestricted opportunity to conduct our own liosjjitalization
and evacuation. The work carried on there under most trying cir-
cumstances challenged any criticism.
The ambulance shortage was so acute that trucks had to be utilized
in the transportation of the wounded. By working the personnel
day and night, oftentimes without adequate rest, and operating our
hospital train and ambulance evacuations to maximum possibilities,
we were barely able to meet our re(iuirements. Reserve personnel
and hospitalization were withdrawn from wherever they could be
spared and sent there for duty.
One evacuation hospital, urgently needed, through lack of motor
transport, had to be ordered up by rail. It was four clays en route
from Bazoilles-sur-Meuse to Coulommiers, Personnel in the region
of Langres. also urgently needed, could not be provided transporta-
tion until the French were appealed to and furnished us with motor
camions for the movement.
When the maximum combat activities of our troops developed,
provision of and supervision over hospitalization and evacuation
provided for tliem centralized in the medical group attached to 0-4
at these headquai'ters. One or more representatives of this group was
constantly in the field during the more important operations on the
Marne, submitting recommendations for coordination by these head-
({uarters, and at times actively directing the operations of the service
at the front. One of the G— i-B representatives sent to the Chateau-
Thieri'v front acted as and was later assigned as chief surgeon of the
" Paris group." At the height of our activities tliere tlie hospitali-
zation provided for our forces was six evacuation hospitals, two
American Red Cross hospitals, and two mobile hospitals, with a total
bed capacity of approximately 7,000. These were successively lo-
cated at Meaux, Juilly, Jouy-sur-]Morin, Coulommiers. La Ferte-sous-
Juarre, Sery-Magneval, Chateau-Thierry, Villers Coterest, Cru-
zancy, and Coincy. Evacuations, which were first regulated from the
station at Creil and then transferred to the more centralized station
at Le Bourget, were largely carried on through the operation of
American hospital trains garaged at Pantine, Paris. We frequently
had to borrow trains from the French, but during the height of
activities we had IG trains of our own in operation there.
4, Medical Remew, Cha:mi'.\gne Defensive.
During this period one of ou.r divisions (4'2d) was detached for
service with the French Army operating cast of Rheims for the i)ur-
pose of resisting the Gernum offensive of July 15 in that region.
142367— 19— VOL 2 32
1476 EF.rORT OF THE SURGEOX GENERAL OF THE ARMY.
From a hospitalization and evacuation standpoint, this division op-
erated remotely from our resources. However, for the first time,
and overcomins: the objections of the French, active steps were taken
to provide the sick and "wounded of a division operating under
French control Avith our own hospitalization. An evacuation hos-
jiital and a mobile hospital Avere established l)ehind their line, in
tlie region of Chalons-sur-^NIarne. and handled all the battle casual-
ties occurring in that division. These formations were evacuated by
our OAvn trains to base hospitals in the rear, and evacuation of
slightly wounded was made by ambulances and trucks to our camp
hospital at Mailly. When the 42d Division was moved to Chateau-
Thierry these formations were transported with the division on
trucks borrowed from the French.
5. Medical Re-view, St. Mihiel- Argon ne-Meuse Offensives.
The hospitalization and evacuation resources, largely procured
through the agency of G-4 and placed at the disposition of the First
xVrmy, are set forth in a detail in that report. As a reference or
guide, its annexation will serve a useful purpose and permit us to
restrict and confine our remarks to generalties.
In the interim between the reduction of the Marne salient, with
gradually lessening American participation there, and our prepara-
tion for the Battle of St. Mihiel, shipments of material from the
States had somewhat, although far from satisfactorily, relieved our
critical shortages. In other words, medical department personnel
and material were constantly arriving, but not in proportion to meet
initial shortages and at the same time keep pace with the increased
needs resulting from augmentation in arrival of combatant troops.
The medical department, through its G— 4 representatives, imme-
diately took steps to cooperate with the chief surgeon of the First
Army in providing, as far as possible, adequate hospitalization for
the large number of casualties expected to oc^ur in the forthcoming
Battle of St. Mihiel. As the number of casualties apprehended hap-
pily were not realized, we found ourselves for the first time facing
a comforting situation of overhospitalization. Had the number of
casualties that we had every reason to expect actually developed, the
medical department would again have found itself short in re-
sources and embarrassed in meeting its obligations. Even at this
time our critical shortages were personnel, hospital equipment, am-
bulances, and hospital trains. The shortage in personnel was par-
ticularly acute, and as we had already withdrawn from base hospitals
all the personnel that could be spared without seriously jeopardizing
their efficiency, to help out in this emergency it was necessary to se-
cure authority for the assignment of 1.200 men of the line from the
Orthopedic Trainin£r Battalion to our mobile sanitary formations.
These men suffered from flat feet or other joint infirmities, but their
acquisition at this critical time tided us over another difficulty.
Our borrowing resources were exercised to the utmost possibilities.
Ambulances and hospital trains were borrowed from the French.
The situation seemed so acute that it w-as necessary to detach 15
ambulance sections sent to Italy direct from the United States for
the Italian Government, and bring them up for our use in the battle.
Following the reduction of the St. Mihiel salient the greatly aug-
mented First American Army began to prepare for further, and what
A. E. F. GEXERAL STAFF. 1477
proved to be final, combat activities in the Argonne-Meuse offensive.
This was divided into a first, second, and final phase, leading np to
the declaration of the armistice. This, the first time that the Ameri-
can forces acted as a unit on a broad scale, found the Medical De-
partment still facing critical shortages in equipment, personnel, hos-
pitalization, and ambulances.
A. 3IKI)ICAL REVIEW OF AMERICAN DIVISIONS WITH FRENCH NORTH OF
CHAISONS-SUR-MARNE, OCTOBER, 1918.
During the Argonne-Meuse offensive it became necessary to detach
two American divisions from the First Army and assign them to
the Fourth French Army, engaged in the offensive taking place to
our immediate left. These divisions were the 2d and 36th. They
were not used b}' the French simultaneously, one division being held
in reserve while the other was in the line. The 2d Division relieved
a French division on tlie front line near Somme-Py on September 30.
On the night of October 9-10 it was relieved by the 3()th Division.
After its witlidrawal on October 10 the 2d Division gradually moved
back to a position in the neighborhood of St. Menehould. arriving
there about October 25 and again rejoining the First American
Army. The 36th Division was relieved on October 28 and also pro-
ceeded on October 30 to the St. Menehould region for return to the
control of the First American Army. "While on this detached serv-
ice with the Fourth French Army these divisions naturally became
separated from the administrative and supply control of the First
American Army. Accordingly, it devolved upon this section to ar-
range for the hospitalization, supply, and evacuation of these divi-
si(ms during their period of separation from the American Army.
Evacuation Hospitals Xos. 3 and 5. Mobile Hospital Xo. 7, Evacua-
tion Ambulance Companies Xos. 5 and 7. and a medical supply dump
were withdrawn from the Army and assigned to position at Mount
Frenet and La Veuve, in the rear of the American divisions, and
nortli of Chalons-sur-iVIarne. These sanitary units Avere located en-
tirely under tentage, on two French sidings which were installed for
serving French evacuation hospitals at that point, and were entirely
self-sustaining in every detail.
As these divisions became engaged in action in rotation only,
the hospitalization provided for them was entirely adequate and
cared for the comparatively heavy casualties sustained by them
with creditable efficiency and dispatch. This was one of the op-
erations carried out with the French where the disposition of sani-
tary units, even before casualties occurred, left us with a feeling
of assurance that ever}' conceivable contingency had been provided
for. The evacuation of these American hospitals was carried out
in tliis territory under French control by American hospital trains
furnished through our St. Dizier regulating station, and immedi-
ately regulated by our 0—1 representative stationed at the subsidiary
regulation station at Connantre.
i\. :\n:Di( AL review of the second corps.
This corps consisted of American divisions attached to the British
Expeditionary Forces. They arrived via England, and under the
1478 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
Abbeville airreenient the Medical Department oroanizations attached
to them were furnished British equipment. All the hospitalization
was provided and exclusively supervised, as far as this office was
concerned, bv the British authorities. There was a provision, how-
ever, in the Abbeville a^Lireement wliich proved to be of inestimable
advantaae to the American Expeditionary Forces medical depart-
ment. We refer to the provision whereby the British requested that
we limit the sanitary train personnel attached to those divisions
to one-half of the complement authorized in the tables of organi-
zation. It seems that this was necessitated through shortage of
British equipment and the fact that a well-organized overhead in
British, hospitalization and evacuation resources were always lo-
cally available for the use of these divisions. Consequently, ap-
proximately the personnel of two field hospitals and two ambulance
companies of each of the 10 divisions brigaded with the British
were sent to France on American Expedition Forces shipping and
concentrated in the seventeenth training area. As there was
little likelihood that this sanitary personnel would ever be called
for while the divisions continued to operate with the British Expe-
ditionary Forces, this personnel, in the form of ambulance companies
and field hospitals, in the seventeenth area, and despite their total
lack of equipment, practically saved the day for us during the op-
erations of the summer. In consultation with G-3 these headquar-
ters, an arrangement was made whereb}' this personnel could be
utilized wherever their services were most needed. They were
thrown in behind the line to augment depleted Medical Department
establishments and some of the ambulance companies were utilized
to good advantage at base ports, in rapidly assembling and forward-
ing incoming ambulances, so urgently needed at the front. This
reserve, that so fortunately came to hand in this manner in our hour
of need, was one of the most important factors that enabled us to
carry on and discharge our weighty obligations at that time.
C. MEDICAL REVIEW OX THE BELGIAN FRONT.
During the final phase of our combat activities, two divisions
(37th and 91st) were detached from the First Army and sent to Bel-
gium to cooperate with the French and Belgian forces in the offen-
sive then taking place on that front. For these divisions a regula-
tion station was established at Dunkerque. An evacuation hospital
and a mobile hospital and two evacuation ambulance companies
were sent there by rail and established themselves behind the di-
visions to care for our own sick and wounded. The casualties were
relatively few, although approximately 4,000 were handled by these
units in a brief comj)ass of time.
D. MEDICAL REVIEW ON THE ITALIAN FRONT.
Our activities here were practically nil. One regiment of Infantry
(332d) was detached from the 83d Division and sent there. With
this regiment we sent a fully equipped field hospital, with such ad-
ditional X-ra}' and other surgical facilities as might be needed.
Extra surgical personnel was also attached to this hospital. As we
were so short of ambulances, the chief of the United States Army
A. E. F. GENERAL. STAFF. 1479
ambulance service attached to the Italian Armj' was directed to
Ijrovide the necessary ambulance facilities to meet the needs of this
regiment, A base hospital (102) was sent to Italy direct from the
United States for the purpose of assisting the Italian medical de-
partment in the hospitalization of their casualties. With the arrival
of our small force in Italy, authority wa;: obtained from the Italian
Government to admit to Base Hospital No. 102 such Americans as
could not be hospitalized in the field hospital referred to ; G-1 kept
in close touch with the senior medical officer on duty with this regi-
ment with a view to meeting his supply and other needs. A small
medical supply dump was established in Italy. To reinforce their
surgical facilities, arrangements had been made with the American
Ked Cross to provide the medical organization on duty with that
regiment a mobile hospital, then at the disposition (jf the Red Cross
in Italy, However, the combat activities of our troops there were
so slight that it was not necessary to take advantage of this loan.
E. 3IEDICAL REVIEW IN RUSSIA.
While passing through England one regiment of Infantry (339th)
and the 1st Battalion of the 310th Engineers were detached from
the 85th Division and sent with the Allied Expeditionary Forces to
western Russia. None of the details of the hospitalization of that
force were handled in this office. One field hospital and one ambu-
lance company (337th) accompanied those forces to Russia. From
reports received, it seems that these medical units furnished all the
hospitalization that was required throughout their operations there.
6. MiSCEIXANEOTJS ToPICS.
A. MEDICAL REPRESENTATIONS AT REGULATION STATIONS.
Regulation stations are established and administered by the assist-
ant chief of staff, G— 1, general headquarters.
These stations are the funnel through which our sick and wounded
are evacuated from our mobile sanitary formations at the front to
our base hospitals in the rear.
Early in our regulation experience the necessity of assigning to
the staff of the regulating officer a member of the Medical Depart-
ment who could supervise the operation of hospital trains became
evident. Up to the period of the second Battle of the Marne, in the
summer of 1918, no gi*eat strain had been thrown on our evacuation
facilities. At that time we were fairly well along toward the com-
pletion of the delivery of the first 10 hospital trains for which an
order had been placed in England in the fall of 1917, The large
number of casualties occurring in the Marne battle were evacuated
through the regulation station at Le Bourget. At that place there
was stationed an officer of the Sanitary Corps (Medical Depart-
ment) who directed the movement of our hospital trains for the
regulating officer. As the evacuation requirements increased it be-
came evident that there should be organized in each regulation sta-
tion a " medical group " to handle the evacuation records and move-
ments of hospital trains. The results achieved by this medical group
at regulation stations have been so uniformly satisfactory that no
1480 REPORT OF THE SURGEON GENERAL OF THE ARMY.
staff or rejriilation stations in the future should be considered com-
plete Avithout one.
Durin»i- extensive operations the efficiency of the Medical De-
partment reposes in the stability of our evacuation service, as repre-
sented in the proj)er coordination of hospital-train movements. Hos-
pital trains are assio;ned to reijulation stations on the order of tho
assistant chief of staff, G-4, at these headquarters. For example,
when plans for the St. Mihiel offensive were perfected, it was esti-
mated that it would be necessary to place at the disposition of the
icoulatiuff officers at St. Dizier and Is-sur-Tille at least GO hospital
trains. Less than 20 of our own trains were at hand at that time, and
it was necessary to borrow from the French the additional number
needed. As the activities of these reo^ulatino; stations are described
in reports to be rendered to you by the regulatino; officers, it is not
deemed necessary to enter into further detail on this subject in this
report. It is presumed that a report of the regulation officer will also
clearly show the method by which hospital trains are handled and
how (t-4-B arranged to provide them daily with a sufficient number
of bed credits in formations in the rear, to which trains could be
dispatched.
The report of the *' medical group "' attached to the regulating
station at St. Dizier under whom nearly all our casualties were
evacuated, at that or other stations, is a complete and valuable
document.
B. HOSPITAL TRAINS.
It was recognized, in the formative period of the organization of
the American Expeditionary P'orces, that we would need, with our
long lines of communication, an unusually large number of hospital
trains.
It developed that the British on the Continent and in England
were using a standard type of vestibuled hospital train which, with
a few modifications, would admirably serve the purpose of the
American Expeditionary Forces. In the fall of 1917 authority was
granted by the commander in chief for the purchase of 15 of these
trains. Upon the conclusion of hostilities a total of 38 of these trains
had been ordered, and 10 were on hand. We also had two hospital
trains of French tvpe, turned over to us on a rental basis. With the
exception of the latter two mentioned French trains, these trains con-
sisted of IG coaches providing accommodations for 360 lying cases
and approximately 600 sitting cases.
Bori'owed French hospital trains, by which a considerable portion
of our wounded were evacuated, were required to stop at intervals
en route for meals, examination of cases, and sometimes removal
from the train of dangerously ill patients.
In the English type of train, as adopted by the American Expedi-
tionary Forces the vestibuled arrangements, kitchen, operating, staff',
sup])ly and ward cars provided practically a complete rolling hos-
l^ital which permitted a serving of meals and surgical attention en-
route, without interruption in transit of the train.
In Part II of this report Avill be found a more detailed description
of the method of procuring and distributing hospital trains.
A. E. F. GENERAL STAFF. 1481
C. EVACUTION OF IJATTLE CASUALTIES FROM THE FROXT LINE.
As delays in evacuation are features frequently misunderstood
by the laity, sometimes willfully misinterpreted by the press for pur-
poses of party criticism, and at times are made the basis of complaint
W the M'ouncled man himself, for future reference it is desired to give
a brief general account of tlie factors b}^ which the Medical Depart-
ment was governed in meeting this battle problem.
For working purposes, those wounded in battle may be appor-
tioned among four diiferent categorits:
1. The very seveiely wounded that can not withstand transporta-
tion beyond the field hospitals without depriving many of them of
their chance to recover. (These constitute about 8 per cent of all
battle casualties.)
2. The less severely wounded that require transportation by litter
or ambulance to the dressing stations and field hospitals, and then
on to evacuation hosi)itals farther to the rear. (These constitute
about 32 per cent of all battle casualties.)
3. The wounded whose injuries are such as to permit them to walk,
if necessary, as far as the dressing stations or field hospitals. (These
constitute about 28 per cent of all battle casualties.)
4. The wounded that are able to walk to field or even evacuation
hospitals. (These constitute about 12 per cent of all battle casual-
ties.)
In " 1 " as soon as the patient's condition as regards shock would
permit, every effort was made to get him as speedily as possible by
litter or ambulance, to the field hospital of the division designated to
receive nontransportable wounded, for operation in that hospital.
In " 2 " the same procedure was followed, excepting that the patient
was retained in the field hospital of the division (not necessarily,
and usually avoided where possible, in the nontransportable hospital)
only long enough to permit of a survey of his condition, a change of
his field dressings or recover}' from shock, pending his transporta-
tion to evacuation hospitals in the rear. Transportation of this class
of cases was preferably carried out by the use of ambulances, but at
times it became necessary to use trucks, heavily bedded with straw, on
which these wounded were placed and on the whole comfortably
transported.
In '* 3 '• while these cases were frequently required to walk as far
as the field hospital, it seldom became necessary for them to walk
back to the evacuation hospital. Many of this class of cases were
transported in trucks.
In " 4 " the same procedure as noted in " 3 " applies.
a'' . In fixed or trench warfai't' occasions arose where a man might
have been wounded soon after dawn but not evacuated from the front
line trenches until the advent of darkness.
In these cases the wounded men were hospitalized in the trench
dressing stations. These were subterranean miniature hospitals.
They were conveniently located as part of the front line and com-
municating trencli system, were well heated, bomb proof, afforded
operating facilities, were equipped with comfortable bunks, and pro-
vided with every means of combatting shock and supplying necessary
nourishment. Well qualified medical personnel were in constant at-
tendance. During periods of intensive bombardment, with all the
1482 REPORT OF THE SURGEON GENERAL OF THE ARMY.
trenches and the baek areas frequently subjected to a destruetive fire
from high-explosive shell, it would have been suicidal on the part of
the litter bearers to have attempted to evacnate the wounded, and at
the same time would have unjustifiably subjected the wounded to
further exposure and unnecessary danger. Accordingly, evacuation
of wounded froui the trenches in active sectors was usually carried
out under (over of darkness. In keeping with the above, one fre-
quently hears reports where wounded on certain se'tors of the front
(hiring the period of trench warfare did not reach the field or evacua-
tion hospitals initil IS and :24 hours had elapsed from the time of the
receipt of their injury. To the military mind, particularly those
conversant Avith the conditions that surrounded trench warfare in
France, this is readily explicable. However, in meeting complaints,
what we particularly desire to emphasize, from the medical view-
point, is the fact that wounded whose evacuation was necessarily^ de-
laved for the reasons above stated were in a position to receive prac-
ti("ally as good care and treatment as could have been guaranteed them
had they been more expeditiously evacuated, and escaped the dangers
above noted.
One great factor controlled the time limit of safety in delaying
operations on wounded. This was a surgical condition known as gas
gangrene. As a result of long experience, this margin of safety was
clearly recognized and constantly borne in mind in all evacuation
problems. The one aim of the Medical Department was to get the
patient as quickly as possible to an evacuation or base hospital Avhere
he tould receive operative and definitive treatment, whenever " safety
first " for the patient would permit.
¥'. In th€ open- or mohile warfare the problems of getting men
back to our hospitals in the rear were radically different, greatly
multiplied, and lacked the sense of security that we had enjoyed
during trench warfare.
On the front line temporary shelter from further enemy fire for
the wounded man who had just fallen was the primary desideratum.
A shell hole, culvert, or other protection was speedily sought, and the
man either carried there, or he crawled or walked to it himself.
Here, frequently under intensive artilleiy and machine-gun fire, first
aid was rendered. To have left these temporary shelters in an at-
tempt to get to the rear would have resulted in many of our wounded,
and the litter bearers transporting them, receiving additional injury,
if not actually killed. Accordingly, it was necessary for these men
to await darkness, or a pronounced advance on the part of our troops,
before they could be removed from such shelter as they had been able
to find. Under these circumstances there was but little that could be
done toward combatting shock, and it was vitally necessary to remove
them at the earliest practicable moment to a dressing station or field
or evacuation hospital where they could get the necessary treatment.
These shelters, to which so frequently the wounded nad to resort
were sometimes half filled with water. At times the enemy fire was
so intense that it was necessary for them to remain in that position
for hours before they could ho, evacuated. Even in the midst of
these distressing surroundings " safety first " to the patient was ob-
served.
Eventually, when the wounded man had been removed to the dress-
ing station or field hospital, the problem of transporting him to the
A. E. F. GENERAL STi^F. 1483
evacuation hospital farther to the rear presented many difficulties.
At times it was impossible to assure competent road police. The
roads leadin<j to the forward areas were frequently congested with
convoys, annnunition trains, field artillery, and all the other motor
transport which of necessity must follow the advance of our troops in
action. Aside from congestion, the progress of these trains was
materially impeded by the shell-torn condition of the roads, destruc-
tion of bridges, and occasional large crater excavations produced by
enemy mines. For this reason, the passage of ambulances was also
held ujj or met with serious interference. Ever}' effort was made to
give ambulances the right of way, but on numerous occasions the
roads became so imj^assable as to nullify any priority in movement
prescribed for them and render futile the attempts of the military
police in charge of roads to facilitate their passage through con-
gested convoys. An important factor that held up ambulance con-
voys was the fact that many of the roads in the forward areas were
subjected to intense machine-gun and artillery fire on the part of the
enemy. Whenever roads became impassable, as they frequently did
for the reasons stated above. I'endering it impracticable to rely upon
our ambuhince service, every effort was put forth to send the walking
wounded back as rapidly as possible, and to litter those unable to
walk, to some place in the rear where the}- could connect up with
the ambulances or trucks, as the case may have been. ^Slany of our
wounded, under the circumstances cited, were taken back on litters
carried by enemy prisoners being sent to the rear. The constant
thought in the minds of our surgeons working on the front line was
to get the wounded to a place Avhere they could be operated upon
and be made comfortable as soon as possible, but as the open war-
fare considerably increased the risk of exposing the wounded being
transported to further danger from enemy fire this accounts for some
of the delays that occurred in these evacuations. Then, when they
had gotten the wounded underway, there were times when the road
blocks held up evacuation columns for a considerable length of time.
Basing our statement on the statistics of thousands of cases
handled, the average time lapsing from the time a man was wounded
until he reached a "triage" or " sorting. station'" providing ready
access to operating facilities, was 5 hours, and the time that it took
for him to reach the evacuation hospital, 10 hours.
In conclusion, it should be pointed out that under the peculiar soil
conditions existing in France no wounds other than those involving
the skin (quite superficial) could be characterized as slight, for the
reason that any wound of the muscular tissues might have embedded
in it a type of microorganism which abounded here, that if permitted
to remain active in the wound produced a very fatal type of '" gas
gangrene." This was the complication that rendered timely opera-
tion and extirpation of the contaminated wounded tissue so im-
portant. It also accounts for a number of cases in which amputa-
tion of a limb became necessary in order to save life, even when
the wounded man believed that his wound was slight. This is in-
serted herein because of the likelihood of there arising in the future
some complaints over amputations performed for apparently slight
wounds, of which it may become necessarj^ to take official cognizance.
1484 REPORT OF THE SURGEON GEXER^U. OF THE ARMY.
D. UNITED STATES ARMY AMBULANCE SERVICE.
The United States Army ambulance service was created by Gen-
eral Order Xo. 75, "War Department, 1917. It provided ior the
organization of a large number of ambulance sections for duty with
the French Army. In the formation of these units, the organization
adopted by the French Army was very closely followed. The basis
of this system is that the French ambulance service is charged only
with the transportation of the sick and wounded, and has no dress-
ing station or litter-bearer sections, as with us.
Immediately after the beginning of the war in 1911, the American
colony in Paris established the so-called American ambulance. This
designation followed the French custom of calling a certain type of
military hospital an " ambulance." Shortly after the formation of
this ambulance or hospital, the field service section of this enterprise
was also organized. The latter consisted of a volunteer ambulance
service which was made up of sections of 20 ambulances each, with a
mobile kitchen, and a truck for transportation of the necessary sup-
plies. These sections were equipped by voluntary contributions from
the people of the United States. The cars used were practical!}' exclu-
sively of the Ford type. A little later the so-called Xorton-Harjes
units were also organized along the same lines. Both of these volun-
tary agencies did splendid work and were very highly appreciated
by the French.
When iNIarshal Joffre and ^Monsieur Viviani visited the United
States in the spring of 1917 they requested that the American Gov-
ernment furnish at once for the use of the French Army additional
ambulance sections. In response to this request, the United States
Army ambulance service was organized, as provided for by the Gen-
eral Order Xo. 75, War Department, 1917. The organization of the
United States Arm}- ambulance service followed very closely that
outlined above for the volunteer formations already in the French
service, and also those which belonged to, and w^ere a part of, the
French Army,
Each section consisted of about 45 men, 20 Ford ambulances, 1
Ford touring car, 1 truck, .and a kitchen trailer. Col. ,
M. C, United States Army, was sent to France in command of the
United States Armj' ambulance service. His first step in the organi-
zation of this service was the consolidation of the volunteer ambu-
lance sections mentioned, or to state it better, perhaps, the absorption
of these units into the United States Army ambulance service. A
certain number of sections were formed by voluntary enlistment of
the members of the volunteer organizations affiliated with the United
States Army ambulance service. The remainder were formed in the
United States and sent to France. When about 70 of these units had
reached France the French (Tovernment believed that their needs
had been met and the commander in chief, American Expeditionaiy
Forces, was informed that no more were required. A considerable
number of these units already organized in the United States were
thereupon disbanded as not being required, and the personnel as-
signed to other branches of the service. Prior to this, however, 30
sections were requested by the Italian Government and were sent to
Italy. Undoubtedly, the French made a serious blunder in declining
the balance of the sections which had been organized under the pro-
A. E. F. GENERAL STAFF. 1485
visions of General Order Xo. 75. War Department. 1917. This arose
through the fact that under the French organization the automobile
service provides all motor transportation, includino; ambulances.
When so provided they are at the disposition of the Medical Depart-
ment. In the present instance it appears that the French medical
department was not called upon for an estimate of its needs, and the
decision that no motor sections were required was made by the service
of automobiles, and without the knowledge of the ]\Iedical Depart-
ment.
When the more open-field warfare of 1918 was well under way it
was found that the number of ambulances required was very much
greater than had been believed necessary because of longer hauls,
consequent wear and tear, and destruction of vehicles by artillery fire,
etc. This digression would not be necessary, except for the fact that
with the rapid increase in the American Expeditionary Forces the
ambulances needed for the equipment of our own combat units failed
to arrive in France. It was, therefore, necessary to ask assistance
from our Allies. The British were unable to help, but the Italian
Government turned over 15 of the 30 sections which had been sent
them from the United States. The French, notwithstanding their
shortage, invariably furnished ambulance sections when our need
was most critical. It was not always possible to give us the number
required, but every effort was made to place at our disposition the
maximum number possible.
When the St. Mihiel offensive was undertaken, the supply of am-
bulances in the American Expeditionary Forces was entirely inade-
quate, as hardly 50 per cent of the number authorized had been sent
to France. It was only through the generosity of the French and
Italians in turning back to us these sections which had been organized
for, and presented to, their respective Governments that the transpor-
tation of our own wounded would be handled. In this respect the
situation of the American Expeditionary Forces was exceedingly
critical, and for that reason the assistance received at that time was
of the greatest value in carrying on our military operations.
In the late summer of 1918, as the authorized ambulance companies
and ambulance equipment for the American Expeditionary Forces
had not been received, and as there seemed little prospect of its being
furnished, a request was made on Washington that the balance of
the companies authorized by General Order Xo. 75, War Department,
191f , amounting to 31, be reorganized and sent immediately to France
for service with the American Expeditionary Forces. This cable
request was approved in Washington and word was received that
they would be sent at the earliest possible moment. Unfortunately,
probably owing to transportation difficulties, none of these companies
arrived until hostilities had ceased.
The French ministry has had occasion to commend this service on
many occasions. It has met every obligation in a manner that had
brought nothing but credit to the American Expeditionary Forces.
It is the opinion of this group that this service might well serve as a
model on which to reorganize our ambulance service. The simplicity
of organization, the economy in personnel, the absolute elasticity of
function, and the splendid system devised to insure repairs and up-
keep resulted in a degree of efficiency difficult to surpass. Tins : er-.'-
ice had been verv carefullv observed, both in its functioning with the
1486 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
French and with the American Expeditionary Forces, as above
stated. It is believed that lessons of the greatest value to the Ameri-
can Medical Department can be drawn from the work performed by
these units. The provision of a transportation service for sick and
wounded, each unit of which is complete in itself and self-sustaining,
is superior to our ambulance companies as at present organized. It
is the belief of this group that from the results achieved by the-
United States Army ambulance service that no time should be lost
in modifying our own tables of organization to permit of taking ad-
vantage of the benefits to be gained by following more closely the
organization adopted for that service. It is to be borne in ndnd that
the United States Army ambulance service represents the cunudative
residts of four years of war. It has been gradually evolved to meet
conditions which pertain both to fixed and mobile warfare.
This group unhesitatingly recommends that the present ambulance
company belonging to the division be radically modified to provide
for two separate and distinct units, one to he known as the " trans-
portation unit " and the other as the " litter bearer " or " dre&sing
station unit.'' It is believed that the ambulance company should be
what its name implies ; that is, an organization made up of approxi-
niately '20 ambulances each; each unit to be self-sustaining and
charged with no other duty except the transportation of the sick and
wounded. The remaining personnel of the four divisional ambulance
companies should be organized into a unit wliich might be called the
"' litter bearer company," made up of four sections. In this way
greater elasticity in the function of both units will be possible. The
question of how much ambulance transportation should be attached
to each division is one which should be given caj'eful consideration.
It is probable that greater efficiency and economy can be obtained by
assigning to each division only the number of ambulance transporta-
tion units or sections which are necessary to meet the needs of the
division under existing conditions, whether this number be 1, 6, or 10.
To do this the ambulance sections must be either corps or Army
troops at the disposition of the corps or Army surgeon who will as-
sign them to the divisions according to existing circumstances, and in
such manner as will permit him to withdraw them at will and replace
overworked units with fresh ones from his reserve in the rear. The
adoption of this formation would permit of the abandonment of the
evacuation ambulance company, as now organized in our service.
A recommendation for changes in the tables of organization along
these lines had already been prepared.
E. LIAISON OF THE AMERICAN EXPEDITIONARY FORCES MEDICAL SERVICE
WITH THAT OF THE ALLIES.
Fortunateh', a member of this section had been in France on duty
as medical observer for a number of months prior to the entrance of
the United States into the war. Before the arrival of headquarters,
American Expeditionarj'' Forces, the question of hospitalization had
been taken up with the Frencli minister of war. With French of-
ficers detailed for that purpose all the Atlantic ports were visited
and inspected as to existing facilities. Work on a camp hospital at
the principal debarkation port was begun by the French, and existing
French hospitals in the ^acinity were vacated and prepared for trans-
A. E. F. GENERAL STAFF. 1487
fer to the American Expeditionary Forces at the earliest moment
that personnel should become available.
From this time on the development of the American Expeditionary
Forces hospitalization program ^vas so intimateh' associated Tvith
the French war ministry that close contact between the two services
was absolutely essential. Moreover, French bureaucratic methods
are such that progress in the transaction of business can be made only
through the utilization of authorized agents. An officer of this
group was, therefore, designated officially as American liaison officer
with the office of the sous-secretaire d'etat du service de sante.
Through this officer all matters which it was necessary to take up
with the French were handled.
As the American Expeditionary Forces grew and the hospitali-
zation progi'am expanded it became necessary to detail officers for
this work in each of the French military regions, normally 20; into
which France is divided. Definite rules were laid down covering
the acquisition of hospital sites. The taking over of existing hos-
pitals, the leasing of buildings for hospital purposes, and. in general,
for the coordination of the two services. Gradually, all routine mat-
ters affecting the different military regions were handled by the local
American liaison officer accredited to the regional French chief sur-
geon's office. Only such questions as involved definition of policies
were referred to the central office.
The early establishment of this intimate cordial liaison with the
French undoubtedly contributed to a very considerable extent in the
development of our hospitalization program. The French service de
sante gave every possible assistance in the working out of a very
difficult and complicated task. TMiile French organization and
methods differ materially from the American, there was never anj'
desire manifested by them to require us to conform to theirs. The
most complete harmony prevailed and, as stated above, every pos-
sible aid was given us, even to the point of crippling their own
service, in supplying hospitals and medical material.
F. PROFESSIONAL SERVICES.
Though not an integral part of this group, the office of the director
of professional services was established at these headquarters pri-
marily through the good offices of the assistant chief of staff, G-4.
The wisdom of effecting this intimate liaison of the professional
services with this group was fully justified by the results achieved.
Calls for the assignment of surgical and other specialist medical
personnel to various organizations at the front, particularly evacu-
ation hospitals, were sent direct to this group. By carefully hus-
banding the limited resources and controlling their distribution,
through the director of professional services, it was possible to utilize
the services of this high-grade personnel to the maximum advantage
of our sick and wounded.
During the height of activities, the professional services comprised
approximately 4.000 officers, nurses, and enlisted men, specially
selected for their professional attainments and formed into teams
such as surgical, shock, and gas, and so mobilized as to permit them
to be sent fully equipped for the work to be expected of them, on
short notice to any part of the front where their services were needed,
or an emergency existed.
1488 EEPOET OF THE SURGEON GEXEEAL OF THE ARMY.
INTKKDKPAUTMENTAL KELATIONSHIP A.ND COOPERATION AT GKXEKAL HEADQIAUTEKS,
AMERICAN EXPEDITIONAEY FORCES.
An admirable spirit of helpful cooperation was constantly mani-
fest. It was only through our close affiliation with the representa-
tives of the other services in the various groups of G-l that we were
able to accomplish our aims in emergencies. Without their cordial
assistance the efficiency of group B would have been seriously
impaired. It is particularly noteworthy that this spirit of nuitual
assistance uniforndy pervaded all departments of G-4.
G. RELATIONS WITH THE EREXCH.
This report would not be complete without reference to the cordial
spirit of cooperation shown by the P'rench and their willirgness to
assist to the full extent of their resources.
Through the French mission at these headquarters, repeated re-
quests were made for hospitals, hospital trains, ambulances, etc.
This help, without which it would have been impossible for the Medi-
cal Department to have satisfactorily discharged its obligations, was
always forthcoming.
Later, a medical officer of the French medical department was, at
the request of the assistant chief of stall:', G-4, attached to this group
and rendered particularly efficient service in maintaining the close
liaison l)etween the two services.
A TRIBUTE TO THE MEDICAL DEPARTMENT MAN FKOit CIVIL LIFE.
Very few medical officers have had an opportunity to enjo}' the
breadth of vision of front-line conditions that fell to the lot of the
members of this group. Combat operations were opened to us on a
vast panoramic scale. Without fear of contradiction it can be asserted
that the general work performed by medical personnel and units in
the zone of the armies came more closely under our immediate super-
vision than that of any other group of medical officers, whose sphere
of observation was of necessity confined to that of the units with
which they happened to be serving.
It seems appropriate, therefore, that we should add a few para-
grai)hs on the character of the service rendered by these men.
The majority of the Eegular Army medical officers called to the
theater of operations, e^en if they had not had previous war experi-
ence, at least through their theoretical instruction and long associa-
tion with trained officers possessed some comprehensive idea of the
difficulties and trials they Avere soon to face in Europe.
However, with the reservist — the citizen-soldier — it was a radically
dilferent proposition. The sudden change to a primitive and un-
familiar environment opened up to him a field of endeavor strewn
with obstacles of which he could not possibly have had the remotest
preconception.
To these men of the Xational Guard, of the National Army, and
of the Reserve, to these front line medical men, be they renowned
surgeons or humble aml)ulance drivers or litter bearers, we desire
to pay a special and well-merited tribute to their loyalty, cheerful-
ness, initiative, adaptability, and self-sacrificing devotion to the
duties they shouldered in coming overseas.
A. E. F. GENERAL STAFF. 1489
To adequately portray their individual and combined efforts to
promote the success of our common cause might even warrant the
introduction of some poetic license in a report of the character we
are herewith submittinfr.
Time and again we encountered these men on the hichways and
byways of the battle field — on the line, in dressino- stations, on ambu-
lances, and in field hospitals — efficiently discharging their duties in
the face of most discouraging physical and professional handicaps.
It's a far cry from a well-appointed and comfortable phvsician's
office in any bu-tling city back in America, with orderly routine and
keynote of one's daily vocation, to the poorly lighted, unheated cellar
of a battle-scarred and shell-menaced remnant of a building on a
French battle field, coping with emergencies that at times must
have seemed insuperable.
Thc^e "front line" medical men shared equally with their brothers
of the line the hardships of distressing campai^ru conditions, accom-
panied the trco]:)S " over the top."' and unflinchingly bore their
casualties and privations with a fortitude that was most commend-
able.
The skill and promptitude with which they succored the wounded
reflected great credit on the profession thev had the honor to repre-
sent. That they could so quicklv adjust themselves to the work at
hand, maintain an endless optimism, and render such splendid serv-
ice with the meagre conveniences provided them was marvelou-^, and
will always remain indelibly impressed on our memory as one of the
brightest pages in the medical chronicles of the War.
Very few had their bravery and self-sacrificing devotion recognized
bv the official award of suitable decorations. The vast majority
of them will remain unhonored, unwept, and un<5ung. For those who
survived the only solace many of them can cherish is the knowledge
of high ideals unremittingly maintained, and of a duty well done.
Due to circumstances over which we had no control, it is particu-
larly to be regretted that so many of these men are destined to return
to civil life harboring a sen-e of injustice done over the failure to
bestow upon them the promotion they have so richly deserved.
While hostilities raged they continued to "carry on" without com-
plaint. Soon after the declaration of the armistice a gradual under-
current of critical discontent became manifest. When they finallv
divorce themselves from our official family and again take up civil
pursuits it is apprehended that a storm of protest will ari~e over the
promotion that has been denied them, even when existing laAvs amply
provided and contemplated that they should have received this
reco.o-nition.
With a sense of equity and simple justice, and as a result of our
observations at the front, writing as Regular Army medical officers,
and in nowise in disparagement of the excellent service rendered by
Medical Department ])ersonnel elsewhere, we bespeak first place in
the hearts of a grateful country for these medical lirothers of the
front line. This applies to the enlisted men of the Medical Depart-
ment just as nnich as to the officers. To the exploits of the latter
the civilian medical profession may well point with pride.
The splendid work performed by Army, corps, and division sur-
geons needs no indorsement hj this group. The results they achieved
1490 REPORT OF THE SURGEON GENER^VL OF THE ARMY.
tlnouiLili their pain.stakin^ devotion to tletuil, their resourcefulness
under the handicap of shortage in material and personnel, and the
hig"h sense of duty actuating them have already been made the sub-
ject of well-merited commendation by the various conmianders upon
whose staffs they so ably served. All of them deserve the highest
praise, but to the officers, with whom we were so closely associated
in uieeting the hospitalization and evacuation demands incident to
combat activities, we feel particularh' indebted, and subscribe foi-
them the fullest measure of thanks for the hearty cooperation and
spirit of teamwork they so consistently displayed.
Supply. — In order to recount the development of "strategic sup-
ply'' for the Medical Department of the American Expeditionary
Forces, a detailed sketch of its inception and growth will be given.
Generally speaking, from l)oth the developmental and operative
standjDoint, this subject may be divided into the two phases of pro-
curement and distribution.
7. Automatic Supply Schemes.
The original supply studies made by the general staff and pro-
mulgated in the late summer of 1917 contemplated placing supply
procurement for the American Expeditionary Forces as much as
possible upon an automatic basis and assumed the earl}^ establish-
ment in France of a 90-day reserve. The accumulation of this 90-
day reserve was of primary' importance and had of necessity to be
incorporated into any procurement plan. Of the total reserve 15, 30,
and 45 days' supply were directed to be held in the advance, inter-
mediate and base sections, respectivel3\
The automatic unit was the amount of supplies necessary for
25,000 men for one month, and the method of obtaining the reserve
was by shipment to France for all troops embarked (with troops
when possible) of a four months' supply in addition to initial equip-
ment. It was anticipated that troops en route to American Expedi-
tionary Forces would upon arrival at their final station in France
have consumed 30 days' supply. This, therefore, would leave a re-
maining increment of 90 days which would accrue to the credit of
the department in depot storage in France. Thereafter, for each
25,000 troops in France there would be shipped to the American
Expeditionary Forces one increment of automatic supply.
A. BUILDIKG A SUPPLY RESERVE.
After a tedious detailed study the automatic supply schedules
for the Medical Depai-tment were elaborated, approved by the gen-
eral staff' of the Services of Supply and general headquarters, and
forwarded to Washington for their acceptance. They were accepted
by the War Department by cable and put into effect June 1. 1918.
Up to this time the accmnulation of a 90-day reserve for the Medi-
cal Department in France had been purely theoretical and not in any
sense an actual fact. For one reason or another, but largely because
of tonnage, embarkation and debarkation difficulties, the auth()rized
reserve of Medical Department supplies in France did not arrive in
correct proportion to the increased strength of the American Expe-
ditionary Forces. Between April 1, 1918,"and October 1 of that year
A. E. F. — GENERAL. STAFF. 1491
huge drafts of trcops arrived in Frame. There was absohiteh' no
rehitionship between tlieir numbers and ihe amounts of initial and
replacement medit al supplies which were laid down in France.
Naturally these deficiencies were met from stock in American Expe-
ditionary Forces depots, with a corresponding sacrifice in reserve.
It is believed that certainly a large part of these difficulties may also
have been attributable to a lack, in the early days, of good medical
representation upon the docks in the United States and in France.
Obviously, if tlie original studies were correct, it was essential that
the reserve of supply arrive in France ahead of troops and that it
should include complete initial equipments. It Avas known to the
supply division, chief surgeon's office, for months that this was not
taking place, and it was therefore necessary to give almost equal
consideration, in the automatic supply, to the question of accumu-
lation of a reserve as to the automatic factor. There was included
therefore in automatic factors a proportionately large item of re-
serve in an attempt to balance depot levels. This meant practicallj^
an inflated automatic. This was carefully considered in the letter
of transmittal which accompanied this study when it was sent to the
War Department. A policy was outlined in this conmiunication
of modifying these schedules every month in connection with the
level upon items in depot.
Depot stocks at all times in France were unequal and it was known
that the modification of this automatic factor would be extremely
necessary until these levels flattened out. This would be largely in-
fluenced by the success or failure of the supply division in the United
States in shipping to France the proper reserve. ' ' •
In the early days of the procurement problem large quantities of
usefid medical stores were accumulated upon docks in the United
States for early shipment to France. Fortunately for the Medical
Department, this material being available and other supply services
being somewhat less fortunate, considerable space was on hand in
bottoms coming to France, with the result that prior to December,
1917, sufficient medical supplies arrived to enable the chief surgeon's
office to handle the situation. There developed, however, after this
time a " starvation period " in which the supply situation was at all
times critical, and only the most strenuous efforts and extremely
good judgment of those charged with distribution saved the day for
the Medical Department in France.
B. PURCHASE or SUPPLIES IX EUROPE.
Througliout the period of July to August. 1917, every effort was
being made by the General Staff to organize and establish upon a
firm basis a system of American Expeditionary Forces ])urchase.
Resources in Europe was never negligible, but for the Medical De-
partment the unfortunate side of the situation was that our people
needed material for immediate delivery, and although considerable
quantities were at times quickly obtained, the majority of orders
placed required at least six months for delivery.
This matei'ially complicated all efforts to conserve tonnage by
acquiring supplies in Europe. With a line of communication several
thousand miles long, a large, newlj- formed Army with a new and
unusual problem on its hands, the question of forecasting needs to be
142367— 19— VOL 2 33
1492 REPORT OF THE SURGEON GENERAL OF THE ARMY.
met by the markets of Europe was an extremely difficult problem.
This involved questions of mobile equipment and innumerable
snuiller items, many of which were already preempted l)y the Brit-
ish or French. It very largely amounted to accepting for late de-
livery any material which might be available and necessitated ac-
ceptance of supplies which under different circumstances would not
have been considered for a moment.
The general purchasing board which w-as established in Paris and
London had associated with it a representative, in both places, from
the Medical Department. The representative in Paris in the early
days was under the chief surgeon's office, headquarters American
Expeditionary Forces, although the chief surgeon, lines of com-
munication, was directly responsible for questions of procurement
and distribution, and as regards the question of purchase, this status
was a complicated feature, and it later became the policy of trans-
mitting orders to the medical representative with the general pur-
chasing board through the office of the chief surgeon, lines of com-
munication.
The presence in Europe of Medical Department supply men as
observers prior to the entrance of the United States into the war
would have greatly facilitated matters of purchase, and, in fact,
questions of procurement and distribution generally.
C. TONNAGE ALLOTMENTS.
For the period prior to December 1, 191T, there are no accurate
figures for the amount of medical or Red Cross tonnage which came
to France. During the following three months, however, it is known
that approximately an average of 1,000 short tons of supplies were
received in Europe for the Medical Department.
In tlie earlier studies of tonnage it was estimated by the authori-
ties in the United States that Metlical Department tonnage would
represent approximately 1 per cent of the total American Expedi-
tionary Forces tonnage. It was later definitely known that if ship-
ments continued along any such basis an accumulation of reserve
in France would never occur, and that the real needs of the situation
could be met by allotting to the Medical Department approximately
1.8 per cent of the total tonnage. Such points emphasized the need
of better liaison between the chief surgeon's office and Surgeon Gen-
eral's office. Although one supply officer went from this side for a
short stay, a real interchange was never established.
In February, 1918, reserve in depots dropped down to the level of
approximately 20 days or less. At the request of the chief surgeon's
office, the question was energetically taken up by cable Avith the
United States in an effort to clear the docks of accumulated stores,
and in the course of the next two months medical tonnage jumped
several hundred per cent. At this time a forecast of tonnage require-
ments was carefully worked out but unfortunately w^as based on er-
roneous assvnnptions with reference to troop movements. It was later
found necessary to materially modify this forecast but the original
work served as an excellent basis for this " revamping." The in-
ability of all supply divisions to accurately foretell the strength of
the American Expeditionary Forces as of any future data was al-
ways a complicating feature.
A. E. F. GENERAL STAEF. 1493
On or about the 15th of April, 1918, there was established a system
of tonnage allotments to the various supply services. These allot-
ments were largely based upon a statement from the United States
of ship space available. Every effort was made by the general stafF
to give the Medical Department a fair share of these allotments. For
a period of about three months these allotments of tonnage were
filled by the authorities at home and even slightly exceeded. For a
considei-able period of time it was indefinite as to whether or not the
Bed Cross tonnage was included in that of the Medical Department,
This valuable auxiliary service was, however, later given separate
tonnage allotments and this hazy situation was cleared up. By an
additional system of using " lighters " at United States ports for
filling in the chinks on vessels the Red Cross was able to bring to
France large quantities of the most useful type of medical supplies.
After August 1, 1918, tonnage allotments made in the American
Expeditionary Forces to the Medical Department were greatly in
ex. ess of shipments actually received, and the level of the depot
sto.ks again began to fall off at a dangerous rate. One of the great-
est difficulties was that of maintaining a level which was consistent
for all items. This was primarily due to the difficulty of properly
modifying the automatic schedules because of the large time element
intervening between the shipment and actual receipt of the auto-
matic supplies for any particular month. During the summer of 1918,
a change was made in the reserve requirement and the 90-day
period was reduced to 45. This was of more theoretical than prac-
tical assistan e to the Medical Department because even a 45-day
reserve had never been attained.
Call upon the United States for exceptional and emergency sup-
plies, although authorized for all services, was seldom found neces-
sary by the Medical Department in as much as practically all re-
placements on medical supplies were susceptible to an automatic
arrangement. A certain amount of unusual and exceptional equip-
ment and replaceuients was, however, obtained upon requisition by
cable and otherwise from the United States.
D, DISTRIBUTION.
During June. July, and August, 1917, large quantities of medical
supplies accumulated upon the docks at St. Xazaire. Every effort
was being made to acquire suitable permanent storage facilities for
the Medical Department in the various sections of the American Ex-
peditionary Forces. As the result of strenuous efforts of individuals
the supplies which accumulated at the dock were gotten under tem-
porai'}' shelter and later, as space became available, loaded on cars
and shipped to interior points in France.
E. ESTABLISHMENT OF MEDICAL SUPPLY DEPOTS,
At an early date a depot was established at Cosne, which later
grew into Intermediate Medical Supply Depot Xo. 3. This depot
was always the Medical Department's nuiin full stock distribution
point, and from this establishment the entire distribution system was
largely elaborated. For a considerable period of time practicallj' all
supplies were concentrated at Cosne and likewise distributed there-
1494 REPORT OF THE SURGEOI^ GENERAL OF THE AKMY.
from. This depot was situated upon a secondary line of transporta-
tion with reference to the American Expeditionary Forces lines of
comnuniication, and somewhat midway between Nevers and Paris.
It is now known that the selection of this site as a main receiving
and distributing depot from the Medical Department point of view
was unfortunate, but at the time of its acceptance the more suitable
located points had been preempted, and this location was taken over
to meet an absolute emergent need ; and even under the circumstances
the site was turned over to the American authorities b}' the French
" with a string attached " and considerable pressure was later brought
to bear to have this establishment released again to French control.
This helease actually occurred after the signing of the armistice,
and all supplies were transshii^ped to Gievres where the work of
detailed issues were taken over by that depot upon the abandonment
of Intermediate Medical Supply Depot No. 3 at Cosne,
All classes of medical suiDplies were concentrated at Cosne. and the
storage space rapidly grew to approximately 80,000 square feet. In
addition thereto, large quantities of stores were concentrated in the
open and under canvas at this depot. All depot personnel arriving
in France were trained and broken in under the supervision of the
officers at this depot, and as rapidly as needs developed trained units
were sent out to organize and manage other depots as they were
established.
Advance Medical Supply Depot No. 1 at Is-sur-Tille and Inter-
mediate Medical Supply Depot No. 2 at Gievres were early put into
operation. The former, an extremely important unit organized in
connection with the regulation station at that point, largely took
over the question of distribution of troops and units in the advance
section. It was not, however, until considerably later that this depot
was made a full stock unit and prior thereto its activities were largely
confined to the supply of combatant organizations. The problem of
supplying the numerous fixed Medical Department organizations in
the advance, intermediate, and base sections continued to be a respon-
sibility of the main depot at Cosne. As the situation developed the
depot at Gievres was increased in capacity and utilized largely for
shipments of carload lots. Small issuing depots were gradually es-
tablished at the main base ports and gradually larger base storage
stations were installed at these places.
r. ESTABLISHMENT OF " ARMY DUMPS " (mEDICAL).
As the Paris group was organized, and later the First Army be-
came organized, the establishment of Army dumps became essential.
In connection with the purchasing business and hospitals in and
around Paris, there had been previously established in Paris a small
medical supply depot, and although this unit was utilized somewhat
along the line of an Army dump, it was not essentially that type of
depot. The First Army clump established was at Lieusaint, ancl this
was organized and administered for the purpose of supplying combat
units in the Paris group, and later the First Army.
The supply table authorized for an Army dump and which in
common parlance later became known as the " Lieusaint list " grew
out of the establishment of this Army dump. The original basis of
this list was the replacements necessary for one combat division for
A. E. F. — GENERAL STAFF. 1495
eight days, and the officer in charge of this distribution point "^as
autliorized to maintain in storage as many times this amount as there
were combatant divisions in his sector. This practically constituted
a stock maximum for his depot. Practically this same system,
although with a modified list, was adapted for use in planning the
distribution of medical supplies when the offensive operation directed
toward the reduction of the St. Mihiel salient, and later against
the Argonne-Meuse sector, were in preparation. Gradually, how-
ever, a i^olicy was developed of establishing corps or Army dumps
for which there was auth(n'ized a definite fixed stock maxinuim with-
out reference to the number of combat units to be supplied, but based
more upon tlie numl)er of such dumi)s established in rehitionship to
the known number of divisions to be employed in the operation.
Such dumps, for instance, were established at Toul, Souilly, Vaube-
court, Fleury, and Les Islettes, and in the order named.
Toward the end of hostilities the problem of distribution from the
supply echelons at the base to those in the most forwarded areas had
been worked out with exceeding care and were about to become effec-
tive when combat activity ceased. They were no more nor less than
an elaboration of the policies under which the units had been pre-
viously functioning, but the later plans were better balanced and all
echelons much more clearly defined. This was also true as regards
the important tecluiique of filling the calls of forward units from
the unit next in the rear.
G. MEDICAL SLPPI.V ECIIELOXS AND SYSTEMS OF REPLENISHMENT.
Essentially this scheme of distribution involved the use of six
echelons. They were as follows:
Divisional medical supply unit.
Army or corps medical supply park.
Army advance medical supply depots.
Advance Services of Supply depots.
It was the policy to establish in eacli base section, as the need de-
veloped, a small issuing depot to cover the local distribution problem,
and in all Services of Supply sections there were established as parts
of hospital centers similar units. These hospital center depots req-
uisitioned and issued all medical supplies for their own centers.
The divisional medical supply unit normally indicated the need
of all divisional organizations upon a consolidated requisition, which
after passing through the office of the division surgeon and G-1, was
forwarded for filling to a corps or army dump. Man}- times the
division medical supply officer was far removed from the division
surgeon and the division staff generally and as a result numerous
requisitions had to be sent to the nearest corps dump in a most in-
formal manner and without any vise or approval. This was recog-
nized as a necessity and such contingencies were provided for by au-
thorizing the dump personnel to honor such emergent calls. It was
found in practice that such authorizations increased the confidence
of those in the forward areas and that the end result was that of
better and closer cooperation with all.
The logical stock for Army or corps dumps would include only
items of combat equipment and supplies and trench stores, and
cJi-visional units would naturally only requisition such articles, but
1496 EEPOIIT OF THE SURGEON GEXERAL OF THE ARMY.
in the early days of the development of tlie corps echelon it was
•necessary for these dmnps to carry limited replacements for such
units as mohile and evacuation hospitals. It was very soon learned,
iiowever. that this produced a useless dispersion of e(|uii)ment diffi-
cult to ohtain and quickl}- rendered immobile a unit which of ne es-
sitv nnist renuiin mobile. It therefore became the policy to confine
items on the fixed sto;k maximmn of such dumps to those of combat
material and trench stores alone. Just so soon as this decision was
made it necessitated the establishment of a new echelon, inasmuch
as larg:e hospitals in the advance zone would be required to replenisli
their stock from an advance supply unit.
It was therefore contemplated to immediately establish (and sites
were actually selected) full stock Army advance medical supply
depots on a basis of one per Army. This unit, althouoh carrj'ing a
complete stock, carried its items, in so far as quantity was concerned,
upon a very limited time basis. The functions, then, of this larger
unit would be primarily to fill the calls of the Army or corps dumps,
and secondarily to fill requisitions from medical units in the advance
zone. The latter was precluded as far as possible by distribution
from the rear through " controlled stores." The limit of the fixed
stock maximum for dumps would have been decided by Arm}' G-4
upon the recommendation of Army chief surgeon, and again could
be modified only through the same channels. Such a policy pre-
cluded the possibility of a dump becondng so overloaded as to become
immobile. The method of call l)y dumps upon the Army advance
unit would normally be in any informal manner. Thus depot officers
in rear echelons in order to fill the calls from forward dumps had
only to know shortages in authorized stock maximums.
Just as it was necessary to establish for Arm^^ or corps dumps fixed
stock maximums, so also was it essential in the case of Army advance
medical supply depots. Those units, although fully stocked and rel-
atively large depots, have of necessity to be able to move at very
short notice. It was therefore necessary to give such stock consider-
able thought and detailed study, particularly in view of the fact
that the material within this depot would be "turning over"' at
frequent intervals, since fixed upon relatively so low a time basis. It
must be remembered in connection with this advance unit that it
vras necessary for the officer in charge to fill the calls from not only
Army dumps alone, but also from fixed and mobile sanitary units.
The method of call from units such as base and evacuation hos-
pitals, etc., upon the Army advance medical supply depot was formal,
inasmuch as requisitions were made out by unit supply officers at
proper intervals, and with the approval of the commanding officer of
the unit were forwarded direct to the depot for filling. This was
obviously the simplest manner of handling this situation, but sim-
plicity in a large combat force is not the only consideration, and at
the outset our people were a^-ting in conflict with existing orders and
regulations which controlled the passage of requisitions through the
various G-l"s and G— 4's including the general statf officers in com-
mand of regulating stations. The paragraph in general orders, how-
ever, with which we were in conflict Avas later abrogated in favor of
certain services whose i)roblems of supply distribution were so
peculiar as to demand such action. The confused points in the effort
lo standardize distribution for all services as they then existed in the
A. E. F. GEN^EKAL STAFF. 1497
supply orders would have been completely cleared up in the rewrit-
ing into one order General Orders 31 and 14. American Expedition-
ary Forces, 1918. The army advance medical supply depot was
essentially an Army unit and under the direct control of the Army
commander, throuofh his chief surgeon.
II. " controlli:d stores " policy.
During the summer of 1918 the policy of " controlled stores " was
developed and put into execution. This system centralized in one
office distribution control up to the limit of depot requisitions and
such other large shipments. Although the primary object of " con-
trolled stores " was to place distribution under a comprehensive
scheme in one office it was also the object to centralize the huge ques-
tion of accountability. Its establishment in the American Expe-
ditionary Forces was in conformity also with accepted policies in
vogue in the United States. This system would throw into one office
a record of all large receipts and at the same time all large requests.
Having such data at hand, distribution was clearly facilitated and
with a resulting great conservation of effort.
I. equalization of stock.
Upon the 1st and loth of each month a complete stock report from
each Services of Supply depot was sent by courier to the chief sur-
geon's office. From these stock reports " controlled stores " compiles
a consolidated stock sheet upon essential items for the entire dis-
tribution system in the rear echelons. From this sheet is produced
an " equalization of stock " sheet and shortages and excesses are lev-
eled off as they aj^pear in the various depots by shifting through
" controlled stores " the stock of essential items in the Services of
Supply. By the consolidated sheet absolute shortages are clearly
indicated and copies of the sheets connected with the equalization of
stock are sent to the various section surgeons and depot officers con-
cerned. A policy of strict economy upon items short had of course
been previously announced. It was manifestly unnecessary for
depots to concern themselves about stock upon essential items except
in emergency, since the machinery of " controlled stores " provides
for their equitable distribution. All other items, however, were
procured by depots through prearranged " automatics " or by requi-
sition.
J. SHORTAGES OF AMBUL.\NCES.
Ambulances are required for the evacuation of the sick and
wounded in every section of the theater of operations. From the
beginning to the end of combat activities the greatest dispersion of
units existed, and upon arrival at destination detached organizations
immediately clamored for ambulance transportation. As a matter
of necessity such calls had to be met as far as possible. Incoming
divisions required filling up of their missing quotas, and an evacua-
tion service at hospital centers and along the lines of communication
at base ports, etc., had to be established. Before December, 1917,
there had already developed an acute shortage of ambulances, and
shipments from the United States because of procurement, and ton-
1498 REPOltT OF THE SURGEON GENERAL OF THE ARMY.
iiaoo diiHc-ulties, wvvv iiiultn- our estiiuiited need, and although cable
after cable was dispatched settiii<>- forth our emergency needs along
this line the shortage continued to accumulate. The vital (juestion
of estimating the need was greatly hampered by the absolute lack
of tables of organization in Services of Supply corps and Army
units. P^xisting tables indicated transportation for combat and
depot divisions alone. As early as possible, however, an estimate
of the situation was made, Avhich resulte<] in the Medical Department
assuming that .from front to rear a minimum of 120 motor am-
bulances per division in Fi-ance would be required. The number of
vehicles recjuired foi* the American Expeditionary Forces to cover
past shortages and future needs was estimated, and the residts of
these estinuites were included in cable referred to above. Only dur-
ing the months of September, October, and November, 1918, was it
apparent that the number of motor ambulances which the authori-
ties in the United States stated that they would float would have
any influence upon reducing our accumulated shortage. Shipments
had heretofore not even covered current needs.
K. POOLING SYSTEM.
The principle of supplying individual units, such as regiments,
service battalions, signal companies, etc., with ambulances was found
to be expensive, both as regards supplies and upkeep of these ve-
hicles, so that in order to conserve our resources and obtain the
greatest use of the limited number of vehicles on hand, definite
" pools " of ambulance transportation Avas established at all hospital
centers, base hospitals, and in each base section. These " pool-s " were
under the direct control of the chief surgeon's office, which office es-
tablished a school located in Tours for the .instruction of officers and
chauffeurs in the handling of these vehicles, as well as the necessary
Arm}' paper work. With the exception of the chief of the trans-
portation section of the chief suregon's office, all officers handling
these " pools " were of the Sanitary Corps. Weekly reports were
sent by each " pool " to the chief surgeon's office showing the number
of cars on hand, trips made by. each, amount of gasoline, grease, etc.,
consumed, as well as the nature of service performed by each ambu-
lance in the " pool." The records of one "'pool " are check against
those of another, and competent inspectors are sent around on tours
to see that each " pool " was given the maximum of service and that its
transport was maintained in the best possible condition.
L. DEMOBILIZATION PLANS.
It is contemplated that with the cessation of hostilities and the re-
turn of troops to the iTiited States our divisional sanitary trains
and other organizations having ambulance transportation will be
directed to leave their amljulances at the "pools" of large hospital
centers such as those at Mars and Mesves, proceeding from thence to
their ports of embarkation. The ambulances at such concentration
points will be carefully inspected by officers and skilled mechanics,
and those cars which are fit only for salvage turned in to the large
salvage depots of the Motor Transport (]orps. Ambulances which
are serviceable will be driven from here by the personnel of an evacu-
A. E. F. GENERAL STAFF. 1499
ation ambulance compan}' to Bordeaux, St. Nazaire, or other ports
for shipment back to the United States, as it is believed that a large
number of them will be required shortlj'^ for service in America, now
that our sick and wounded are being sent back in increasing numbers.
Temporarih\ it is desired to have in the advanced region a location
such as Joinville, to which ambulances from returning divisions can
be rapidly inspected and some of them diverted for service and re-
placement with the army of occupation.
M. LIGHT RAILWAYS.
During the St. Mihiel and Argonno offensive some use was made of
the narrow-gauge (60-centimeter) railway' lines, to evacuate casual-
ties. Hospital trains were formed from the retuining cars and ap-
pliances that wer.^ readily removable were attached to the flat
gondolas of this system, so that it was possible with a train composed
of an engine and 10 cars to transport some SO " lying" cases. This
method of transportation Avould have been very saving of ambu-
lances, and it is believed had the war continued for even a few months
more a great deal of use would have been made by the Medical De-
partment of the 60-centimeter railway for evacuation of casualties.
At the time of the signing of the armistice, some 500 cars were
available for purposes of evacuation and it was practicable to manu-
facture others as fast as need for them developed. These cars, how-
ever, which weTv^ used in the St. Mihiel-Argonne-]SIeuse operations
were built with the center of mass too high for the rough construc-
tion of the light railways in the sector, and derailments were so
numerous as to cause, in many instances, abandonment of this system.
Pi-actically without exception, the nvcessities of a smooth working
machine were available to the medical department of the American
Expeditionary Forces in inailequate amounts. The data given in
this summary applies entirely to material, including supplies, equip-
ment, amljulance, and hospital trains, but from other reports it will
be seen that the status of medical personnel was about equivalent
to that of material, and shortages along this line ranged from 40
per cent in April to about 20 per cent in October, 1918.
It will be seen, therefore, tliat the Medical Department was called
ui^on to handle its side of a rapidly dcA'eloping combat problem in the
forAvard areas and the concomitant hospitalization and supply
problems in the rear with the most inadequate material and per-
sonnel. Generally speaking, therefore, our greatest problem Avas to
decide upon prioi-ities of distribution and to determine upon the best
possible method of utilization of our limited resources. Situations
developing therefrom became, at times, so acute that it seemed .in-
evitable that the " cracking point " would be reached before the re-
spite of a winter season came. That such a catastrophe did not oc-
cui" was due solely to the continuous efforts and driving force of an
already much overworked personnel. To develop standards for the
futur.^ based upon the equipment, supplies and ISIedical Department
personnel actually available to the medical department of the
American Ex])editionary .Forces would be a great injustice to the
valiant men and women who made a success of the sanitary service
in the face of the ever-present difficulties which have been so briefly
touched upon above.
1500 KEPOET OF THE SURGEON GENERAL OF THE AHMY.
N. SUMMARY.
CRITICISMS.
Liv k of detailed and coordinated supply plans.
Absence of Medical Department siii:)plv representatives as ob-
servers in Europe prior to entrance of the United States into war.
Shortao-e of administrative offi ers in supply divisions in France,
thereby causing great delay in completion of tonnage fore: asts and
automatic replacement schedules for medical department, American
Expeditionary Forces.
La k of Tables of Organization for units other than the Infantry
Division, thereby precluding accurate estimates upon the need of
equipment, supplies, and transportation.
Impossibility of estimating ultimate strength of American Ex-
peditionary Forces as of any future date.
Lack of adequate Medical Department supply representation upon
docks at ports of embarkation and debarkation.
Failure to establish proper liaison by exchange of officers between
supjDly divisions of the chief surgeon's office and that of the Surgeon
General's.
Lack of proper medical representation with the administrative
and coordinating se tions of the general staff prior to March 15,
1918, during which period the larger policies of supph^ were being
developed.
Absence of a definition of policies and a clear division responsi-
bilities in supply matters between the office of the chief surgeon,
general headquarters, and lines of communication prior to March
15, 1918.
Lack of coordination of procurement and distribution of certain
classes of supplies between the Medical Department and American
Red Cross; this consisted largely of a failure to adequately analyze
the procurement problem.
Great lack of personnel trained in Medical Department supply
work.
Great shortage of motor transportation for assignment to depots
for short-haul trucking.
Great lack of coordination between shipments of units and per-
sonnel and initial equipment for those units from the United States;
great quantities of such equipment which should have been in France
awaiting its unit either failed to reach the American Expeditionary
Forces or only did so many months after the personnel for same had
arrived. This was the greatest single factor causing the reduction
of reserve medical supplies in France,
The selection of site for main-receiving and distributing depot at
improper point on railway line.
Great dispersion of xVmerican Expeditionary Forces with lack of
corresponding and proper dispersion of supj^ly depots.
Tremendous shortage of light and heavy motor ambulances, which
shortage in both vehicles and spare parts continued to accumulate
up to the signing of the armistice.
Imprat ticability of securing a sufficient number of hospital trains
in Europe and because of tonnage situation our inability to aug-
ment suppl}^ by procurement in United States.
A. E. F. — GENERAL STAFF. 1501
O. SUGGESTIONS.
BASIC PRINCIPLES OF SLPPLY.
With the cessation of hostilities the problems of " strategic sup-
ply " ceased to exist. To attempt, therefore, to suggest a plan which
might approach what Avoiild have been the ideal method of medi-
cal sripply control within the American Expeditionary Forces would
be like plotting one of the several solutions of a paper problem. One
of the great lessons learned over here, however, whs the n.eed of
definite and Avell-coordinated plans. The absence of any scheme of
action Avas a manifest embarrassment to the Medical Department,
and it is believed that while the facts. are fi-esh in mind a plan which
with modification might fit any overseas expedition should be sug-
gested. However imperfect such an outline may be, it will form a
provisional basis from which something really acceptable may be
developed by those who later study the valuable experience and
many lesions resulting from the American effort in France.
Without question a war plans division of the general staff in some
form will exist after the war. It is to be expected that a militaiy
police for the United States will be developed as a result of the
lessons of this war. The manifest interest of the Medical Depart-
ment in operation plans must be re:'Ognized to the extent of no
longer considering that department merely one of the Services of
Supply, and it is to be hoped that this change of attitude will be
incor])orated into any policy which may be developed.
Within the War College and the several sections of the general
staff adequate representation will doubtless be given the Medical
Department. Such details will be essential to the development of the
Medical Department's share in plans for the future, and such a sys-
tem will also develop a number of medical officers trained in the
duties of general staff work. With a remodeling of our Army edu-
cational system there will be aA'ailable for such details officers who
have shown aptitude in such work from among the graduates of
the new line and staff schools. Presumably each main section of
the general staff will have a medical representative thereon and it
is believed that the activities of these officers might well be coor-
dinated through a supervisory group in one of these sections. It
has been suggested that this section be the coordinating section if
such a group is created in tlie United States.
The organization then of the ^Medical Department representation
with the general staff would be analogous to that of the American
Expeditionary Forres. One of the chief functions of this super-
visory group should be that of developing the Medical Department
side of the plans for future operations.
A not inconsiderable amount of detailed work connected with such
a study would be with reference to questions of function, personnel,
organization, equipment, and transportation for Medical Depart-
ment units. Before plans for the sanitary service of an ex])edi-
tionary force could come into conference, such details would have
to be determined at least in provisional form. In general, as re-
gards any expedition, it would furthermore be necessary to know
the objective to l)e attained, climate to be expected, length of front
anticipated, lines of conununication to be established, nature and
1502 REPORT OF THE SURGEON GENERAL OF THE ARMY.
iiuinber of base ports avuilable, size of the force to be employed^
and the length of time of its utilization. Such data being available^
a well-balanced sanitary service could be recommended, and out of
conference there would come a definite problem for the Medical De-
partment. The above sequence would follow for each operation
planned, and from a series of such studies there would have de-
veloped a very large but concrete problem of procurement and or-
ganization for our department.
The problems connected with organization are of interest here
only secondaril}'. Our greatest interest is centered in procurement
of material. Out of the problems of procurement of material there
will develop one of about equal importance, that of distribution.
Before we can proceed further in the matter of procurement and
distribution of material, consideration must be given to certain other
parts of the plan. An expeditionary force is usually reinforced pro-
gressively and the details of this progression, with attached time
element must be known. Having this information, it is possible to
work out a shipping program and upon the basis of this priority
schedule to forecast the tonnage requirements.
The ship space allotted the Medical Department should provide
for the necessary initial equipment, replacement supplies, reserve
stores, and a sufficienc}- of strictly Medical Department transporta-
tion, and the priority established should permit of the necessary
shipments of this material coincident with or in advance of the
shipment of troops. The amount of supplies and transportation
to be held in reserve within the expedition will be largely dependent
upon distance from source and such other procurement, storage, and
traffic difficulties. This, however, like other general policies, will
be announced for the information of all concerned. The (}uestion
of the shipment of initial equipment is one that i> vital to any force.
There is no more complicating factor as regards supplies than that
of units of personnel arriving for which there is no initial equip-
ment. Such equipment, like other material, has a more or less defi-
nite consumption factor and must be stocked in reserve. Supply
depots, therefore, carry items of initial equipment, and for these
depots to attempt to suppl}^ new units arriving from reserve stocks
is fatal to that reserve. The equipment, therefore, for each unit
should be laid down at the destination of that organization in an-
ticipation of its arrival. To attempt to ship an organization and
its equipment upon the same boat has been found to be impracti-
cable and should not. orclinarih', be attempted unless conditions ma-
terially change in the future.
During the davs of peace, heavy, bulky, and expensive items of
equipment gradually become part of supph' tables. The advisability
of producing suppl}^ tables solely for peace times and separate and
distinct tables for campaign must here be given consideration. In
the interest of e onomy in ship sjDace, a most radical elimination must
be practiced in an effort to get down to essentially a war basis. The
extent of this elimination will have a noticeable influence upon the
reserve accumulated and tonnage consumed — provided, of course,
"the game is played " conscientiously by all service. At the conclu-
sion of hostilities in France in Xovember, 1918, after several processes
of elimination, our supply tables for all classes of material were far
too elaborate and that deeper cuts were not made was for politico-^
A. E. F. — GENERAL STAFF. 1503
diplomatic reasons rather than for hick of appreciation of the need.
Radical elimination, however, must be practiced equally by all serv-
ices, else we will see very bulky and heavy items that have been
eliminated by one service being brought to the expeditionary force
by another. The question of standarclization must be gone into just
as thoroughly as that of elimination. It is believed that the im-
portance of this equipment and supply study alone justifies the ex-
istence of a permanent board to continuously study and keep up to
date just such questions. Such a board Avill undoubtedly spend much
of its time at a field experimental school and must work under the
supervision of the purchasing, storage, and traffic section of the gen-
eral staff.
Upon the final production of a complete list of equipment and sup-
plies detailed data with refereni e to weight and volume must be com-
piled in connection therewith. These weight and volume figures
must refer to standard shipping packages of the item in question
and must indicate clearly the number of such items contained therein.
It therefore becomes nee essary to include in specifications to manu-
facturers a requirement that they furnish the necessary tonnage data.
When such information has been obtained, it should be compiled in
such form as to make it readily possible to go from weight to volume
and vice versa for any item upon the supply table when prepared for
shipment. Statistics of the exact same nature as those described
above must be compiled for the standard types of motor, horse, and
rail transportation, to be used bj' the medical department of an ex-
peditionary force. Given such information as thees statistics on
weights and volumes, together with the shipping program of the
force, the question of forecasting tonnage requirements becomes
relatively a simple matter, provided, of course, there exists for all
units, whether medical department or otherwise, accepted and ap-
proved tables of organization indicating personnel and transporta-
tion allowed.
We have thus far settled upon the units to be utilized and the ma-
terial that should be sent overseas as their initial equipment. In con-
nection with this, it must be borne in mind that a full initial equip-
ment should include everything necessary to make that unit self-sus-
taining for a definite period of time, from a Medical Department
viewpoint. From this point it would now seem natural to proceed
to the immediate plans for procuring and distributing the material
for the force, but such is not the case without considering another
factor of great importance. This is the factor of consumption or the
wastage to be anticipated in initial ec{uipment and supplies during
service. This factor, together with an estimation of the needs along
the lines of exceptional supply, will form the basis for our figures
for the replacement of material. The former factor, that of consump-
tion, is the real basis for an automatic supply, or for its subsequent
modification. We must, therefore, produce complete and theoretically
perfect schedules for an automatic replacement of all equipment and
supplies, and be prepared to make, tentatively at least, a list of ex-
ceptional supplies and equipment which may be needed, depending
upon certain varying circumstances. Having prepared such lists
and the schedules of automatic supply, we are in position to definitely
say what material must be shipped overseas for any particular ex-
1504 REPORT OF THE SURGEON GENERAL OF THE ARMY.
pedition and ^vitllin what time element. We have, therefore, before
us a definite i)rocnrenient problem.
There now exists a purchasing-, storage, and trallie section of the
general stali' in Washinaton. 'J'his section is responsible, with cer-
tain exceptions, for ({uestions arising in connection with material
in home territory. In preparing for the future it is believed that
all questions of procurement of material will be responsibilities of
this section of the general staff, and the various services will merely
indicate the bases of their procurement problems together with the
necessary specifications upon items. The question of contracts for
equipment and supplies enumating frt)m one central source will have
amongst other advantages that of precluding competition between
the various War Department bureaus in the question of procuring
supplies. It will further the matter of standardization and elimina-
tion and will place squarely up to one section of the general staff the
responsibility of obtaining and holding in storage ready for ship-
ment all necessary material for an expeditionary force. This means
good supply coordination and a thorough investigation of our na-
tional military resources, including those of transportation and stor-
age. Such a progressive move is going to call forth larger appropria-
tions for the purpose of producing a reserve in home territory of mili-
tary stores. This will further neiessitate a more careful study of
the possibilities of standardization and elimination, since reclamors
against such appropriations are almost sure to be heard.
With the advent of hostilities, supply divisions in home territory
must be immediately prepared to release from storage large quantities
of material for shijiment overseas. These supplies will be released
from the reserve of both perishable and nonperishable stores which
will have been accumulated up to the point of equilibrium between
consumption and replacement. Consideration must here be given to
the fact that within an expeditionary force a reserve must also be
accumulated. This will materially inciease the burden placed upon
the division of procui'ement. Supply divisions must further be pre-
pared to immediately supply trained units of personnel to cover the
need for advance supply representatives, purchasing agents, dock
representatives, details to the general staff, and personnel for gen-
eral distribution purposes. This, therefore, contemplates the ac-
cumulation of a reserve of trained supply officers and men. In home
territory when an overseas expedition is engaged against the enemy,
there exists not only the large procurement problem for forces at
home and abroad, but also the problem of home distribution and re-
lease of material for shipment overseas. Whether control of this dis-
ti-ibution is vested in a War Department bureau or in a section of
the general staff', there is certain to be required a carefully worked out
scheme of " controlled stores " in order that available resources may
be utilized to the best ends.
The development of storage and distribution within an expedition-
ary force depends largely upon the existence or nonexistence of an
actual combat problem for troops upon arrival. In other words, the
lines of connnunication may consist solely of the ocean route, or may
consist of that and in addition thereto a long railway haul up to
enemy territory. With the former, for an indefinite period, combat
supplies only must be pushed forward as the fighting troops progress
and real bas'es and land lines of communication, with attendant back
A. E. r.— GEXEEAL, STAFF. 1505
area formation, will only be developed slowly. With the latter, the
problems of distribution Avhich exist at home will largelj^ be dupli-
cated, but will be supplemented by those of actual combat. Distri-
bution jilans. therefore, within an expeditionary force var}^ according
to circumstances, from the simple supply of combat replacements to
a complete and elaborate system of "controlled stores" and other
details of su])ply distribution.
The distribution plans which were developed for the forces in
France were the result of many months of trying experience. It is
true that in actual practice some of them did not really exist, but had
the war gone on the entire scheme would have been in actual use.
The first great need is a well organized supply division in the
chief surgeon's office, with single and absolute control. The main
subdivisions of this office will be those of procurement and distribu-
tion. Under the former will fall local purchasing and procurement
from home territory. The officer in charge of this work must have
an exact duplicate of the automatic schedules that are in the hands
of procurement and distribution officers at home. To him will fall
the task of properly modifying these lists in keeping with depot
levels. He must also anticipate the need of exceptional equipment
and supply and be prepared for many emergen y requests for same.
This work will require an assistant trained in cable work. This
assistant must have accurate knowledge of every cable sent or re-
ceived which refers in any way to supply. The question of the
initiating of orders to purchase locally is a responsibility of this
subdivision. Procurement must develop in cooperation with distri-
bution a system of storage, depot and tonnage reports, for upon
such reports that office is wholly dependent in the matter of stock
levels, storage space available, and the checking of receipts against
tonnage allotments. This office nuist further be in a position to fur-
nish for any period a forecast of the needs of the department in
ship space. There should be, therefore, a tonnage and statistical
section of the supply division, and this work properly falls under
procurement. The proper coordination of i^rocurement activities will
require the most careful liaison between the division of supply and
those of transportation and hospitalization, for they represent the
market to which the goods are distributed. To the office of the
chief of the supply division there should be detailed a representative
of the material section of the American Red Cross and likewise a
supply representative from the Medical Department should be on
duty with the American Eed Cross if useless expenditure of money
and needless duplication of effort is to be avoided. Interest in this
coordination will be divided between distribution and procurement
and this liaison is, therefore, properlj^^ a subsection of the division
of supply.
The subsection distribution will, like procurement, have several
subdivisions. Chief amongst these will be that of " controlled stores."
Into " controlled stores " will flow reports of receipts from home terri-
tory and all large requests for issue. Further details of the woi"k of
this section will be referred to later.
The next most important branch of distribution is that of depot
inspection. The sphere of acti^ities of this office must be from the
base ports to the divisional supply units. Close touch must be main-
1506 REPORT OF THE SURGEON GENERAI^ OF THE ARMY.
tained lu'tweon inspection and depot and supply oificers from front
to r( ar. In this way tlie greatest assistance may be rendered to the
Medical Department chief of all units, combat or otherwise, in ques-
tions of supply. At the same time this is the only method by which
we may preclude under, or over, stocking in nnits and in those small
depots' Avhich do not ordinarily make depot reports, and it will be
through such inspections that information is obtained by procure-
ment relative to n-^w and exceptional needs of troops. Such a system
of inspections will greatly reduce the detail travel which would or-
dinarily have to be undekaken by those in charge of procurement,
and particularly distribution. A considerable part of the time of
these lattt r officers must be spent on the road, but the time thus spent
should be very largely devoted to the large questions of policy and
to the observation of results obtained.
In connection with the division of supply, or probably as a main
division of the chief surgeon's office, there must be a division of
finance and accounting. The question of property accountability in
an expeditionary force ^ ill be wholly dependent upon the breadth of
the interpretation placed upon field service or other regulations bear-
ing upon this matter. It is believed that the continuance of real ac-
countability within an overseas expedition was never contemplated
and if a sufficiency of trained administrators is available, such ac-
countability woulcl never be needed. A certain degree of responsi-
bility and informal invoicing and receipting between the supply divi-
sions at home and abroad, and between depots and units overseas will
be required, and it is presumed that money accountability will al-
ways be strictly maintained. Such matters as finance, however, are
outside of the questions here to be considered. A division of finance
and accounting will be an important adjunct to a supply division
and such accountability of property as must exist should be main-
tained in one office.
" Controlled stores " receives requisitions fi'om depots, certain
Medical Department units, and from section surgeons, that part of
requisitions which can not be filled from the stores under their con-
trol. It is contemplated that distribution of controlled stores may
extend up to and including the second echelon of supplj', that of
Army medical dumps. The execution of the details of " equalization
of stock " falls to the subdivision '" controlled stores " in cooperation
with the statistical personnel. The office of the section surgeon is
one of the ]Doints to which' certain supply control must be decen-
tralized. These officers pass upon requisitions of units within their
territory and direct issues from depots most suitably located within
their sections, forwarding calls for such amounts as their depots are
unable to supply to " controlled stores." The control of hospital
centers should remain in the office of the chief surgeon, and requisi-
tions from hospital center depots Avhich have been passed upon by
center commanders will, therefore, be forwarded to " controlled
stores," which may direct the issue. Issuing depots, up to the thira
echelon (Army medical supply depots) normally forward their calls
for replacements to " controlled stores." The needs of the second
and third echelons, wjiich have fixed stock maxinnnns, are automati-
cally met by an informal call or by stock reports to the echelon next
in rear. Such calls, however, may be filled either wholly or in part.
A. E. F. GENERAL STAFF. 1507
when sufficient reason exists therefor, by rehiring the rail to *' con-
trolled stores."
Certain storage space and certain supplies received from home ter-
ritory are the sole property of ''controlled stores" and records of the
daily flow in and out of these stores must be kept. Supplies under
control will be kept in decreasing amounts from base sections for-
ward. They will normally be held in large base storage stations and
in other large nondetail issuing storage depots from which carload
lots may be readily shipped. Ultimate disposition of such stores
may be from receiving and sorting stations at the docks, or not nntil
such stores have been for some time in an intermediate depot, de-
pending upon the need. One of the greatest fields of usefulness of
"controlled stores" will be that of laying down initial equipment at
destination of units in anticipation of their arrival, thereby relieving
a local distribution point of a very appreciable load. The need at
depots of independent motor transportation will be great for every
echelon of supply. There are many times when rail transport is
either hopelessly blocked or not suitable to the need. At least depots
and autotruck pools should be convenient to one another.
Except as heretofore indicated, questions of supply arising within
the Army combat zone are handled by groups chief surgeon, or by
the chief surgeon of the highest combat unit present. The control
of Army supply units must be left to the authority "who has author-
ized their maximum stock allowances, and, as previoush^ stated in
text above, this is done by Army chief surgeons and Army general
staff sections (G-4).
The forward echelons have been more or less covered under the
development of strategic supply, but an additional word in connec-
tion therewith and with the diagrammatic sketch may be useful. The
divisional unit is an extremeh' useful addition to our division and
must be retained. Medical dumps at Army parks will ordinarily be
needed on a basis of about one per corps. Their sole function should
be that of supplying the need of the several divisions actually in
front of them. They must also be prepared to assist each other
with either supplies or transport in emergencies. Naturally these
dumps are not full-stock units. The several dumps of an Army are
refilled in the manner already outlined from a full-stock Army
depot. These larger depots, on a basis of one or more per Armj'^,
must be pushed as far forward as reasonable safety Vv'ill permit.
To these last-named units will fall the task of supplying the
Army and corps medical department units and in emergency also
certain Services of Supply units, such as forward base hospitals.
Furthermore, combat units in rest and reserve which ma^^ be too
far in the rear of dumps must forward their requisitions to these
depots. The greater bulk of replacements to these larger Army
depots must come automatically from the still larger Services of
Supply controlled depots in the rear (advance-intermediate depots).
These units are also full-stock depots and have functions similar to
the Army units. They are, however, in immediate touch with and
are controlled by distribution, although a portion of their stock is at
the disposition of the section surgeon. These advance-intermediate
medical supply depots are normally stocked through "controlled
stores" as a result of the equalization of stock, in so far as essential
142367— IJ^— VOL 2 34
1508 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
items are concerned. Upon other items an automatic replacement
system from the next echelon in rear may be established if deemed
wise or these " holes " in stock may be filled by call upon " controlled
stores."
All depots and storage stations in rear of the advance-intermediate
depots except the small lo:al distribution points are a part of "con-
trolled stores." One or more large full-stock and detail-issuing
depots (as shown above) might Avell be in a position to establish an
automatic flow of supplies to the forward units from the inter-
mediate section. This echelon will still remain a part of "controlled
stores," however, and may yet further be utilized to cover the local
distribution needed. Such units would normally receive the results
of purchase. The proximity of good rail and road facilities to
these depots is of paramount importance and sites for such units
must be selected with great cai-e. All other large units in rear are
merely duplications of one another, inasmuch as they are for carload-
lot shipment, are not full stock, do not make detailed issues, and are
a part of "controlled stores." Such stations are enlarged and dupli-
cated as the force grows and as the number of base ports is increased.
VIII. MEDICAL ACTIVITIES OF THE AMERICAN EXPEDITIONARY
FORCES IN THE ZONE OF THE ARMIES.
1. Reports or Chief Surgeons or Armies.
A. FIRST ARMY.
After a period of intensive training, on January 15. 1918, the
United States 1st Division relieved the French Moroccan Corps in
the sector north of Toul between the St. Mihiel salient and the Mo-
selle River, this being the official entry of the American troops into
combat. Evacuation Hospital No. 1 was installed February 1, 1918,
in the Sebastopol Barracks 3 miles north of Toul in the middle of
the sector, marking the first front line hospitalization attempted,
this unit being 25 kilometers in rear of the trench line.
The 2d, 26th, and 42d Divisions were placed in relatively quiet
sectors for instruction in trench warfare under French command,
and Evacuation Hospital Xo. 2 was established at Baccarat and Mo-
bile Hospital No. 39 at Aulnois sous Vertuzey to increase the hos-
pitalization.
The 1st Division was relieved by the 26th Division on April 3,
1918, and after a brief period of rest was transported to the neighbor-
hood of Montdidier, where on April 25 it occupied a section of
trenches, its hospitalization under agreement with the French author-
ities being provided for by the Army Red Cross hospital at Beauvais.
The (xerman offensive beginning on March 21, 1918, thrusts were
made with success against the line north of Montdidier held by the
British, and suddenly changing his objective the enemy drove a wide
and deep salient in the line held bj' the French between the Aisne
and Marne Rivers, the greatest advance being made in ISIay in the
direction of Paris.
That part of the French line to which the 1st Division had been
assigned offered a stubborn resistance which foiled the patent effort
of the enemy to divide the British and French junction, and conse-
quently he redoubled his efforts between the Aisne and Marne and
A. E. F. AEMIES. 1509
forced the French across the Marne, his best divi;sions being em-
ployed here in great numerical superiority to the P'rench, who wisely
refrained from throwing in their reserves as it was not definitely de-
termined at this time that the drive in the direction of Paris was
the main enemy objective, as great preparations had been reported
at other points on the long line.
The 2d Division had been transferred from its area to the neighbor-
hood of Chaumont-on-Vixau, near the location of the 1st Division,
with the intention of its relieving the latter, which had su^tained
and successfullv repelled numerous assaults in great force.
On May 28. 1918. the 28th Regiment of Infantry of the 1st Divi-
sion made a brilliant and successful surprise assault upon the strongly
fortified village of Cantigny, which it held, and this action caused
the enemy to make 12 assaults in mass against the 1st Division
which were repulsed with great losses to the enemy, the Americans
tenaciously holding the ground gained.
The losses sustained by the 1st Division in this conflict were as
follows :
Men.
Killed 13 186
Wounded 31 621
Captured or missing 1 15
Five enemy officers and 220 men were captured.
From this time on the conflict became general from the North Sea
to Verdun, and the German thrust in the direction of Paris by way
of Chateau-Thierry had attained such magnitude that no room was
left for doubt as to his intentions.
The outlook was decidedly gloomy, as all efforts to check the ad-
vance in this direction appeared futile, and acting in his capacity as
commander in chief of the allied forces, Gen. Foch on May 30, 1918,
ordered the transfer of the 2d Division to the vicinity of Meaux,
where the first elements arrived on May 31. The 3d Division had
also been ordered to this point b}^ train and truck, and the 26th
Division was preparing to move to this sector.
The Tth Machine Gun Battalion of the 3d Division arriving in
trucks on the morning of June 1 was barely in time to take up posi-
tion at the bridgehead at Chateau-Thierry, and though without
previous combat experience it made a magnificent defense against
overwhelming forces flushed with victory, it checked the crossing of
the enemy at the main avenue of approach, suffering a loss of half
its effectives in a few hours, but enabling the elements of the 2d
Division to advance and take up position across the Paris-Metz
highway, and for the elements of the 3d Division that had arrived in
the meantime to make preparation for entrance into what was to
prove a most sanguinary conflict, but also the crucial point of the
war which was to mark the high-water line of the German flood, and
the ebb of his fortunes that ultimately stranded him upon the reef of
defeat.
The 2d Division after a desperate struggle against some of the
picked German divisions succeeded in effecting a crossing of the
Marne, being ably supported by the 3d Division and the Sixth French
1510 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
Army, and thrusting the enemy back engaged in the contlict upon
the wooded heights above the Marne which will be known in history
as the battle of Belleau Wood.
The confusion created by the rapid advance of the enemy in the
direction of Paris had affected the entire country, the railroads prob-
ably more than other institutions, and this with the paucity of
motor-truck transportation made it practically impossible to trans-
port evacuation hospitals to the scene, or to have hospital trains ap-
proach near enough to the battle area to be of use. It had been
specifically agreed in writing that American troops operating under
French command would receive hospitalization at the French in-
stitutions, but the demoralization consequent upon the German ad-
vance precluded the use of these institutions, and after triage and re-
dressing the seriousl}" wounded and gassed were moved by ambu-
lance from the field hospitals to the hospital at Jouilly maintained
by Mrs. Harry Payne Whitney for French aviators, the less severelj'
wounded and gassed being transported by ambulance to the five
Army Eed Cross hospitals in Paris over a poor road of 65 kilometers
in length, adding to the shock in spite of the warm weather, though
it was the only recourse of the American command confronted by
insurmountable obstacles and a total lack of transportation facil-
ities at this time. The medical officers of these divisions performed
prodigies in caring for the sick, gassed, and wounded, but human
endeavor could not move hospitals at this period of utter demoraliza-
tion and abeyance in transportation, and while some suffering was
caused it must be remembered that the actual conditions in war do
not admit always of the nice adjustment of theories formulated in
peace, and also that the lesson learned here is additional argument
for the Medical Department to possess some motor transportation of
its own by which its evacuation hospitals can be shifted as occasion
demands.
The German advance having been stopped desultory fighting with
small losses occurred daily.
By dint of great effort. Evacuation Hospital No. 7 was established
at Chateau Montanglaust near Coulommiers the first part of June,
where it was joinecl several daj^s later by Mobile Hospital Xo. 1,
both affording a bed capacity of 1,100 with good hospital train
evacuation facilities; and at this time the Army Red Cross estab-
lished a hospital at Jouy-sur-Morin with a capacity of 600 beds, its
train evacuations being effected at La Forte Gaucher, 4 kilometers
distant.
These hospitals with Jouilly sufficed for the troops engaged at
this time in the sector and performed remarkable work^
To coordinate the control and supply of the American divisions
in this sector an assistant chief of staff, G^, was established at La
Forte sous Jouarre, and an advanced depot placed at Lieusaint
southeast of Paris and regulated through Le Bourget.
It had become evident to the French high command that the
enemy though cliecked at the Marne would make other attempts at
some unexpected point, and signs of activity being reported in the
vicinity of both Soissons and Chalons, the 2d Division was with-
drawn from near Chateau-Thierry and with the 1st Division placed
in reserve under the Tenth French Army south of Soissons, and the
42d Division w^as established in support of the Fourth French Army
A. E. F. — ARMIES.
1511
at Siiippes north of Chalons, these dispositions being made the first
week in July.
Evacuation Hospital Xo. 4 was established at Ecurv and Mobile
Hospital No. 2 at Vatry, both for service with the 42d Division, and
Evacuation Hospital No. 5 was designated for service with the 1st
and 2d Divisions, its postponed arrival being due to the declination
of the French to permit an American hospital in the area of the
Tenth French Army as the French agreement to hospitalize our
wounded was evidently deemed sufficient.
During this time the 26th and 28th Divisions had arrived in the
Marne sector and their control with the 3d was vested in the com-
manding general of the First Army Corps, American Expeditionary
Forces, under the Sixth French Army, while the 1st, 2d, and 4th
Divisions were under the commanding general of the Third Army
Corps, American Expeditionary Forces, attached to the Tenth
French Arm}^
On the night of July 14-15, 1918, after a terrific artillery prepa-
ration, the German Army opposed to the Fourth French Army
north of Chalons attempted a violent thrust with the rail center of
Chalons as the objective, and though the 42d Division was in sup-
port it speedily engaged in a struggle with the enemy who had ad-
vanced rapidl}' under cover of his barrage, and at one time during
that eventful night found itself surrounded on three sides, its ad-
mirable handling, hoAvever, enabling it to not only check the enemy
but inflict heavy losses upon him with relatively slight loss to the
Americans. The losses sustained in that combat are as follows:
Oflacers.
Men.
Killed
4
3
305
Wounded
990
Gassed
225
Captured or missing
1
30
This division remained on the defensive till July 23, when it
was transferred to the Marne.
On July 15, 1918, the enemy made a heavy thrust in the direction
of Paris to the south of Soissons, between the Aisne and Marne
Rivers, and early on the morning of the 18th the 1st and 2d Di-
visions of the Third Corps, held in support to the Tenth French
Army near Crepy, were cast into action, and by the fierceness of their
onslaughter not only checking the enemy advancing in mass but
inflicting severe losses, at the same time suflfering heavy losses which
are as follows :
Men.
1st Division:
Killed
Wounded
Captured
Enemy prisoners taken
2d Division:
Killed
Wounded
Captured or missinp. . .
Enemy prisoners taken
1,176
4,678
1,528
3,375
452
2,572
764
2,879
1512 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Due to a mistaken idea as to the need of secrecy, neither the A. C.
of S. G. — 4 at La Forte or G. H. 2 wore informed of the imminence
of comhat. This fact, coupled with the declination of the P'rench
command to admit American hospitalization to this area, prevented
Evacuation Hospital No. 5, which was then en route, from arriving
on the scene in time to be of much service, and the hospitalization
of the French was so inadequate that it did not suffice to care for even
the French casualties.
As Paris was but a short distance from the scene of battle, hos-
l^ital trains were rushed to Crepy, where the wounded and gassed,
after receiving such care as the field hospitals afforded, were loaded
into comfortable trains and speeded as preoperative cases to the five
Army Red Cross hospitals in Paris for definitive treatment.
Evacuation Hospital No. 5 having been rushed to Sery Magneval,
near Crepy, on the earnest plea of those who had denied it admit-
tance, only receiving the nontransportable cases, but its presence
proved a godsend to a Scotch division rushed in to relieve the 1st
and 2d Divisions with such haste its sanitary train was left far
behind, necessitating the loan to it of the greatly fatigued sanitary
train of the 1st Division which transported the wounded of this
gallant division to Evacuation Hospital No. 5 for definitive treat-
ment, from which location all were evacuated to Sonlis, freeing this
hos])ital for further service or relocation.
This experience proved the last attempt for months to brigade
American with French troops, and the 32d, 42d, and 77th Divisions
having arrived in the Marne sector, these and the divisions men-
tioned beforehand were concentrated on the general line of the Marne
under the First and Third American Corps with elements of the
Sixth French Army incorporated, all being under the coordinating
control of the A. C. of S. G-4 representing general headquarters,
this group of divisions being known as the Paris group.
During this period Evacuation Hospital No. 8 had arrived at
Jouilly, Evacuation Hospital No. 6 at Chateau Perrouse near La
Ferte, Evacuation Hospital No. 1 at Meaux, and Mobile Hospital
No. 2 at Chateau La Trousse near Luzaney ; Evacuation Hospital No.
5 at Sery Magneval being packed for a move when the 1st and 2d
Divisions joined the other American divisions.
From July 20 to August 10, the American and French divisions
had forced the German troops nearh^ to the Vesle River in the di-
rection of the Chemin des Dames, inflicting heavy losses upon the
best divisions the enemy could muster, in an effort to check the steady
progress of the French and American armies which was creating
a tremendous effect upon the German populace who had received
information in spite of the activities of the censors.
The First Army, American Expeditionary Forces, was officially an-
nounced on August 10, 1918, with the commander in chief in com-
mand, auxiliary troops were added, and the Auierican Army began
the independent career it maintained to the end.
The arrival of heavy Army artillery before the organization of
the First Armj^ enabled the divisions to leapfrog eacli other and pre-
sent a fresh division to the greatly fatigued enemy, who by the middle
of August retired behind the Vesle enabling the French armies on
the right near Rheims and on the left near Soissons to converge to a
point with the Chemin des Dames as the center.
A. E. F. ARMIES. 1513
When the American First Army had advanced 30 kilometers north
of the Marne, EA'aciiation Hospitals 5 and 6. with the Armj' Red
Cross Hospital No. Ill from Jony, and Mobile Hospital No. 1 from
Montanglaust, ^Yere established at Chateau-Thierry and its suburbs
on August 1, and on August 9 Evacuation Hospital No. 1, Mobile
Hospital No. 2, and Army Eed Cross Hospital No. 110 from Beau-
vais, were installed at Coincy, halfway between Soissons and Chateau-
Thierry, both points possessing good rail facilities for hospital train
evacuation and easy access from the front. Evacuation Hospital No.
3 arrived on August 3, and after following the troops with tentative
location for several days was finally established at Crezancy near the
Chateau-Thierry-Rheims road on August 12.
The Germans having withdrawn toward the Aisne River and the
Chemin des Dames, his progress being accelerated by the French
armies on the left and right, the First American Army was with-
drawn to the Neufchateau area for preparation for the next offensive,
the 32d and 77th Divisions remaining to assist the Tenth French
Army in pushing in the salient created in the region east of Soissons,
upon the successful completion of which they withdrew on August
30 to join the other American divisions in the new area.
Evacuation Hospital No. 5 had been moved to Yillers-Cotterets to
hospitalize the wounded of the 32d and 77th Divisions, and the other
evacuation, Army Red Cross, and mobile hospitals were placed in
rest in the new area.
During the first part of August a singular diarrhcea had afflicted
all in the Marne country, French, Americans, Germans, and French
civilians alike, this diarrhoea being without tenesmus or temperature
and the mortality nil. Sanitarians deemed it a fly-borne disease of
dysenteric nature, for the entire country was infested with myriads
of flies. At this time the bread supplied left much to be desired, for
being baked by the flash method in large loaves the interior was
raw dough in lumps and the loaves were permeated with mold.
As a similar disease made its appearance in the Second American
Army months later when the cold weather had destroyed all flies,
•we are still in the dark as to the nature of the disease which, if
dysenteric in type, is without doubt a mild and most singular mani-
festation of the disease, and it is but fair to term it camp diarrhea
of unknown origin, as the water supply was not implicated.
The casualties in the Aisne-Marne offensive from June 1-August
30, 1918, in the various combats described are as follows:
Killed 6, 064
Wounded 40, 974
Sick 9, 032
Gassed 3, 808
On August 16, 1918, the staff of the First Army, American Expe-
ditionary Forces, began preparations for the reduction of the St.
Miliiel salient based upon the battle order, the date of the offensive
being unannounced and speed enjoined.
The battle order announced that 10 American divisions with corps
and army troops reinforced by French heavy artillery would assail
the line north of Toul from Richecourt to Romeny, the II French
Colonial Corps would attack at the point of the salient after the
American line had advanced to the first phase objective line with the
mission of mopping the forest that was located in this region, and
1514 REPORT OF THE SURGEON GENERAL OF THE ARMY.
that four American divisions reinforced by heavy French artillery
would attack south of Verdun at a point opposite Les Eparges, the
objectives being attained in three phases of a day's duration each.
Tlie Fourth Corps, American Expeditionary Forces, was assigned
that portion of the line north of Toul between Richecourt and Limey;
tlie First Corps, American Expeditionary Forces, the line from
Limey to Romeny, the right flank division being astride the Moselle
River and to act as a holding force: the II French Colonial Corps
the point and both sides of the salient and in contact with tlie Ameri-
can forces on the east and noith : the foui- American divisions between
Les Eparges and the II French Colonial Corp^ holding the line
froui just sonth of Verdun under the Fifth Corps. American Expe-
ditionary Forces, Army headquarters to be located at Ligny-on-
Barrois. which was the nearest available point to the three sectors
of the line.
The battle order was subsequently altered to assign one division
(26th) to attack at Les Eparges, the other three in this sector being
in reserve, and added two divisions as Arm}^ reserves behind the
Fourth and First American Corps. This disposition of forces neces-
sitated a triple hospitalization, and to that end sanitary formations
were secured from the French department of armies of the east.
It having been estimated the three-phase offensive would net
33.000 casualties, 45 hospital trains were obtained from the French,
which, with the IT American trains and 15,000 beds in the Toul sector,
6,000 in the French II Colonial Corps sector, and 4,500 in the
Verdun sector, were deemed sufficient to dispose of the estimated
number of casualties and sick expected from the 490,000 men engaged.
Hospital trains were to be regulated through the I'egulating office
at St. Dizier.
The triple nature of the hospitalization and evacuation demanded
three representatives, one at Toul, one at Souilly, and the surgeon
of the II French Colonial Corps at Brize, while the chief surgeon
of the army was located at Neufchateau on the main telephone trunk
lines to coordinate the activities on all fronts and insure supply.
In the early hours of September 12, 1918, after two hours of the
most terrific artillery preparation the world had known to that
time, the barrage lifted, and in a dense fog the First American Army
advanced in its maiden independent effort to achieve a victor}^ so
completely and quickly accomplished that the Avorld at large was
astounded, the enemy being surprised and overwh.elmed in spite of
his futile and frantic denial in an effort to minimize the effects of
the disaster upon the already suspicious and demoralized German
public.
The advance was so rapid the three-phase objective was lost to
view, the troops making practically unopposed progress as fast and
as far as a line may advance in one day and maintain contact with
all the elements and with the Services of Supply, till at the ultimate
line it halted at command and repulsed the repeated assaults of the
enemy who had rushed up divisions in an effort to check the Ameri-
can advance before the objective which gave domination of the Metz
basin could be attained. While the main conflict occupied only one
day and part of another, the official period is from September 12-16.
the latter part being largely artillery exchange.
A. E. F. ARMIES. 1515
Tlie relatively small number of casualties sustained in this of-
fensive in proportion to the number engaged is as follows:
Toul front:
Wounded, including 303 German prisoners 3,446
Gassed 532
Neurological cases (shell shock) 147
Total 4, 125
Died Jroni -.vounds 104
Evacuation'^, including large number of sick in hospital at beginning
of offensive 6, 539
Number of hospital trains used 17
II Fn^nch Colonial Corps:
Wounded, Including 98 German prisoners 321
(iassed 0
Xeurological cases 0
Total 321
Died from wounds :. 32
P^vacuations 0
Verdun front :
Wounded . 625
Gassed 4
Xeurologicn! cases 135
Total 764
Died from wounds 22
Evacuations 725
Number of hospital trains used 5
The rapid advance with slight casualties did not warrant the
moving forward of evacuation hospitals, and the entire number of
sick, gassed, and wounded men could have been provided for in the
hospitals at the front had it not been that uncertainty of further
offensive tactics counseled the freeing of those hospitals for possible
battle use.
An experiment was made in this offensive to determine the ef-
fectiveness of employing psychiatrists at the divisional triages and
shell-.-hock hospitals at the front, and when it is considered that out
of a total of 282 cases 225, or 79 per cent, were returned to the front
line within three days, the success of this employment must be
manifest, as it preludes a wastage in man power from which one
of our allies suffered greatly.
In this offensive the use of a field hospital for each division in
line to act as a triage or sorting station was given full scope, and
this use. which had been tentative in the Marne offensive, was so
successful that the dressing -station and station for slightly wounded
were found superfluous, as this sorting station well to the front took
the place of both in open combat.
Superstition had through four years of trench warfare invested
the heavily armed German fortification on Mont Sec with dreadful
powers of destruction. The 1st Division was assigned the seemingly
forlorn hope of taking this place. With the expectation of so many
casualties. Mobile Hospital No. 39, at Aulnois sous Yertuzey. was
allotted to the severely wounded of this division alone, while the
slightly wounded were assigned to Evacuation Hospital No. 11 with
Field llospital No. 41, at Sorcy.
1516 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Tlie rioht flank division on the Toul front beine: exposed to direct
fire from the north and cross fire from the east, was assigned Evacu-
ation Hospital No. 13. at Chaligay, for severely wounded, and Field
Hospital No. 163 acting as an evacuation hospital, at La Malgrange,
for slightly wounded. The interior division shared the other evacu-
ation, mobile, and base hospitals in relation to the corps and di-
visional lines of separation, and all shared in the gas, contagious,
and neurological hospitals in the Justice Barracks.
The casualties sustained in this offensive, exclusive of wounded
German prisoners, were as follows:
Killed ' 769
Wounded 4, 294
Gassed 532
Neurological cases 282
Total 5, 877
Died from wounds 1.58
Enemy prisoners captured 14, 400
This offensive emphasized the shortage in evacuation hospitals,
medical personnel, and ambulances. This lack of balance between
combatant and medical organizations had been repeatedly reported
to the War Department by the chief surgeon, American Expedi-
tionary Forces, but through military necessity had not been reme-
died up to this period. At this time the Medical Department of
the American Expeditionary Forces was lacking 60,000 personnel,
hundreds of ambulances, and many evacuation hospitals, necessi-
tating the adoption of such expedients as the use of nonmedical per-
sonnel, the use of field hospitals as evacuation hospitals, the bor-
rowing of ambulances from French and American base hospitals,
borrowing medical officers from base hospitals and divisions, and
nurses and enlisted men from base hospitals, till a great part of the
resources of the Medical Department of the American Expeditionary
Forces had been placed at the disposal of the First Army, and still
did not suffice.
While the St. Mihiel offensive was in progress the First Army
staff made preparations for an offensive upon a much larger scale
to be staged in the Argonne-Mesuse sector from the western border
of the Argonne Forest to the line held by the French northeast of
Verdun, the objective being interruption of the enemy's main artery
of rail connnunication between Mesieres and Longuyon and forcing
him back on his vital pivotal flank, the successful attainment of this
operation insuring his rapid withdrawal from the territory north
of this point to the North Sea.
With the knowledge that the enemy had added largely to the
natural defenses in this very difficult terrain and would exert himself
to the utmost to prevent his pivot being forced, it behooved the First
Arm}' staff to assemble a sufficiently large force to always present
fresh divisions to combat the picked divisions the enemj' would hurl
against the Americans regardless of losses, and to so supply that
force that it could continue the offensive unremittingly. To this end
the First, Fifth, and Third Corps of the First Army, with the ITth
French Corps reinforced by two American divisions, comprising 25
divisions in all, corps and Army troops. Army reserves, and auxili-
1 Subject to revision.
A. E. F. ARMIES. 1517
aries being added, all to the number of nearly a million men, were
assigned to station in this sector with a front of 22 kilometers, the
headquarters remaining at Liga}' on Barrois with an advanced post
of command at Souilly.
As September 26. 1918, had been designated as the day of begin-
ning the offens^ive it became a herculean task to transfer the troops
necessary, in addition to the divisions already in the area for par-
ticipation in the St. Mihiel offensive, and to assemble the supplies and
units, and this latter task demanded personal reconnaisance of the
terrain by the chiefs of services on the First Army staff.
The French authorities had already assigned certain formations
to the medical service of the First Army for the St. Mihiel offensive
and other formations in adition were taken over.
The First and Fifth Corps had contagious hospitals run as an-
nexes of the nearest evacuation hospitals and functioned by their
personnel, the Third Corps being served by the existing French
unit at Benoite Vaux.
Large well stocked medical supply parks were established at Vaube-
court and Fleury, the existing park at Souilly being enlarged.
Hos])ital trains were garaged in numbers as near the front as pos-
sible, their movements being directed by the regulating office at St.
Dizier.
The ambulance shortage being acute 15 sections of the United
States Ami}- Ambulance Service of 12 cars each were obtained from
the Italian Government, 9 French sanitary sections of 15 cars each,
and 30 sightseeing busses with a seating capacity of 30 per car, were
obtained from the French Government, and the total number of
ambulances equably apportioned, the shortage still being 750 for
an Army of the size to be employed in spite of tables of organizatioc
prepared and issued as a standard for transportation.
The battle order contemplated three phases, the objective being
a ridge dominating the railway from Sedan on both sides, the French
Fourth and Fifth Armies to the west in the Champagne sector at-
tacking simultaneousl}', and the Fourth French Army and the First
Corps of the American First Army to make contact at the head of the
Argonne Forest.
As secrecy was essential to success all movements were made at
night, the lowering weather precluding serial observation by day,
and on September 25 all was in readiness.
In the early hours of September 26, 1918, the earth trembled with
an unprecedented barrage from 1,000 field guns, said by observers to
be the heaviest ever delivered on any field of battle, the roar being
so terrific the spoken command was futile during its continuance.
As dawn came the dense masses of American Infantry moved for-
ward across no man's land and forced the enemy over the most
difficult and heavily wooded countr\' to be found in France, except
in the impassable Vosges Mountains, the absence of roads and the
mud consequent upon the downpour of the preceding week making
progress slow for foot troops and almost impossible for horse-drawn
vehicles and motors.
The enemy had massed machine guns in every thicket and at the
head of every ravine, this being more pronounced in the Argonno
Forest than elsewliere, for he had vast stores in the forest and had
1518 REPORT OF THE SURGE0:N GENERAL OF THE ARMY.
made elaborate preparations for defense b}^ wire entanglements 500'
feet in depth, behind "which the machine gunners were intrenched-
Progress on the forest side was therefore slow and tlie casualties
severe, while the P^ifth Corps made progress with difficulty up the
slope of Montfaucon, and the Third Corps on the right advanced
rapidl}^ in comparison.
But one road, Varennes to Grand Pre, skirted the forest on the
east, and below Varennes the enemy had employed ground mines so-
successfully the Artiller}- and supply columns could with difficulty
move at all, this delaj^ing the advance at this part of the line until
the Engineers by supei'human effort built a by-pass and filled in
the huge excavations. The middle sector assigned the Fifth Corps-
had practically no roads, requiring oblique movement from either
the First or Third Corps sectors, and the first portion of the road
in the Third Corps sector from Avincourt to Malincourt Avas inde-
scribably deep in mud, all this contributing greatly to delay the
advance and making the passage of the ambulances with wounded
en route to the evacuation hospitals a stupendous task, which vras
accomplished solely by the persistence of the splendid drivers and
the great aid of the military police, for this passage the first day
was made in the darkness of a rainy night.
The reduction of the forest not being accomplished on the schedule
of the battle order, nor the heights of Montfaucon taken, fresh di-
visions were assigned the tasks, and to the 1st Division fell the
forest, the most difficult undertaking that or any other division ever
attempted. Thoroughly accomplished in all forms of combat but
still fatigued from the St. Mihiel offensive and its long journey on
foot to this new sector, this splendid division took up its task
in a businesslike manner, and by dint of hard and almost guerrilla
fighting conquered the forest, inflicting severe losses upon the enemy
and capturing many prisoners and much booty, but suffering heavy
casualties itself.
The remainder of the First and the Fifth and Third Corps had
advanced, and the roads being repaired and the congestion reduced,
the time had arrived to advance some of the evacuation hospitals to
shorten the haul for the wounded.
On October 1, Evacuation HosjDitals Nos. 3 and 5 were transported
from the area to Mont Frenet and La Veuve, respectively, to serve
the 2d and 36th Divisions, which had been detached from the First
American Army for service with the Fifth French Army in the
Champagne sector north of Chalons, their ambulance companies
accompanying them. Mobile Hospital No. 7 from Paris also arrived
at Mont Frenet. Evacuation Hospital No. 14 was moved from Vil-
lers Daucourt to Les Inlettes on October 7, and Mobile Hospital
No. 1 from Clair Chanes to Fromereville on October 9.
Between October 1 and 7 the personnel of Evacuation Hospitals
Nos. 20, 22, and 23 arrived and were distributed among the other
hospitals, which were being taxed to their utmost.
The 2d American Division, supposed to be in support of the Fifth
French Army north of Chalons, was used to branch the line on Octo-
ber 3, which it accomplished with its usual dash, being relieved by the
36th Division on October 8, this use of these troops continuing until
October 12, when both divisions withdrew and rejoined the First
A. E. F. AEMIES. 1519
American Army, the casiialtie.^ sustained in tliis local combat being
given later imcler the total for the Argonne-Meuse offensive. After
evacuation of patients Evacuation Hospital Xo. 3 returned to the
First Army, arriving at Fontaine Ronton on Xovember 10. Mobile
Hospital No. 7 was transferred to the Second Army, and Evacuation
Hospital Xo. 5 j^roceeded to Dunkirk to join Mobile Hospitals Xos.
8 and 9 for service with the 37th and 91st Divisions, detached from
the Second and First Armies, respectively, and to operate under
French command.
On October 12 the Fourth and Sixth Corps with Army and corps
troops, and Evacuation Hospitals Xos. 1, 2, 12, and 13, with Mobilfi
Hospitals Xos. 3 and 39, were detached from the First Army and
assigned to the Second Army, which came into being on that date,
under the command of Lieut. Gen. Bullarcl, the commander in cliief
relinquishing the First Army to Lieut. Gen. Liggett. The Second
Arm}^ acting as a holding force, and never being rec|uired for offen-
sive tactics, no further mention is made of this splendid force, which
had been created for an offensive between Metz and Strasl^ourg.
Evacuation Hospital Xo. 15 moved from Revigny on October 12
and established at the Glorieux of Verdun to care for the wounded
of the Third Corps, and assist in caring for the wounded of the Sev-
enteenth French Corj)S that had begun the offensive to the east of the
Meuse.
It had become clear that evacuation by any road straight through
the Fifth Corps sector was impossible, and that oblique evacuation
to the First and Third Corps sectors was the sole way to get the
wounded out, and though it violated an established principle. Xaturo
made the land before man formulated the principle, and terrain
always governs war.
At this time the wave of influenza that was sweeping over the
continent engulfed the First Army, that already had as much to
hear as it could sustain, and for a time it appeared as though its
ravages would seriously affect the military operations by overwhelm-
ing the sanitary formation.
By triaging all affected with signs of the disease as carefully as
the wounded were sorted, masking all affected, and transporting the
uncomj)licated cases in ambulances carrying no other class of patients
to the hospitals at Revigny set apart for this disease, and similarly
transporting those evidencing the slightest signs of pneumonia to
a special hospital hastily established at Brizeaux village under the
charge of expert clinicians, and keeping the unaffected in the opea
air, the incidence of morbidity and the mortality rate from this
epidemic was below that of troops in the training areas and the base
sections.
While this menace did not stop the operations it slowed them per-
ceptibly, and after passing the offensive was redoubled in vigor,
the irresistible pressure of the Infantry, with the Artillery keeping
in touch day by day forcing the enemy back, his best divisions being
mercilessly hammered until sheer fatigue caused their withdrawal,
the relieving divisions still weary, finding themselves ever confronted
by fresh and vigorous American troops.
It had become an established custom to withdraw a division upon
signs of distress and replace it with a fresh division from the Second
Army which was not engaged in an offensive.
1520 REPORT OF THE SURGEON GENERAL OF THE ARMY.
An advanced medical supply park was established at Les Islettes
on 0( tobev 15, and a unit prepared for the same service at Verdun.
Mobile Hospital Xo. 6 was advanced to a point near Varennes on
October 17, and the personnel of Evacuation Hospital Xo. 21 arrived
for service with Army Eed Cross Hospital Xo. 110 at Villers Dau-
court the same date. Mobile Hospital Xo. 4 was moved from La
Grange aux Bois to near Cheppy on Octol)er 27. Mobile Hospital Xo.
1 was transferred to Esnes on October 27, and Evacuation Hospital
Xo. 4 was advanced to Fromereville on October 29.
On Xovember 1, 1918, after a terrific and concentrated artillery
preparation the three American corps advanced to their final objec-
tive, the enemy giving wa}' easily and manifesting signs of great
distress, having lost heavily in casualties and prisoners in spite of
the employment of the best divisions at his disposal.
This steady advance of the Americans against the enemy's pivot
had enabled the forces of the Allies to the north to drive the enemy
confronting them beyond his long established and supposedly im-
pregnable defenses, for the domination of Hie Mezieres-Longuyon
railroad by the American artillery left the enemy only one main
artery, and that too far to the north to be of assistance in extricating
the mass of trooj^s he had concentrated in an effort to check the
Fourth and Fifth French Armies and the First American Army.
Mobile Hospital Xo. 8 moved from Deuxnouds to Exermont on
Xovember 3 : Evacuation Hospital Xo. 14 moved from Les Islettes to
Varennes on Xovember 8; and Field Hospital Xo. 41 (Army) from
Villers Daucourt on the same date, Varennes being the only point
for rail evacuation for the First and Fifth Corps, the road north of
Varennes to Grand Pre not being in operation at this time.
To offset the impossibility of establishing the large and heavy
evacuation hospitals at points off the rail mainly because of the lack
of truck transportation, every available truck being employed to
supply the huge quantities of ammunition, forage, and rations to
the large force, divisional and corps field hospitals were placed in
echelon to act as rest stations for the ambidance convoys en route to
the evacuation and mobile hospitals, and were so supplied that food,
warmth, and shock treatment were available, even definitive opera-
tions provided for.
The Third Corps at this period having advanced as far north as
desired, assailed the precipitous heights across the Meuse River
known as the Cote St. Germaine, the Fifth Division crossing a shell
and machine-gun swept march, some of its units swimming the river
and scaling the heights on the opposite side in the face of a murder-
ous fire to eventually capture the stronghold and force the retreating
enemy into the open, this performance being one of the most bril-
liantly executed and courageous chapters in the history of the war.
The 17th French Corps with two American divisions attached now
advanced to the north and east of Verdun, and with the Third Ameri-
can Corps consolidated the gains east of the Meuse.
Four years of artillery exchange had so destroyed the railroad
from Verdun to Sedan on the west bank of the Meuse that the Engi-
neers could not repair it in time to be of use, and no attempt was
made to install evacuation hospitals north of Verdun in this area,
for a plunging fire from the heights had made this terrain untenable
A. E. F. ARMIES. 1521
till the Cote St. Gerniaine was captured, and Evacuation Hospital
No. -i at Fromereville had suffered from indirect shelling although
conspicuously marked and well protected from direct fire.
On Xoveniber 8 the Infantry of the First Corps pursued the rap-
idly retreating enemy to the river bank opposite Sedan, halting to
permit the leading elements of the Fourth P'rench Army that had
converged to this point to enter and capture this historic city.
With great exertion Evacuation Hospital Xo. 7 was moved from
Souilly to St. Juvin on November 9, and Mobile Hospital Xo. 1 from
Eanes to Bautheville on Xovember 10, these being the two highest
points attained by Army hospitals, but evidencing the efforts of the
Army chief surgeon to keep in touch with the combatant troops as
long as a motor truck was available, for when transport failed the
sole recourse in the absence of railroad facilities was applying the
mobile surgical and X-ray camions of the mobile hospitals to the di-
visional triage hospitals, and slowly evacuate the operated when
transporta])]e through the chain of division and corps hospitals to
the evacuation hospitals.
A glame at a contoured map of this region will show the physical
obstacles to be overcome, and it should be recalled this very terrain
had been the scene of disaster to more than one army in the past;
therefore it is with pride the medical department of the First Ameri-
can Army invites attention to its achievements in poviding hospital-
ization for the combatant troops in this most inhospitable and rugged
terrain where not one house was left standing in the former villages,
and where roads were scarce and deeply scarred by shells, all move-
ments being accomplished in the deep mud following the incessant
fall rains.
In spite of persistent rumors of an imminent armistice the First
Army continued its offensive, pursuing the rapidly retreating and
disheartened enemy, who essayed an escape through the Ardennes
Forest which would have proven his Waterloo had the armistice not
been officially declared to be effective at 11 a. m. on Xovember 11,
1918, Infantry and Artillery vieing with each other in gaining
ground, the seismographic tracing showing the artillery fire on the
American side continuing to within one minute of the armistice hour.
Within nine hours after the armistice had become effective all
wounded had been hospitalized and operated.
The losses sustained in this offensive, which will descend in history
as one of the most difficult military operations successfully per-
formed, and in which the largest single army in the world has known
was employed, are as follows :
Killed (subject to revision) 17,647
Wountled, exclusive of 2,635 wouuded prisoners 69, 832
Gassed 18,864
Neurological cases (shell shock) 2,029
Total 108, 372
Medicjil cases, largely influenza 68,760
Died from wounds 3,528
Evacuiition.s 143, 051
Hospital trains used 408
Neurological cases returned to duty in 3 days 1,204
1522 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Tlie followiiifr table of operations of the Army Evacuation Ambu-
lance Service is of interest in consideration of the matjnitude of the
military operations:
Trips nuule li4, .721
Ciirriod prone 53, 210
rjirrioil sitting 78. (373
TotMl carried 12G, 883
Kiloinetors run ■ 907, 910
Avoraf^e number of patients per trip : Corps. 4.6 ; Army, 4.8.
Average one-way haul : Corps, 22.4 kilometers ; Army 12.2 kilometers.
Peroentaae prone patients to total: Corps. 47.6; Army, 46.6.
Average innnher kilometers traveled by patient-^: Corps, 10.3; Army, 5.4.
Average number kilometers traveled per diem by Army ;iinl)ul:inces: 19,737.
The larije miniber of evacuations from the Army area was made
nece-=;sary because of the lack of a station to which slie'litly wounded,
gassed, venereals, and those ill for a period of 10 days or 2 weeks,
could be sent. Such a station corresponds to the French Depot de
Folopes and should have had a capacity of at least 10,000.
The towns in the rear of the Army affordinix no buildings like those
in Toul in the Second Army area and tentage being unobtainable,
the solution lay in evacuation to the advance and intermediate sec-
tions with a consequent loss of men for a long period, an injudicious
use of hospital trains, and a congestion of the hospital centers that
would have proven a calamity had the offensive continued.
From July 10-Xovember 11. 1918. the Second American Corps,
composed of the 27th and 30th Divisions, had operated under the
British north of Amiens with conspicuous success, the losses su.stained
beine: as follows:
Officers.
Men.
27th Division:
Killed
Wounded and gassed .
Made prisonsr
Died of wounds
musing
Prisoners captured —
30th Division:
Killed
Wounded and gassed .
Made prisoner ,
Died of wounds i
Missing
Prisoners captured —
5.3
184
2
11
.3
65
57
125
3
1.278
6,958
115
241
347
2,292
1,287
5,345
27
201
3.750
' No data.
From October 19-November 11, 1918, the 3Tth and 91st Divisions
were attached to a French command in Flanders and did signal
service in driving back the enemy in that sector, their sick and
wounded being cared for by Evacuation Hospital No. 5 and Mobile
Hospitals Nos. 2 and 9. The casualties sustained are as follows :
A. E. F.
-AEMIES.
1523
37th Division:
Killed.
Wounded
Made prisoner and died of wounds > .
Missing
Prisoners captured
91st Division:
Killed.
Officers.
12
Wounded and gassed.
Made prisoner
Died of wounds '
Missine
Prisoners captured . . .
Men.
227
1,279
135
356
216
665
1
1 No data.
The following table is of interest, giving the data compiled for
two periods, viz, the arrival of the first American unit in France,
June 15. 1917, to the armistice, November 11, 1918. and the real par-
ticipation of the American troops in combat from June 15, 1918, to
November 11,1918:
June 15,
1917, to
Nov. 11,
1918.
June 15,
1918, to
Nov. 11,
1918.
172,849
33,309
9,925
164,939
32, 149
9,471
Total battle casualties
216,083
206,559
' Subject to revision.
The apparent discrepancy between the battle figures and the totals
represents the casualties occurring on the line between offensives, as
action did not cease after the official inclusive dates, except that of
November 11.
At this writing nearly 12.000 men are unaccounted for, which num-
ber in the final analysis will materially alter the above figures, and
this seemingly large number of mi.ssing men may be accounted for in
many ways, viz : The exchange of identification tags intentionally
or unintentionall3% the former practice being usually in jest though
sometimes with a view to escape future consequences, and the latter
occurring in bathing and delousing establishments through careless-
ness or haste ; absence without leave and secretion in some secluded
village for fear of consequences ; destruction without evidence by the
direct bursting of a shell or caving in of a dugout; death in some out-
of-the-way location and nondiscovery ; capture and death in enemy
prison or en route to prison without notification under the laws
of war.
The sanitation of the various fields of combat upon which the
American forces performed such splendid deeds of arms has been a
source of controversy between theoretical sanitarians accustomed to
the impedimenta enjoyed in municipalities and in trench warfare,
and practical sanitarians whose experience have taught the absurd-
ity of expecting or demanding the anesthetic perfection insisted upon
in molulization and training camps or in stable trench warfare, where
142367— 19— VOL 2-
-35
1524 REPOET OF THE SURGEON GENERAL, OF THE ARMY.
facilities are at hand which may not for obvious reasons be found
witli a constantly moving command engaged in mobile warfare.
With the knowledge that the American forces were at death grips
with a powerful and ruthless enemy, the sanitary officers at the front
refrained from making recommendations that common sense de-
clared impractical, and confined themselves to seeing that the com-
batant line was supplied with good water and hot food, insisting,
however, and with success, that labor troops and reserves police the
landscape when this duty did not interfere with the more important
one of supplying the combatant troops.
When it came to sanitation of the terrain to the rear of the battle
line customary standards were insisted upon and maintained, in
spite of the torrents of rain and the consequent mud; and at the
front and rear prompt action was taken in regard to infectious dis-
eases, with the success noted before, for when all is said and done the
correct handling of infectious diseases and a good water and food
supply arc the foremost duties of the military sanitation at the front,
and this duty was excellently performed by the medical officers of
the zone of the armies.
The lessons learned by the Medical Department in the zone of the
armies are manifold, and are being formulated in a manuscript by a
board of officers who have the advantage of front-line experience,
as well as the written opinions of those who have filled positions at
the front and are deemed competent to pass judgment upon the essen-
tial and nonessential alike. This manuscript will be presented for ap-
])ioval by higher authority as the basis of a Medical Department
field service and equipment manual.
The most important lessons learned, however, are : War is a game
of transportation, and each branch of the service, particularly the
Medical Department, must provide equipment that may be easily
and quickly transported upon motor trucks which must be pro-
vided in adequate numbers with trailers, and that ambulances, per-
sonnel, and hospitalization must be present in a proper ratio to the
combatant troops to preclude the acloption of expedients that were
never contemplated in tables of organization for a well-balanced
force, for only in this way may the sanitary service give the maxi-
mum of efficiency.
A bald narrative is a poor standard by which to judge of the
enormous amount of labor entailed upon the ISIedical Department
of the American Expeditionary Forces in the zone of the armies, in
the greatest war of history, under the most trying conditions of
terrain, transportation, and weather, and those unfamiliar with the
situation will never realize the gigantic task successfully performed
nor the great personal expenditure of vital energ^?^ involved in the
performance by every officer, nurse, and enlisted man.
The fine spirit and cooperation of the entire sanitary personnel is
beyond praise, all working for the common cause without thought of
fatigue or self; the medical officers performing prodigies on the
field, in the operating and ward tents, and in supply and administra-
tion; the splendid ambulance drivers overcoming all obstacles to
their mission and entering the zone of fire with a disregard of dan-
ger that was sublime; the dental surgeons unable to perform their
normal duties applying first aid on the front line to release medical
officers for other work and controlling litter-bearer squads under
A. E. F. ARMIES. 1525
fire; the enlisted personnel courageously and doogedly performing
their duties under a gruelling fire even though ready to drop from
sheer fatigue after laboring hour upon hour in the exhausting duty
of litter bearing; even the nurses displaying a courage and calm-
ness under shell fire and aerial bombing that served as an incentive,
and by their devotion to duty, tenderness, and self-sacrifi e adding
increased luster to the crown of American womanhood.
B. SECOND ARMY.
The Second Army was organized b}' General Orders 175, Head-
quarters American Expeditionarv Forces, 1918, to take effect October
10, 1918.
Operations began on October 1'2, 1918.
The Army was discontinued April 15, 1919.
Area occupied. — Headquarters of Second Army were at Toul, and
the territory occupied was that in a general way betAveen the Meuse
and Mo.-:elle Rivers, with a strip of territory west of the Meuse
south of Verdun adjoining the First Arm}- area and a narrow strip
east of the Moselle north of Nancy adjoining the French Army in
that area.
Constituents of the Second Army. — During the existence of the
Second Army the following corps and divisions were constituents:
COKPS.
IV Corps, October 12, 1918, to November IT, 1918.
VI Corps, October 12. 1918. to April, 1919.
IX Corps, December 3, 1918, to April 15, 1919.
II Frencl' Colonial Corps, October 12, 1918. to Novembv r G, 1918.
\III French Corps, November 6, 1918, to November 13, 1918.
DIVISIONS.
3d Division, November 4, 1918, to Noveuibei- 17, 1918.
4th Division, October 24, 1918, to November 17, 1918.
5th Division. December 12, 1918, to April 1, 1919.
7th Division. October 12, 1918, to April 15, 1919.
28th Division, October 12, 1918, to March 5, 1919.
33d Division, October 25, 1918, to December ]2. 1918.
December 17, 1918, to April 1, 1919.
35th Divi.sioii, November 8, 1918, to February 20, 1939.
37th Division, October 12, 1918. to October 18. 1918.
79th Division, October 12, 1918, to April 10, 1919.
88th Division, November 6, 1918, to April 15, 1919.
92(1 Division, October 12. 1918. to December 15, 1918.
85th Division (replacement), December 1, 1918, to January 14. 1919.
The French divisions of the Second and Seventeenth Corps.
CoipK and Adiii/ tr<joi)H. — Strength of Army troops, approximately 35,000.
Total strength of Second Army on day of armistice, 215,049, exclusive of the
Second French Colonial Corps.
Medical Department units. — The following Medical Department units were
, transferred from the First Army to the Second Army at the time of its or-
ganization :
Evacuation Hospital No. 1, Sebastopol.
Evacuation Hospital No. 2, Baccarat.
Evacuation Hospital No. 12, Royaumeix.
Evacuation Ho.spital No. 13, Charapigneulles.
Mobile Hospital No. 3, Rosiere.s-en-Haye.
Mobile Hospital No. 39, Aulnois.
Field Hospital No. 117, Sebastopol.
Prov. Evacuation Amb. Col. 1, Sebastopol.
Evacuation Ambulance Co. 4, Royaumeix.
1526 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Durin<r the existence of the Second Army the following: Medical
Department units were assigned:
Evacuation Hospital No. 15.
Evacuation Hospital No. 18.
Mobile Hospital No. 7.
Evacuation Hospital No. 37.
Field Hospital No. 39.
Motorized Section, 115th Sanitary Train.
Evacuation Ambulance Companies Nos. 7. 32, 33, 68, 69, 70, and 71.
Sections 570 and GOO, United States Army Ambulance Service.
Ambulance Company No. 39.
Organization of chief surgeon'' s office. — The tables of organization
in existence provided for —
1 colonel.
1 lieutenant colonel.
1 major.
1 captain.
1 sergeant, first class.
2 sergeants.
8 privates, or privates first class.
The inadequacy of this personnel is immediately apparent. The
organization of the chief surgeon's office as it actually existed at the
time of the armistice and the duties of the various sections and de-
partments are shown in the accompanying chart (inclosure "A").
This organization of the office of the chief surgeon of a field army has
been submitted as the proposed organization in new tables of or-
ganization.
Professional consultants. — ^A better term for these is " assistants "
in which capacity they render service which justifies their positions
on the staff of the chief surgeon of a field army. For the formation
and prosecution of policies relating to the care of the sick and
wounded of a field army, numbering from a quarter to a half million,
this personnel centrally organized in the chief surgeon's office is ab-
solutelv essential. In order to keep in touch with the various pro-
fessional activities of the Medical Department — medical, surgical,
orthopedic, neuropsychiatric, urological, roentgenological, and gas
medical service — the chief surgeon requires specialized assistants in
each of these departments.
Hospitalisation. — The hospitalization problem of the Second
Army differed from that of the First Army in that the base hospitals
at Toul were within ambulance distance of the front line occupied by
the Arm}'. At the time of the armistice the base hospitals (Justice
group), at Toul, had a capacity of about 17,000 beds. In addition
to the Toul (Justice) group, a base hospital was established at Com-
mercy. with a bed capacity of about 5,000 ; another was contemplated
at Lerouville, while at Nancy arrangements had been made for tak-
ing over French hospitals which would have accommodated about
15,000 patients. Thereafter, in future operations, the area occupied
by the Second Army would have been supplied with about 35,000
base hospital beds to which evacuations could be made without the
use of railroad. A redistribution of evacuation and mobile hospitals
of the Second Army was made so that at the time of the offensive the
distribution was as follows:
A. E. F. AKMIES. 1527
Evacuation Hospital No. 1, Sebastopol.
Evacuation Hosiptal No. 13, Champigneulles.
Evacuation Hospital No. 12, Royaumeix.
Evacuation Hospital No. 18, St. Mihiel.
Mobile Hospital No. 3, Rosieres-en-Haye.
Mobile Hospital No. 39, Aulnois (later advanced to Chaillon).
Mobile Hospital No. 7, Bernecourt (in reserve).
The location of hospitals at the time of the armistice is shown
in the accompanying map (inclosure "B".) The plan of evacua-
tion of the Second Army for the offensive of November 9-11, 1918,
was essentially as follows:
EVACUATION OF SICK AND WOUNDED.
(«) VI Corps sector and all ti'oops therein:
Seriously wounded. Mobile Hospital No. 3.
Slightly wounded, Evacuation Ho.spital No. 1.
Gassed, Base Hospital 87, Justice group.
Neuropsychiatric, Base Hospital 87, Justice group.
Contagious Diseases, contagious hospital. Justice group.
Normal Sick, any base hospital, Justice group.
(b) IV Corps sector and all troops therein:
Seriously wounded. Mobile Hospital No. 39, between Heudi-
court and Chaillon.
Slightly wounded. Evacuation Hospital No. 12, Royaumeix.
Gassed, Evacuation Hosiptal No . 1, Sebastopol : Evacuation
Hospital No. 12, Royaumeix ; Base Hospital 87, Justice group.
Neuropsychiatric Base Hospital No. 87, Justice group.
Contagious Diseases, contagious hospital. Justice group.
Normal Sick, Evacuation Hospital, No. 12, Royaumeix.
(c) Second Colonial Corps (French) :
Seriously wounded, Mobile Hospital No. 39 (between Heudi-
court and Chaillon).
Slightly wounded, gassed, neuropsychiatric, contagious, normal
sick. Evacuation Hospital No. 13, at Caserne Oudlnot, Com-
mercy.
Neurological Hospital No. 3 was established at Varvinay, an ad-
vance position within 4 kilometers of Mobile Hospital No. 39, which
modified the evacuation order previously issued.
The plan of hospitalization, evacuation and supph' in operation
at the time of the armistice consisted in an advanced office of the
chief surgeon established at Bernecourt. at which place were posted
the officer in charge of hospitalization, the evacuation officer with a
pool of all available motor ambulances and an advance medical sup-
ply depot. Liaison was established with the corps and divisions, the
evacuation and mobile hospitals and the base hospital group, at
Toul. The chief requirements of the situation called for constant
supervision of the hospitalization in order to direct the flow of
patients so as to prevent congestion and hasten evacuation, and to
provide for the sites for the advance of mobile and evacuation hos-
pitals in case of advance Of the troops. The casualties during the
last few days of the operations were comparatively few and not
enough to tax the sanitary units engaged in their hospitalization and
evacuation. Mobile Hospital No. 39 in its advanced position near
Chaillon received and operated about two hundred and fifty seriously
wounded during the last two days of the operations.
1528 REPORT OF THE SURGEON GENERAL OF THE ARMY.
After the armistice, the Second Army moved forward occupying
the area to the northern limit of Luxemburg, A redistribution of
Army hospitals was then made, as follows:
Evacuation Hospital No. 1. Sehastopol.
Evacuation Hospital No. 13. AValferdanfie. Luxemburg.
Evacuation Hosjjital No. 15, Glorieux. Verdun.
Evacuation Hospital No. 18, Briey.
Field Hospitals Nos. 1.57. 158, 159, Mars-la-Tour.
Field Hospital No. 39. Stenay.
To each evacuation hospital was assigned an evacuation ambulance
company.
Mobile Hospitals Nos. 3. 7, and 39 were withdrawn and returned
to the United States, or to the Services of Supply area.
The change from war to peace conditions necessitated a reorgan-
ization of the hospitalization service which resulted in the trans-
formation of the evacuation hospitals into institutions differing lit-
tle from base hospitals.
Evacuation from the Army. — The evacuation from the Second
Army hospitals to base hospitals was done exclusively by motor
ambulances. In this respect, the operations of the Second Army dif-
fered essentially from those of the First Army. The general plan
of evacuation as used in the American Expeditionary Forces by hos-
pital trains, under the direction of G-4, was never necessary in the
Second^ Army on account of the proximity of the base hospitals.
Ligh! \ railway transportation. — Within the Second Army area
were n. ny miles of the (Ul-centimeter light railway system. A plan
was dri, \vn up for the utilization of this system which it was thought
might be of ser^ace. especially during quiet times. This method
had not been found satisfactory for the reason that the cars are top-
heavy and often jumped the tracks. A plan was drawn n p. provid-
ing litter-posts, chains or straps for support of litters, the extra
equipment to be carried in each car. Two trains of seven cars each
were at the time of the Second Army offensive placed at the dis-
posal of the chief surgeon. A copy of the agreement for the use of
light railway follows:
1. Light railways will be employed in evacuation of sick and wounded from
points on railway lines in forward areas directly to evacuation hospitals.
2. During active operations all empty rolling equipment returning from for-
ward areas will be available foi- this purpose except that required for move-
ment of troops, material or amnuinition service. During quiet periods a special
hospital train will be at the disposal of Medical Department at all times. An
operator from light railway service will be stationed at each clearing station
and will be connected by telephone with the ofhce of the light railway train
dispatcher. Requests for transportation of sick and wounded will not be
transmitted to G-4 of the Army, but the requirements of Medical Department
will be met without delay. Trains of wounded will have precedence over all
traffic excepting animunition, troops, and material destined for the front.
3. When practicable light railway sidings will be installed at evacuation
hospitals upon request of chief surgeon of the Army.
4. Corps and division surgeons will take into consideration the location of
both light railways and roads in selecting triage or sorting stations.
5. Medical Department will provide all necessary personnel for loading and
unloading sick and wounded and for their care en route.
6. Medical equipment necessary for hospital train will be provided by Medi-
cal Department.
A. E. F. ARMIES. 1529
TRANSPORTATION.
All Medical Dej)aitnieiit transportation was supervised, distrib-
uted, and admini^^tered by a medical officer in the office of the chief
surgeon. Ambulance companies and evacuation ambulance com-
panies were assigned to evacuation hospitals and to the IV and VI
Corps.
ii!.3 .'{eneral plan of evacuation within the Army area was the nor-
mal plan of divisional evacuation to the divisional hospitals by divi-
sional sanitary trains. The corps ambulances supplemented by the
Army reserve ambulances evacuated the divisional hospitals to the
evacuation and mobile hospitals. A central pool of ambulances un-
der the direction of officers detailed from chief surgeon's office was
in readiness to supplement the activities of corps and divisional am-
bulance" and to provide evacuation as needed by the evacuation and
mobile hospitals.
Medical and a.mhidance service of Army troops. — Tables of organi-
zation for a field army do not provide for a medical officer to super-
vise the service of the Army troops, exclusive of the Army artillery.
A multitude of Army troops scattered as they are throughout an
Army area and frequently changing station are without divisional
or corps control and require a medical officer specifically detailed to
supervise their activities. One of the most difficult problems con-
fronting the chief surgeon of a field army is the medical attendance
and ambulance service of miscellaneous troops, whose dis^^T'ibution
over an Army area and in interstices of divisions vras exter 've. To
meet this situation a medical officer was detailed and a plan adopted
and put in force in the Second Army, which follows :
1. The region occupied l).v Army tL'oops, Second Army, will be divided into
definite areas, in each of which an ambulance station will be established.
2. From these ambulance stations daily rounds will be made covering the
camps of all troops within the area.
3. These stations will be designated by the chief surgeon, Second Army, and
changes will be made by him in their locations and the area covered as vari-
-ations in the concentration and positions of the troops may require.
4. The senior medical officer at the ambulance station will provide a medical
officer to accompany the ambulance on its rounds and will furnish him with such
medical supplies as may be necessary. He will likewise arrange and regulate
the proi)er handling of emergency calls. Lack of ambulances and the need for
economy in their use require that the emergency in each case shall be a real
one.
5. Ambulances on their rounds will be accompanied by a medical officer. In
addition to the evacuation of the sick from organizations provided with a
medical officer, the ambulance surgeon will take sick calls for any organiza-
tions not so provided.
6. Ambuhnices f<u- this service will be detailed under the direction of the
chief surgeon. Second Army. The commanding officer of the ambulance com-
pany from which the aml)ulances are drawn will retain technical control of
this transportation, see that proper supplies are provided and repairs made.
He will replace and change ambulances on duty at various stations as may be
necessary to keep them in proper running order.
7. The commanding officer or surgeon of any unit of Army troops to which
this service is not extended shall communicate directly with the chief surgeon's
office. Second Army, in order that proper arrangements can be made.
Directions were given to medical officers furnishing this attendance
;and reports of their activities were exacted. To supplement this
plan, instructions were issued to corps and division surgeons to fur-
nish medical attendance and ambulance service to all Army organiza-
tions stationed within their areas.
1530 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
The plan of ambulance routes covering certain areas with daily
visits by the medical officers in charge gave quite satisfactory results.
The fact that Army trooi)s were for the most part divided into small
units rendered it impossible to attach Medical Department personnel
to each. Frequent changes of station, and in many cases their isolated
location, still further com])licated the situation. The gradual intro-
duction into the area of the Second Army of Services of Supply
organizations and the transfer to the Services of Supply of Second
Army units, commencing shortly after the armistice and continuing
through the period January 1 to April 1. transferred the service more
and more into one belonging to the advance section. Services of Sup-
ply. Xo distinction had ever been made in regard to care between
Second Army and Services of Supply troops, and the management
of the service continued under the supervision of the chief surgeon^
Second Army, till March 28, when the Medical Department personnel
and units engaged in this work were turned over definitel}^ to the
advance section, and with them the management of the service. Cer-
tain modifications in the original plans were made from time to time,
as conditions required. The following are the most important:
(1) For units of the Air Service it was necessary to station ambu-
lances at flying fields to be present for duty at all times. (2) For
Engineer and Pioneer Infantry on demolition or other hazardous
service, in addition to the ambulance on the ambulance run other re-
serve Ambulances were stationed at definite points to be on call in case
of emergency, as accidents not permitting of delay might require
their use at any time. (3) For outlying organizations too remote to
be included on a regular route separate ambulances had to be as-
signed. (4) For organizations in and about the larger centers, as at
Toul. the stationing of groups of ambulances on call was found to
best meet the requirements of evacuation.
The successful functioning of the service depended in large part
on the simplicity of the plan adopted and its elasticity. Constantly
changing conditions required constant readjustment and no system
complicated by establishment of collecting points and depending on
the cooperation of several factors would have brought about satis-
factory results. Patients were evacuated in each case to the nearest
hospital and without delay. Retention of technical control of am-
bulances by ambulance companies insured economy in operation and
proper care of the transportation.
The total strength of Second Army troops, as shown by the report
of the statistical section, was as follows, on the dates indicated :
Officers.
Jan. 1 , 1919 i 1 , 456
Feb. 1, 1919 1, 475
Mar. 1, 1919 1 1,308
Mar. 2S, 1919 655
Apr. 1 . 1919 1 683
Men.
24,411
27,254
22,638
8,755
7,571
Following is a table showing in a general way the total number of
troops served by the medical and ambulance service. The outstand-
ing feature of this table is the number of detachments not provided
with medical officers which received dailv attention:
A. E. F.
-ARMIES.
1531
Total strength of troops.
Number
Total
number
of pa-
tients
evacu-
ated.
For sick calls and
For evacuation
Total
number
For week ending—
of
1 routes.
evacuation.
only.
of
detach-
j
i
Number.
Detach-
ments.
Number.
Detach-
ments.
1919.
Jan. 4
7
6,621
55
8,403
41
158
96
Jan.U
7
5,660
56
9,700
41
151
97
Jan 18
6,392
8,783
68
87
8,895
9,467
41
37
124
126
109
Jan. 2.5
8
124
Feb. 1
10
10, 107
95
8,632
39
147
134
Feb. 8
9
9,286
86
8,542
34
125
120
Feb. 1.5
8
7,099
64
5,199
21
66
85
Feb. 22
9
8,173
77
7,941
34
147
111
Mar.l
9
7,936
74
6,887
29
118
103
Mar. 8
8
6,794
62
6,109
24
123
86
Mar. 15
...1 8
6,935
no
5,691
21
68
76
Mar.22
8
6,321
51
6,317 28
85
79
Dental service. — The dental service of the Second Army was super-
vised by the chief dental surgeon. The assignment of an officer to
supervise the activities of the dental corps of a field army has been
justified by experience.
Prior to the armistice the dental service suffered from the initial
lack of equipment, the unsettled conditions of military activity, and
the poor billeting area occupied by the Second Army. No provision
"Was made in equipment tables for the transportation of dental out-
fits. The divisions usually assigned as many dental surgeons as prac-
ticable to the sanitary train but those attached to organizations were
frequently compelled to abandon their equipment for lack of trans-
portation. Upon the cessation of hostilities it was found that only a
small proportion of dental surgeons were supplied with portable
dental outfits and a negligible amount of dental work had actually
been performed. During hostilities, however, the dental surgeons
did very creditable work as assistants to the triage officers, often
taking the places of medical officers in the care of wounded.
It is the opinion of this office that under the conditions prevailing
in the American Expeditionary Forces in France, the dental service
is essentially an area proposition. Thirty-one dental surgeons can
not be used by a division while in the line. The plan recommended is
the establishment of additional infirmaries in the training and rest
areas or in the Army replacement depots, where systematic surveys
can be made of the men coming out of the line or coming into the
area for replacement. In this way all the dental surgeons can find
useful employment. Only the most urgent treatment can be given
in active campaign and for this purpose about 12 dental sur-
geons, each with the light modified equipment, are sufficient for a
division.
Organization and activities. — The chief dental surgeon of the
Army supervises the activities of the division dental officers who are
directly in charge of the division dental surgeons. The dental .serv-
ice of Army troops is directly supervised by the chief dental surgeon
of the Army. A complete dental survey was made of every organiza-
tion to which there was a dental surgeon attached and the men were
classified as " A," " B," or " C," each class denoting the urgency of the
dental work required. Systematic inspections were made of all
1532 REPORT OF THE SURGEON GENERAL OF THE ARMY.
dental surgeons and their establishments, and an effort was made to
standardize the methods to insure supplies and material and to keep
in clobC touch with the dental surgeons oi)erating in smaller units of
the Second Army. A system of reports was established, consisting of
a " Daily report of dental work." whicli was rendered weekly to the
chief dental surgeon direct or through the division dental surgeon,
A '"' Keport of personnel and equipment *' was required of each dental
surgeon on duty. From the reports receiA-ed in the chief dental
surgeon's office there was prepared a '' Weekly report of totals " for
each division which showed the number of various dental operations
performed by each division, and the total number of dental officers
on duty. This report formed a ready and accurate means of compari-
son. A copy of this report was sent to each division surgeon and
acted as a stimulus and greatly improved the dental service.
Equipment and supplies. — Each dental surgeon had a modified
portable outfit. One portable dental laboratory Avas supplied to each
diA-ision, each evacuation hospital, and to the attending dental sur-
geon at Arm}- headquarters. It Avas thus possible to do all operative
and prosthetic dental operations within the divisions or at the evacu-
ation hospitals or at Army headquarters. Gold, which is not fur-
nished by the GoA'ermnent, was purchased in Paris by the dental
surgeons and the work charged for at a rate which insured repayment
to the individual officers. The adoption of this plan became advisable
in order to forestall requests of officers and enlisted men to proceed
to Paris for treatment.
Each evacuation hospital was supplied with a dental oral outfit for
the adjustment of mechanical appliances needed in the reduction and
treatment of fractures of the jaw.
Replacement of supplies was effected through requisitions j^assed
through the chief surgeon's office for the action of the chief dental
surgeon.
Medical supply. — The nuiin source of supply for the Second Ai-my
was advance medical supply depot at Is-sur-Tille. Supplies were
forwarded through the regulating station at that point. To provide
for replacement and immediate issue of supplies to troops in the line,
the medical supi^ly park at Toul had been established by the First
Ami}' and was transferred to the Second Arm}-. This was stocked
on the basis of 10 divisions and later as the Second Army became or-
ganized, on a basis of 15 divisions. This depot was restocked b}'^
" replacement requisitions " as provided by General Orders 44, Head-
■quarters American ExpeditionarA' Forces, 1918. Immediate issues
were made to troops upon requisition for 10-day periods. approA'ed
by the chief surgeon, Second Army. To further facilitate direct is-
sues of supplies in emergencies, an advance depot Avas established at
Bernecourt and another at St. Mihiel in the Second Army area.
These depots were stocked with articles most needed by troops in
action, viz : Blankets, litters, cots, splints, dressings, and autitetanic
serum, which were issued direct, the requisitions being approA'ed later.
After the armistice, as the troops moved forward, other depots were
established at Mars-la-Tour and at Walferdange, Luxemburg.
The operation of the system of requisition and supply described
in General Orders 44 was suspended during activities, and at all
times replacements (exclusiA^e of initial equipment) were made by
approval of the chief surgeon. During quiet periods and for all
A. E. F. ARMIES. 1533
initial equipment the provisions of General Orders 44, Headquarters
American Expeditionary Forces. 1918. were complied with, the
divisional medical supply officer preparing the ref'uisition. approved
by the division surgeon, by G-1 of the division and then forwarded,
as in the case of other su])plies, to G-4 of the Array, who sent the
requisition to the depot, the supplies being forwaided through the
regulating officer.
The medical supply service was satisfactory from the standpoint
of the Serond Army. The successful accomplishment of this enor-
mous undertaking to sup[)ly the rai)idly increasing forces Avith
articles differing essentially from those on our supply tables reflects
credit upon our supph^ officers. There was no essential shortage
of procurable arti les in the Second Army and practically no com-
plaints, notwithstanding the abandonment of supplies due to lack
of transportation, the frequent changes of station of troops, and
the unreasonalde requests from the smaller units. So far as this
office has knowledge, practically no supplies were furnished to or-
ganizations of the Second Army l)y the Red Gross, though some
independent units joining tlie Ai-my seemed to \v,\ye been dependejit
on this source. While acknowledging the ]:>rol)ability that Red Cross
supplies liad in many instances filled actual needs and prevented suf-
fering, this system of uncontrolled and unregulated procurement and
issue is wrong in that it does not depend u.pon nor operate in con-
sequence of a comprehensive survey of the whole supply system;
it results in pi'omiscuous issues in quantities not well considered nor
adjusted to the actual requirements of the whole Army or any unit
of the Army, and is therefore wasteful. Furthermore, it creates a
confidence which it can not justify nor is it held responsible for re-
sults. Every tendency in recent staif organization of the service
of supply is toward standardizing of methods of requisition and
issue and the placing of responsibility with the office guaranteeing
supply. If the Red Cross is to furnish medical supplies these sup-
plies should be turned in to depots for issue according to recognized
method in practice.
SANITATION.
Organisation. — The department of sanitation of the Second Army
Avas organized with a sanitary inspector, two assistant inspectors, a
provisional sanitary squad of 1 officer and 40 enlisted men, and a
mol^ile ai'my laboratory.
The chief functions of the department Avere —
(a) The adoption of a sanitary code or ordei- adaptable to con-
ditions existing in the Second Army.
{h) Supervision of sanitation of divisional and corps and Army
troops.
(c) Establishment of a system of area sanitation for the di-
visional rest areas and areas not constantly under sanitary control
of organizations.
Within the more or less constant limits of the Army area a con-
tinuous circulation of units takes place, a shifting of troops to and
fro, an active Avandering about like that of ants in a hill. It is
apparent that tliei-e is much Avasted energy and loss of efficiency if
every diA'ision is required to organize its sanitary arrangements de
1534 REPORT OF THE SURGEON GENERAL OF THE ARMY.
novo whenever it is moved. The knowledge gained and the work
done by one division is lost to the one that moves into its place, and
a new investigation of water sources, billets, dumps, latrines, baths,
and everything bearing upon the control of disease becomes neces-
sary whenever divisions change locations. It has been found, in
consecjuence, that some form of constant central supervision by the
Army itself will remove those obvious defects. This is the princi-
i)le wliich underlies the British Army sanitary organization, and it
is this system, in its essentials, that we have found worth}' of emu-
lation. We have borrowed from the British system certain essential
elements, but have attempted to adopt these to the more mobile condi-
tions which prevailed on all parts of the front during the latter
months of the war. The following outline describes briefly the plan
instituted in the Second Field Army, American Expeditionary Forces,
with the official approval of the commanding general. The plan is
similar in most of its details to that conceived and carried out for the
supervision of the advance section, American Expeditionary Forces,
by the chief surgeon of that section, but differs from this in the
attempts made to remain prepared for sudden extension forward of
the Army area and the rapid organization of conquered territory.
1. Outline of ylmv for area sa7iitation, /Second A^miy. — The Army
area is divided into administrative subdivisions to be known as
sanitary sections. The area as at present constituted will be di-
vided into three sucli sanitary sections, and in the future expansion
or change in the territory occupied by the Second Army can be
easily adapted to corresponding changes in the subdivisions.
In a central point in each sanitary section there will be stationed
one commissioned officer, lieutenant or captain, medical or sanitary
coips, chosen for his training in practical sanitary methods.
Each sanitary section will be again subdivided into 8 to 12 sub-
areas. These will be so outlined as to be small enough to be pa-
trolled on foot, thus obviating the necessity for additional trans-
portation. Into each subarea will be placed two or three enlisted
men and noncommissioned officers, chosen for their general intelli-
gence and training in sanitary inspection. Further training will
be given these men by the commissioned officer commanding the
squads in each sanitary section.
It seems likely that a number of sanitary squads so selected can
at the present time be obtained for personnel or divisional sanitary
squads now assigned to the Services of Supply.
1. Duties. — Duties of the conimissioned officer in charge of squad :
The commissioned officer assigned to eaih area will —
(1) Maintain in the town of his station a sanitary school for the
instruction of noncommissioned officers and enlisted men of sanitary
squads, and a shop for the construction of sanitary appliances, such
as latrine seats, etc.
(2) He will select and distribute men of his squad to the 8 to
12 subareas by receiving reports and keeping in constant touch with
them, by circulating in his area.
(3) He will keep in touch with all matters of sanitary importance
in his section and f urnisli all such information to zone majors,
medical officers, and commanding officers of all units that enter the
area.
A. E. F. ARMIES. 1535
(4) He will keep in constant toucli with corps and divisional
surgeons in his area, furnishing them all informatio at his disposal.
(5) He will be directly responsible to the chief surgeon of the Sec-
ond Army through his sanitary inspector, reporting all matters that
in his opinion need correction.
2. Diitiei^ of sanitary squads. — Sanitary squads will be divided into
groups of about 15 to 20 men who will work at the station of the
5quad commander, in the shop and in the sanitary school. The re-
mainder will be assigned in groups of 2 or 3 in each of the small sub-
areas. The place in each subarea at which thej^ are stationed will be
so chosen that from it they can patrol the entire area on foot. These
men under the direction of a commissioned officer will —
(1) Keep detail maps of the subarea, showing everything of sani-
tarv importance — water s^mrces, latrines, urinals, stables, cesspool,
dumps, baths, lavoirs, kitchens, billets, barracks, camps, etc.
(2) They will inspect and keep in repair permanent sanitary ap-
pliances located in their subareas, Such as latrine seats, baths,
kitchens, etc., drawing upon the sanitary shop of the section for
labor and materials.
(3) They will keep in touch with the engineer water personnel
working in the subarea.
(4) They will, as well as possible, keep themselves informed of
infectious diseases occurring in the civilian population in the sub-
area and see that such disease is promptl}^ reported to the proper
medical authorities,
(5) They will furnish all information gathered by them to town
majors and commanding officers of incoming troops as soon as they
enter the area.
(6) They will report all sanitary defects which require attention
to squad commanders of section.
(7) They will plan improvements of permanent sanitar}' installa-
tions and confer with the squad commander regarding them.
(8) They will report upon the condition of subarea on parts of
it whenever troops leave this area.
(9) They will exercise no administrative or other authority, their
functions being those of inspection.
(10) Their maps Avill be kept up to date and copies furnished in-
coming troops and others whose health depends upon such knowledge.
(11) It should be understood that the enlisted men of sanitary
squads are not labor troops, i. e., they do not police or care for
grounds, billets, and areas, or dispose of refuse. They function as
assistants to the sanitary inspector of the Second Army.
These arrangements provide an adequate sanitary supervision,
which serves the important purposes of keeping constant guard over
the area occupied by the Army, facilitating the tasks of the incoming
troops, obviating the necessity of frequent and useless repetition of
sanitary surveys of the same territory and keeping the Army authori-
ties constantly informed of pervailing conclitions and needs. By
constant cooperation with billeting majors and with officers and men
of the water service of the engineering department, moreover, these
squads for a coordinating link which serves to convey necessary in-
formation from one service to the other.
When the Army area changes by advance or lateral shifting it is
a relatively easy matter for the squad commander, whose area is ad-
1536 REPORT OF THE SURGEON GENERAL OF THE AIIRIY.
jiicent to the newly acquired territory to extend his work into this.
If complete change in the location of the Army takes place, the
sqiiatl comniaiulers concentrate their men at a central point, move
them forward and after a rapid survey on their motorcycles, in
consultation witli the billeting officers of G-1, redistribute personnel.
Such a shift should not require more than three or four days at the
most, and as a matter of fact, when the system has once been thor-
oughly established and the personnel trained, the survey of a new
area can be carried out with increasingly greater speed.
When the Army is engaged in active combat it is best to exclude
from the above scheme of organization a strip of territory about
4 kilometers deep, immediately behind the trench lines. This area
is subjected to shellfire and any kind of constructive activity of a
permanent nature is rendered difficult. In. this area it is best to leave
sanitai'}' work entirely to the divisional authorities, in direct consul-
tation with the Army sanitar}- inspector, wlio should keep in close
personal touch with the divis-ions in the line.
Relations of the Army sanitary office to the sanitary inspectors of
divisions.— The Army sanitary organization should not interfere
in the slightest with the sanitary organization of the several divis-
ions in the Army. The routine sanitary supervision of divisional
troops in all matters pertaining to health should be left as hitherto,
in the hands of division surgeons and division sanitary inspectors.
It is the duty of the Army sanitary inspector, however, and all the
machinery at his disposal to reinforce the divisional facilities, to ad-
vise the responsible divisional officers and to place at their disposal
the experience and knowledge he may have gathered by reason of
his intimate acquaintance with the area.
Reports. — It is necessary for the sanitary inspector of an army to
keep constanth' informed concerning the prevalance of communi-
cable diseases in all troops of the Army, both those in divisions and
those designated as Army troops. For tliis purpose he must maintain
in his office some kind of a reporting sj-stem whereby he can con-
stanth' keep his hand on the pulse of the sick rate. What the Army
sanitaiT inspector needs to know is whether contagious diseases are
occurring Avhen and where, and in which company units.
Paragraph 12, Manual of Sick and Wounded Reports, American
Expeditionary Forces, September 15, 1918, provides that special
daily telegraphic reports of admitted communicable diseases must
be sent to the chief surgeon, American Expeditionary Forces, bj- all
field, evacuation, camp and base hospitals. Report must give name,
rank, company and place of oriq-m of infection whenever possible.
For the purposes of the individual field army it is sufficient to require
duplicate telegrams from all the field and evacuation hospitals in
the Army and to request similar duplication of telegrams from any
base hospitals that are situated so close to the Army area that they
may receive patients direct from Army units without their passing
through field and evacuation hospitals. On receipt of these tele-
grams, an assistant in the office of the sanitary inspector takes them
each morning to the statistical office of the Army, checks the loca-
tion of the units from whicl^ ^he diseases were reported and then
lists them and records the information in the following manner:
A. E. F. AKMIES. 1537
(a) Eecord by units : A book is kept in which separate pages are
so lined that cases of epidemic diseases can be entered by date and
company, one page given to each unit in which the disease occurs.
(h) Spot map: A wall map of the entire Army area is kept and
wlien an infectious disease occurs a pin is stuck into the location fi-om
which the disease is reported, pins with a variety of colored heads
used for different diseases. Each pin is thrust through a little square
of paper on which is written the date and the unit. When the area
is one of an army actively engaged in combat, in which units are
moving to and fro witli great rapidity, the knowknlge of the place
from which the case is reported loses value by virtue of the fact that
the disease was probabh- not ( ontracted in the place from which
the report comes, and from the fact that by tlie time the patient has
been in hospital two or three daj's, this unit may have moved to
another location. However, the spot map can nevertheless be made
of value by the following procedure. At the end of each week the
information found on the spot map is entered in a book. In this way
there is constructed a record of all places in which infectious diseases
have occurred during the week. When this information has been
entered in the book for the past week the pins are taken out and
replaced with common pins (without colored heads), which are
left to form accumulated evidence of all infectious diseases that have
occurred in each place. Wlien a large number of su;h pins ac-
cumulate in any single space, it is simple by going back to the book
in which the diseases are kept b}' places, at all times, to find out
^\■hicll particular variety of disease has occurred there. Beginning
with the new week, the colored pins are again entered as before.
The map, thus, at all times, shows not only the nature and location
of the disease occuiring within the Aveek, but also indicates by a
massing of the common pins whether or not these places have been
frequent sources of diseases. After a while it is of value to study
the movement of unit;' in which infe rtious di>eases have oc iirrevl and
draw lines across the maps with red or blue pencil along the paths
of movement followed by these miits. This can easil}^ be done by
I'eference to the information in the "unit"' and "'place"' record and
and it may occasionall}' be found tliat lines drawn for infected units
may intersect at places at which a considerable number of infectious
diseases have occurred. By putting in dates it may sometimes be
discovered that a unit -Avhich has reported connnunicable disease has
passed through places from which similar cases were removed from
other units, within periods representing incubation times.
As implied in the above, a further record, arranged by places, is
kept in an ordinary ledger in such a way that there is a page for
every town in which a communicable disease has occurred and all
cases reported from these towns are entered on this page.
To summarize, we then have a cross-indexing of records as follows :
(1) Eecord by units from which contact studies can be made.
(2) Map record of places, as described above.
(3) A ledger in which the occurrence of diseases is recorded by
plaf e of occurrence.
(4) A week book in which weekly records of the map are presented
nfter the renewal of pins.
1538 REPORT OF THE SURGEOK GENERAL OF THE ARMY.
AMien intluenza occurs as an epidemic, the cases are usually so
numerous that telegraphic reports are not feasible. In this disease
and a few others, therefore. Ave must rely on the direct information
by contact with the officers in charge, with whose cooperation
intensive study of the situation must be made when epidemic condi-
tions prevail.
THE WATER .SERVICE.
The supervision of the drinking water within the Army area falls
naturally into a number of phases. There is in the first place the
necessity for the prompt discovery of water sources, estimation of
probable output of each available source, with a rough sanitary
survey of surroundings as indicating the probable degree of pollu-
tion. The larger water sources must be located at which it may be
useful to establish automatic chlorine sterilization apparatus for
the establishment of cart-filling points ; provision must be made per-
haps for piping of such water supplies. Finally, there must be strict
supervision of the quality of water obtained from these sources.
The arrangements at the present time authorized for the super-
vision of water supplies in armies, are as follows :
There is attached to each field army a body of Engineer troops who
are especially assigned to the water service. These troops maintain
an office at Army headqiuirters from which they send out parties of
trained engineers and attached sanitary officers to survey as rapidly
as possible the entire Army area. They rapidly follow up the ad-
vancing troops and in the experience of the past sunmier we have
found that this service has functioned very satisfactorilj^ and with
promptness and willingness to cooperate with the Medical Depart-
ment. The engineers have furnished maps of water points in the
areas and by means of this sanitary personnel and attached labora-
tories have made bacteriological and other examinations of water sup-
plies and have installed AVallace-Tierman chlorination appartus both
mobile and stationar}", at all points where permanent chlorination
plants seem to be warranted. It has been possible to transmit this
information to divisional sanitary inspectors when divisions moved
into new areas, thus relieving them of the necessity of going over the
entire ground themselves. This has furnished an important basis
for the control of water supply.
Analysis of any water source is of no practical value unless fre-
quently and periodically repeated. For this reason, after the pre-
liminary survey has been made and gross pollution discovered by
bacteriological analysis this will be of value in indicating whether or
not such a source should be completely excluded, but it is not prac-
tical to attempt to control the water supply by periodical laboratory
analysis. It is best to assume that all water except that in which
the engineering service has established permanent chlorination appa-
ratus, is polluted and must be chlorinated in Lyster bags or water
carts. This must be supervised by a sanitary officer attached to the
staff of each division surgeon, whose sole function it is to attend to
the divisional water supply. It is the duty of this officer to famili-
arize himself without delay with the records of the water engineers,
to mark the locations of water points and engineer installations in his
divisional area, to instruct divisional units in the proper use of the
hypochlorite of calcium tube^, and Lyster bags and water carts, and
A. E. F. ARMIES. 1539
to circulate constantly among the divisional troops correcting, super-
vising and enforcing these measures. It is not feasible to furnish
such an officer with a laboratory equipment for laboratory analyses,
this being both impractical and unnecessary as indicated above, but
he can with profit employ iodide and zinc sulphate solution for the
control of proper chlorination, and can teach unit medical officers,
mess sergeants and others in the division this method of control.
Mess officers, also, should investigate from time to time whether all
divisional units are properly supplied with Lyster bags and whether
they are having difficulty in procuring a sufficient supply of calcium
hypochlorite tubes.
It is the duty of the Army sanitary inspector to keep in his office
a complete record of the work of the water engineers on a map fur-
nished by them and constantly kept up to date to see that this infor-
mation is transmitted to the divisional sanitary inspectors and the
medical officers of Army units, and to assure himself from time to
time that Lyster bags and hj^pochlorite solution are available and
are being used. This he must do by conferring with divisional
water officers.
Although poison examinations of water have not been found neces-
sary at the present time it is nevertheless important that some pro-
vision be made for the prompt detection of such contamination, when
troops are advancing over conquered territory. It is therefore de-
sirable to have one of the standard poison examination chests which
are splendid for the gross detection of alkaloids and poisons in the
hands of the divisional sanitarj^ officer since he is the only trained
man who is in touch with the advancing troops. To have these chests
in the hands of the water engineers or the corps or Army personnel
is almost useless.
One of the difficulties encountered in the routine chlorination of
water is the occasional failure by lack of foresight or miperfect
coordination with the quartermaster department of units to obtain
the needed supply of calcium hypochlorite. Accordingly, a recom-
mendation was made to general headcjuarters that hypochlorite be
issued with the ration, which was adopted and published in General
Order 16, general headquarters, American Expeditionary Forces.
LABOEATOBY AND EPIDEMIOLOGICAL SERVICE.
A mobile laboratory, mounted on trucks and equipped to do epi-
demiological work, was organized by the central Medical Depart-
ment lalDoratory for use in the Second Army. The officer in charge
was provided with assistants and motorcycles to assist in epidemi-
ological surveys. Two siTch laboratories are believed necessary for
each field army. In addition to the moblie laboratory. Army labor-
atories were established in two of the evacuation hospitals. These
were equipped for Wassermann and darkfield examinations.
It is doubtful, at the present time, whether the divisional labora-
tories as formerly organized and equipped should be continued.
When divisions are reasonably stationary, such laboratories can be
of great value for the performance of clinical pathological work for
field hospitals, and can materially aid in the speed and detection of
communicable diseases, more particularly meningitis, diphtheria,
amoebic dysentery, malaria, and tuberculosis. It should never be at-
142367— 19— VOL 2 36
1540 REPORT OF THE SURGEON GEDSTERAL OF THE ARMY.
tempted to equip sucli a laboratory for extensive laboratory work,
for Avhen divisions are moving or actually engaged in combat in-
superable transportation difficulties invariably arise. Moreover^
under such circumstances patients who are sick for more than a few
days are evacuated to hosj)itals where laboratory facilities are avail-
able and the largest epidemiological problems can best be handled
under any circumstances by the mobile army laboratories described
above. The bacteriologist in charge of these cars can be trained by
the Army sanitary insi)ector to make epidemiological studies and
thus utilized can indej)endently attend to the rapid contact and car-
rier studies which should be made in direct coordination with the
actual laboratory work. It is our belief that a thorough laboratory
training is essential to work in epidemiology. The divisional labor-
atory man shoidd be utilized in the same way as special assistant to
the divisional sanitary inspector.
In discussing laboratory work in field armies it should always be
borne in mind that an army engaged in combat or holding a sector
is not the place for research. The laboratory should be an instru-
ment in the hands of sanitary authorities for the prompt detection
and arrest of communicable diseases. For these reasons, it is of
great im})ort that we should consider briefly the extent of laboratory
work which it is wise to carry out in active field armies.
The most practical solution of the clinical pathological problems
for divisions would seem to be to maintain a number of such organi-
zations for assignment to divisions when circumstances are such that
the laboratory can functionate to advantage. These laboratory units
organized as at present could remain under the control of the director
of laboratories of the Army and assigned to divisions for indefinite,
temporary duty when the respective divisions are at rest, assigned at
the request of the division surgeon, and withdrawn and unassignecl
wherever needed when the particular division is in combat or moving.
One of the fundamental principles underlying successful epidemi-
ological laboratory work is to restrict it to the amount which can be
accurately done. We are entirely out of sympathy with the exten-
sive carrier examinations which were instituted in the camps of the
United States for the control of meningitis upon the occurrence of a
single case. Our own observations have not given us the impression
that this work has had much effect upon the reduction of the disease
incidence and we are absolutely sure that the technical inaccuracies
inevitable in such wholesale bacteriology largely defeat the purpose
of the work.
It is in our opinion more important to restrict the laboratory work
at first to rapid and accurate diagnosis, and to abstain from extensive
carrier work until a number of cases have occurred in one and the
same unit. The principles of prevention of most of the diseases of
importance for Army sanitary control are fairly well understood,
and after the discovery of a single case in a unit it is more important
as a rule to concentrate speedily upon the correction of general sani-
tary defects for the control of the particular diseases.
The procedure adopted in the Second Army in the management of
first cases of connnunicable diseases is illustrated in the sanitary
order hereto attached.
A. E. F. AEMIES. 1541
The epidemiological examinations and tests made by the labora-
tories is here given :
Second Army mobile laboratory 5,438
Second Army laboratory at Evacuation Hospital No. 1 3. 805
Second Army laboratory at Evacuation Hospital No. 13 3, 129
Altogether the mobile laboratory performed 888 examinations for
typhoid carriers.
lOPIDEMICS.
There were no epidemics among Second Army troops except that
of influenza which did not develop to the same extent prevalent
throughout the American Expeditionary Forces, and tlie outbreaks
of typhoid in the 79th and 88th Divisions. The figures relative to
typhoid and all other connnunicable diseases are presented elsewhere
in this report. Meningitis never became a pi-oblem. The typhoid
in the 79th Division developed in Xovember and December, 1918,
with another increase in February and March following. The move-
ments of the 79th Division troops during October and Xovember
took them into the regions former]}' occupied by German troops
around P^traye, Eeville, Crepion. Gibercy. and Damvillers, where the
Germaus had a hospital with considerable intestinal disease, some of
their latrines being reserved for " intestinal cases." Previous to this
the troops, while in action in Xovember. drank water from shell
holes, springs, and wells. Diari-hea developed so th.at estimates of
regimental medical officers ranged from 50 to 75 per cent of the com-
mand. A number of cases developed during the fighting around
Montfaucon du.ring the latter part of October and this is anotlier
probable source of the infection. The division surgeon reported that
about 50 per cent of the replacements received about -25 October,
1918, had no records of typhoid inoculation. The mobile laboratory
undertook a study of the kitchen force, examining 336 men, 17 per
cent of whom gave a history of diarrhea. Of these men 9 were
found to be carriers. Briefly stated, the results of that survey re-
vealed the pre-ence of approximately 3 per cent of carriers among
kitchen personnel and a like proportion among 100 men having noth-
ing to do with the kitchens. Twenty-nine per cent of all men exam-
ined gave a history of having had '' bowel trouble " between Septem-
ber and December, 1918, yet none were so affected at the time of the
survey. It is important to note that the 3 per cent of carriers were
found only among those men who gave a history of having had " bowel
trouble " last fall. It does not appear unlikely, therefore, that souie
at least of the ''bowel trouble" experienced by the men last fall
were unrecognized abortive or modified typhoid fever; the modifica-
tion having been caused by the })rotective vaccinations that had been
given to the men prior to that date; a conclusion of obvious impor-
tance in its bearing upon shipping of carriers into the United States.
With a view of deciding if the 3 per cent (approximately) of car-
riers found auiong those men of the 79th Division who were exam-
ined could be taken as a trustworthy tyjjhoid coefficient, a similar
study was instituted in the 7th Division, which has been conspicu-
ously free from typhoid fever, tliough some of tlie uien of that divi-
sion are known also to have had " bowel trouble '' last autumn. The
results of that survey show that of 35-2 men desiirnated as kitclien
1542 REPORT OF THE SURGEON GENERAL OF THE ARMY.
personnel, one was shown to be a " carrier "' of paratyphoid " A "
and one of dysentery (Flexner type) making 0.3 per cent for each
or combined a carrier rate of six-tenths of 1 per cent of carriers of
infective intestinal bacteria. Of 100 enlisted men (not kitchen per-
sonnel) exammed, no carriers at all were found. Of the 353 kitchen
pereonnel examined 14. or 4 per cent, ga^e a history of having had
diarrhea and IT, 4.8 per cent, gave history of ha\ang had typhoid
fever; and of the 100 nonkitclien personnel examined, 25, or 25 per
cent, gave a similar history of " bowel trouble." Xo true typhoid
carriers were found. The diarrhea varied in intensity and occurred
between August, 1918, and ]Slarch of the present j^ear, the majority
having occurred during October. November, and December, 1918.
From this study it is obvious that witliout taking into considera-
tion other circumstances, particularh' environmental conditions, the
figures quoted for the 79th Division can not be taken as a safe index
of the presence of typhoid carriers in an organization, nor is one
justifiecl in concluding that the existence of diarrhea in an organiza-
tion necessarily means infection of a specific character.
Between February 5 and March 11 a sharp outbreak of typhoid
occurred in the 2d Battalion, 350th Infantry. 88th Division, located
at Morlaincourt. This outbreak originated ahnost certainly from the
use of polluted water, and was perpetuated with equal certainty by
personal contact. The total number of cases that occurred between
the dates mentioned was 21. and the highest total for a single week
was 6, for the week of February 12-18. In the course of investiga-
tion it developed that there were three sources of water to which this
organization had access. One of them was found by all methods of
inspection to be free from danger, and there were no cases of typhoid
fever among the men using this source exclusively, while the remain-
ing two sources were found grossly polluted, one of them arising as a
spring under a house in which there was a case of typhoid fever.
There were 27 (possibly more) cases of the disease among civilians.
In several of the houses occupied by those cases, soldiers were bil-
leted and 11 of them also contracted the disease, pointing to transmis-
sion by contact.
Eeinoculation of the entire Second Army was begun about March
5 and completed with the exception of about 8 or 9 per cent by April 1.
SANITARY SCHOOL.
A school for noncommissioned officers of the Medical Department
and line was established at Mars-la-Tour. in Februar3\ which would
be the basis for similar schools to be established in the divisions.
In general, it can be said that the schools have brought together
an excellent group of men. Very great interest has been manifested
by them in the work and in a few cases decided ingenuit}' in devising
new types of apparatus has been exhibited. The grading of the men
forms a most interesting exhibit, for almost uniformly the grades are
above what is regarded as average. An idea may be obtained of the
general cliaracter of instruction given by the following schedule at
Mars-la-Tour :
1. Map making, having regard to location of sanitary defects.
2. Communicable diseases, from standpoint of preventive measures.
3. Sanitation of billets, kitchens, mess halls, and latrines.
A. E. F. ARMIES. 1543
4. Disposal and salvage of waste.
5. Disposal of manure and other organic waste.
6. Water supply, protection, and purification.
7. Vermin and insects as disease carriers, methods of abating such
nuisances.
8. Food con.servation, preparation, serving, kitchen personnel, and of
mess kits.
9. Correct method of making a sanitary inspection.
10. Review of work done.
11. Final examination and grading.
The courses arranged by the divisional schools have followed the
general plan of the Mars-la-Tour school.
THE PROBLEM OF RETURNING (REPATRIATED) PRISONERS OF W^AB.
Following the armistice between 6.000 and 7,000 repatriated pris-
oners came into the Second Army area. These were mostly Russian,
Italian, a few French, British, and Americans. In a general way
their physical condition was good, but they represented only those
who had been able to walk, for it was in this way that they managed
to return to France. No epidemic diseases were found in their camp,
but on account of danger of typhus fever it was deemed unwise to
allow them to pass into the American area until they had been bathed
and deloused. Medical attendance was furnished and under the di-
rection of the sanitary inspector all were bathed and deloused and
held under daily observation. No epidemic diseases appeared among
them.
Under certain conditions of combat, especially during rapid ad-
vances of large bodies of troops, the policing of a battle field becomes
a sanitary problem of considerable importance. This is the case
more especially in hot weather when the dead bodies of men and
animals rapidly become foci for the breeding of myriads of flies
which infest kitchens and mess tents and carr}' infection from the
faeces almost inevitably accumulated in open trenches and in woods
where troops have camped for brief periods in the intervals of active
fighting. Under such circumstances diarrhea and dysentery become
epidemic and any defects in vaccination in bodies of troops become
noticeable by scattered cases of typhoid and paratyphoid fever. It
is even possible, indeed we believe that we have some evidence to
warrant the assertion, that many cases of mild fevers with intestinal
symptoms occurring at such times represent mild attacks of the
typhoid and paratyphoid group of disease.
The following extract from a Second Army order illustrates the
system in sufficient detail:
1. Memorandum No. 8, these headquarters, 26 October, 1918, emphasizes
several provisions concerning the burial of the dead, which are covered by
General Orders, Nos. 10, 30, 50, 89, 106, and 122, and Bulletin No. 41, G. H. Q.,
A. E. F.. 1918.
In order to carry out these provisions and to facilitate the prompt burial
of those killed in action, the following arrangements will be made in your
corps :
(1) The administrative order pertaining to the field order will direct that
one company of Pioneer Infantry or equivalent, with the necessary picks,
shovels, ropes, teams, and wagons, will be assigned to each combat division.
The commanding officer of this company will report this organization in due
season to the division sanitary inspector, under whose direction the dead
men and animals will be buried. ,
1544 REPORT OF THE SURGEON GENERAL OF THE ARMY.
(2) Three cliaplaiiis from each division will be detailed for temporary
duty with this Pioneer company. In addition to their religious duties they
will act as burial ollitvrs, and secure tlie effects of the dead and dispose of
them in compliance with existing orders.
(3) In addition to the duties outlined above, the Pioneer company will
be used to i)olice the temporary camps of rapidly advancing troops.
(4) Upon cessation of an action, and after the duties directed have been
performed, the sanitary inspector will request orders returning the Pioneer
company to their proper stations.
(5) These arrangements for the burial of the dead will be enforced only
during and immedhitely after an action. At all other times, the burial of the
dead will not be a function of the sanitary service.
A study of the venereul disease situation in the Second Army
naturally resolves itself into two periods or phases : First, the period
during which the troops were in the line when the opportunity for
exposure was slight, and second, the period after the armistice when
the troops were in part withdrawn to better billeting areas and part
sent forward to the territory formerly occupied by the enemy and to
the Grand Duch}' of Luxemburg. Statistics from combat divisions
during active periods were notorioush' untrustworthy as shown by
the many failures to even make reports, but the statement may be
made without contradiction that the fighting forces were couipara-
tively free from venereal disease. Most of the troops of the Second
Arm}- continued to occupy the old devastated area initil February
or March which furthei' favored the low rate. Two factors, how-
ever, operated to increase the rate — the granting of leaves and tlie
occupation of Luxemburg, from which sources came most of the
venereal diseases. The annual I'ate of new cases per thousand, com-
piled weekly for the entire Second Army from October to April,
averaged 22.11 ; from December to April reports were received from
practicallv 95 per cent of the troops. The average for the entire
American Expeditionar}' Forces during this period was 39.62.
ADMINISTKATION OF UKOLOGItAL DEPARTIIENT.
Medical officers were assigned to duty as divisional, corps, and
Army urologists. The Army urologist served as assistant to the chief
surgeon, systematizing the methods of prophylaxis and treatment of
venereal diseases. He exercised supervisory control over the corps
and divisional urologists and had immediate charge of the Army
troops and the ^■enereal treatment centers.
The existing orders regarding venereal disease control were deemed
sufficient, and it only remained to execute their provisions and to
avoid the pronmlgation of new orders and circulars concerning a
subject so well understood. The chief duties, therefore, of the Aruiy
urologist were inspectorial, with the aim of bringing about adherence
to the prescribed methods of control and treatuient.
More in detail, the measures relied upon to control venereal dis-
eases are:
(a) Inspection: The seuiimonthly insi)ections were insisted uj^on
and reports of same required on the monthly sanitary report. Ar-
rangements were made for the inspection of miscellaneous Army
troops to which no medical officer was assigned.
(h) Punishment: The double penalty of court-martial for con-
tracting venereal disease and for failure to take prophylaxis and loss
of pay ; all new cases were reported on the sanitary report and were
A. E. F. — AEMIES. 1545
reported to the judge advocate, by whose office they were followed
up to see that court-martial was had in each case.
(c) Instruction: Instruction was given to every organization by
medical officers and line officers and chaplains. Outlines of these
talks were prepared by the Second Army for both medical and line
officers and together with a digest of existing orders on the subject
of venereal disease were submitted to corj^s and division commanders.
The operations of General Orders. 215, Headquarters American Ex-
peditionary Forces, 1918. which provided for the retention of all
cases of venereal disease in the effective stage at the base ports, pro-
duced good results.
(cl) Prophylaxis: Numerous prophylaxis stati(ms were established,
the equipment and technique standardized, and frequent inspections
made. Medical personnel with prophylaxis equipment were detailed
to accompany all leave trains to furnish proj^hylaxis to the men at
leave areas and en route thereto. Individual prophylaxis packets
were issued to certain selected individuals and to small detachments
likely to be separated from prophylaxis stations.
(e) Treatment.
General scheme. — It was felt that venereal diseases would be more
uniforndy and intelligently treated if the cases were concentrated
at venereal centers under the care of officers trained in that work.
The s "heme adopted in the Second Army, as issued in Circular Xo.
11, office of chief surgeon. Second Army, follows:
1. Army venereal renters. — These will be established at —
Evacuation Hospital No. 1. at Sebastopol (near Toul).
Evacuation Hospital Xo. 1.3. at Walferdange, Luxemburg.
These stations will be provided witli a Wassermann laboratory and dark-
field apparatus.
2. Divisional venereal ccnt( rx. — Each division will mnintain a venereal hos-
pital or center.
3. Surgeons or Army. c-or])s. and divisional units will send all cases of vene-
real disease to the nearest venereal centers. This includes all new cases as
they develop and all old cases requiring treatment.
4. From the ven.ereal cases sent to divisional venereal hospitals or centers
there will l)e inunediately sorted out and evacuated to one of the Army cen-
ters the following cases:
(1) All complicated gonorrheas.
(2) All venereal sores.
(3) All cases of syphilis with open lesions.
5. Specimens of blood for Wasserm.inn test will be sent to the nearest labora-
tory so as to arrive on Mondays and Thursdays.
6. Divisions being served by camp hospitals of the S. O. S. will not send
venereal cases to these hospitals, but will be governed by paragraphs 3 and 4
of this order.
Labor parties. — WhereA er practicable, patients with chronic con-
ditions in divisional centers were placed on a dut}^ status and all
those capable of performing manual labor were assigned to duty in
labor parties.
The total number of patients in the Army and di^dsional centers
numbered nearly 1.000.
DETAILS OF TREATMENT.
A brief re.sume of the methods of treatment employed follows:
Chuncioid. — Importance of early diagnosis of exact nature of sore
as de.scribed above: r.o (hanffe from well-es^nblished methods of
1546 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
treatment; cleanliness; ointments; protargol and glycerine; argyrol,
or iodoform: in later stages antiseptic powders. Carrel-Dakin so-
lution proved to have no marked effect.
Gonoi^liea. — Previous standard methods used. Acute cases kept
in bed. or at least as quiet as possible: given three injections daily
one-half to 1 per cent protargol, retained five minutes. Subacute
cases do light police work, treatment changed according to progress.
Chronic cases do full detail work; receive two special treatments
per week — sounds, prostatic massage, and deep instillations. Prog-
ress of case followed by microscopic slides of urethral discharge and
prostatic fluid. Complicated cases are sent to Army centers for
appropriate treatment. Patients are returned to duty after per-
sistent disappearance of clinical symptoms, controlled by negative
microscopical findings.
Syphilis. — It is in the treatment of syphilis in the American Ex-
peditionary Forces that the greatest changes have occurred over the
methods in civil practice, at the time of America's entrance into the
war. These changes consist in simplified methods of administering
the same drugs formerly used. Arsenic and mercury, preparations
used : Arsenic is given in the form of novarsenobenzol, a preparation
closely resembling neosalvarsan. This does not require neutrali-
zation or great dilution, and can be given in increasing doses with
rarely anj^^ reaction on the part of the patient. This allows inten-
sive treatment without untoward results. Mercury is given in two
forms, intravenously and intramuscularl3^ Mercury cyanide : At
the beginning of the treatment when an intensive effect is desired,
mercury is employed intravenously in the form of 1 c. c of 1 per cent
solution of mercury cyanide, given daily on the days intervening be-
tween the intravenous administration of novarsenobenzol. This
allows the introduction of the maximum amount of mercury with
the minimum amount of irritation. Gra}' oil : Later on in the course
of the treatment intramuscular injections of gray oil in the buttocks
are substituted for the cyanide, which, if continued too long, is not
well borne.
System of treatment. -T\\q, scheme of treatment includes a pri-
mary intensive course for all cases covering a period of 42 days.
This is followed by three secondary courses during the first year,
with periods of rest intervening, the progress of the case being con-
trolled meanwhile b}" Wasserman tests of the blood and spinal fluid.
The treatment of the second year depends entirely on the progress
of the case as shown by the results of the tests of the blood and spinal
fluid.
GENERAL HEALTH, SECOND ARMY.
Complete and reliable statistics representing the noneffective rate
of an Army in the field, under the conditions prevailing in the Ameri-
can Expeditionary Forces in France, are not available and can not
be collected from any system of reports practicable within the Army
itself, for the following reasons:
(1) The Army does not hospitalize all of its sick.
(2) Many cases are admitted direct to camp or base hospitals or
are transferred to them from divisional and Army hospitals.
(3) Excej^t in epidemic diseases reports are not received back by
the Army of the actual diagnoses of cases transferred on tentative
diagnoses.
A. E. F. DIVISIONS. 1547
(4) Frequent shifting of divisions from one army to another.
(5) Frequent transfer of sick and wounded through divisional
and Army sanitary units to the base hospitals.
(6) Under the regulations men sent to base hospitals were dropped
from the rolls and replaced by effectives.
(7) Monthly reports of sick and wounded do not pass through
Army headquarters.
It is, therefore, evident that the only complete and reliable statis-
tics are those compiled from records that reach the central office;
that is, the chief surgeon, American Expeditionary Forces.
It is practicable, however, to present accurate records of venereal
and epidemic diseases. Ever}' new venereal case is reported to the
chief surgeon, Second Army, and duplicates of all telegraphic re-
ports of epidemic diseases from all Army hospitals and by special
arrangements from the base and camp hospitals serving the Army
are received. These reports, together with the reports of typhoid
and paratyphoid reported back from the chief surgeon, American
Expeditionary Forces, have resulted in statistics as to venereal
diseases which we believe are accurate.
The general health of the Second Army troops was exceptionally
good throughout the period of its existence. The epidemic of in-
fluenza prevailing in the United States and in the American Expe-
ditionary Forces did not develop into alarming epidemic in the
Second Army, due probably to the distribution of the men in scat-
tered billets and improvised shelters in the field. The factors most,
potent in spreading respiratory diseases, namel}', the grouping of
large numbers of men together in crowded barracks, did not enter
into the respiratory disease situation in the Second Army as it did
in many other places.
2. Division Surgeon's Reports.
a. third diaision.
Every effort has been made to perfect coordination between the
division surgeon's office and the other offices of the division staff, the
medical units of the division and the corps and Armj^ surgeons. The
result has been freedom from friction and the hearty support of all
concerned. Close personal contact has been maintained by the
division surgeon's office with all organization surgeons and com-
manding officers of sanitaiy train units, the aim and purpose being
one of guidance, helpfulness, and support.
The division surgeon's office landed in France at Bordeaux, April
6, 1918, and on April 13, 1918, was established with headquarters at
Chateauvillain, Haute Marne, Training Area No. 9. The next six
weeks were devoted to reorganizing, training, and equipping the
medical units for active work at the front.
On May 29-30, 1918, the 3d Division moved to the Marne, with
headquarters at Viels Maisons, Seine et Marne, France. From that
date until July 14 the problem before the division surgeon was
largely one of selecting hospital sites, reconnaissance and preparing
the medical department of the division for the proper care and
evacuation of the large number of wounded which were sure to be the
result of the cominof conflict.
1548 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Upon reacliing the Marne in Jnne the division was brigaded with
the Thirty-eighth Corps of the Sixth French Army and occupied a
sectoi- chiefly from Chateau-Thierry east to Mezy. The main body
of the advancing German troops had reached Chateau-Thierry June
1, 1U18. and were pre\ented from crossing the ^larne River at that
point by tlte Tth Machine Gun Battalion of the 3d Division, and
troops from the 10th Colonial Division of the French Army. It was
at this point that the division received its first casualties. The period
from June 4 to July 14 was comparatively quiet except for occasional
raids and artillery' duels in which Ave suffered some casualties.
At nddnight of July 14-15 the enemy began an exceedingly vigor-
ous offensive, laying doAvn an intense artillery barrage, which ex-
tended as far back as Pertibout and Essises. The division surgeon
on the morning of July 15 saw his medical department working
smoothly as the result of i:)reviously well-laid plans for the evacua-
tion of the Avounded- from the shelled areas. The sector occupied by
the 3d Division south of the Marne was covered by extremely good
roads, enabling the ambulances to make good time to and from the
front. It soon became apparent that the 60 available ambulances
were inadequate for the evacuation of Avounded and trucks were
secured from the division transport officer for the transportation of
the slightly Avounded and gassed. It is doubtful if in any great
battle strictly Medical Depai'tment ti'ansportation Avill ever be ade-
(juate unless it is kept on hand greatly in excess of the ordinary daily
• needs. During the second battle of the Marne as many as 80 trucks
Avere used at one time for the evacuation of Avounded.
The German offensive was stopped and immediately folloAved up
by a successful attack by the American and French troops on July
18, enabling the 3d Division to cross the Marne just beloAv Gland and
at Mezy. From this time on the character of the fighting was en-
tirely of the open style of warfare. The problems of the Medical
Department Avere not fixed and had to be adapted to the constantly
changing line of advancing troops.
On July -22, 1918, the division surgeon's office moved from Viels
Maisons, Seine et Marne, to Chateau la Dultre, Avhere it remained
until August 16, 1918. During this time the division surgeon spent
most of his time locating and inspecting hospitals, supervising the
evacuation of Avounded to and from the field hospitals, two of which
were located at Chierry on the Marne and one at Cob. an several kilo-
meters south of Fismes, and in visiting the regimental surgeons.
The office force Avas busy compiling data from the reports of the vari-
ous sanitary organizations Avhich would shoAv daily the exact status
of the division as regards casualties, sick, personnel of the medical
department, etc. There Avas a constant change in personnel, both
officers and enlisted men. The sick and Avounded of the Medical De-
partment had to be replaced. Medical officers at the front became ex-
hausted or suffered from a nervous breakdoAvn, due to the constant
strain of enduring heaA^' shell fire, or long hours of work, necessi-
tating relief from time to time.
The sanitation at this time was exceedingly poor due to our rapid
adA'ance and crossing oA'er a country which had been recently CA'acu-
ated and destroyed by the enemy. Much time and thought were
given to corrective measures. Orders were issued coA^ering the situ-
ation as far as possible. Diarrhea Avas the chief medical problem.
A. E. F. AKMIES. 1549
The division surgeon required the division sanitary inspector to visit
all organizations to see that corrective measures were carried out.
Excellent cooperation on all sides resulted in amelioration and event-
ually satisfactory conditions.
The great success with which the Medical Depurtmeni of the di-
vision handled the problem of evacuating and caring for the wounded
on the Marne are due to —
(1) Tlie well organized and trained Medical Department units
with the regiments.
(2) The well organized field hospitals and ambulance companies.
(3) An efficient medical-supply unit.
This efficiency was developed during the training period by the
hard work and cooperation of every officer and enlisted man in the
Medical Department.
Tlie work of the Medical Department of the division was cited
in (General Order 34. Headquarters. 3d Division. 10 August. 1918,
signed by Gen. Joseph T. Dickman, who at that time commanded the
division. An extract from this order reads as follows :
It is, therefore, desired to record the services of the doctors and nurses wiio
worked so tii-elessly and skillfully, caring for and saving the lives of our
wounded men: and the drivers of trucks and anihulanies. who fearlessly per-
formed their work day and night under slieil and machine-gun tire, with the
result that wires, though constantly <'ut, were repaired and the wounded were
ti'ansferred to the hospitals without delay, ard supplies carried to the men
in the front lines. To these, and to all menihors of the division who.se work
has enabled the division to render a national service, the comman ling general
wishes to express his sincere appreciation and gratitude.
After the enemy had been driven across the Vesle River all our
troops were brought back south of the Marne, given a few days'
rest, and moved on August 16 and 17 to the Gondrecourt area for a
period of training. At Gondrecourt the problem before the division
surgeon was the reconstruction of the medical units of the 3d Di-
vision. Each regimental surgeon and commanding officers of field
hospitals and ambulance companies were re<iuired to follow out a
schedule of training calculated to fit the replacements for front-line
duty and at the same time to extend the knowledge of the original
members of the detachments for further service. The subject of
medical supplies was given much thought and attention. The or-
ganizations during the second battle of the Marne had never lacked
medical supplies, due to the splendid efficiency of the medical sup-
ply officer. As supplies were abandoned by the units, the medical
supply officer had them collected into his depot. When the division
left the Marne he turned his supplies into the Army medical supply
dump at Chateau-Thierry. At Gondrecourt the reserve supplies
were fully conq)leted up to requirements of the Medical Department
Manual. In addition, a new table of supplies was issued from the
division surgeon's office requiring additional articles, such as Thonuis
and Cabot splints, shell-wound packets, etc. On the Marne 16 men
from each battalion had been selected as litter bearers. These men
were given additional training in bandaging and first aid in the
Gondrecourt area.
The division sanitary inspector inspected medical detachments as
regards completeness of their equipment, special attention being
paid to the stock of splints and antit«tanic serum : also as regards
1550 REPORT OF THE SURGEON GENERAL OF THE ARMY.
the state of discipline, appearance, and trainino;. Careful inspec-
tions were required regarding kitchens and the chlorination of water,
■with a view to not onl}^ protecting the men against diarrhea in
this area but also to impress upon them the importance of carry-
ing out good sanitation at the front. The sanitation of this area
has been fully described in another part of this report.
A memorandum from the chief surgeon's office had strongly rec-
ommended the employment of motor cycles with litters attached in
place of the usual side car. The division surgeon succeeded in
intei-esting the American Eed Cross officials, and an order was given
by them for the manufacture in England of 12 of these motor cycles
with litters attached. Up to the time of the signing of the armistice
the litters had not been received, and so the order was canceled by
the Red Cross.
On September 5. 1918, the division left the Gondrecourt area and
arrived on the St. Mihiel sector, with headquarters at Boucq. Stand-
ing in front of the office one could see to the left Mont Sec and Vig-
neulles, and on the right the region around Seicheprey and Flirey,
where the Americans had suffered their first casualties, in November,
1917. The next day from this vantage point one could watch the
progress of the battle and see the shell falling on Mont Sec. That
night the burning of Vigneulles and many small villages by the
enemy, could be seen from this point. The 3d Division, with the
exception of the Artillery regiments, did not go into action on this
front. The result of the battle is well known. The organizations
were visited while thev were bivouacked in the neighborhood of
Beaumont and Manclres. Sanitary conditions were good and the
morale and physical condition of the troops was excellent.
On September 16 the division surgeon's office left Boucq for Julve-
court, arriving there on the 17th. In this region the di\dsion was
bivouacked in the Bois de la Cote and neighboring woods in order
to conceal their presence from enemy planes. Travel in the daytime
was limited as much as possible. This move was preparatory to
the Argonne-Meuse offensive. It was decided by the division com-
mander to leave all offices of record in the rear, and the division
surgeon's office was attached to the adjutant's office and stationed in
a group of Adrian barracks on the edge of the Bois de la Cote. The
division surgeon himself, in order to better coordinate the work of
the Medical Department, had his personal office with G-1 in a near-
by village, and throughout the remainder of the campaign associ-
ated himself closely with the offices of the chief of staff, G-1, and
G-3.
While in this area supplies were replenished to the full allowance.
On the night of September 26 the Argonne-Meuse attack began. On
September 27 the division surgeon's office moved to Souhesmes le
Grand, where it remained wuth the division adjutant's office during
the entire month of October and until November 2, when the 3d
Division was relieved from the lines. The division surgeon moved
with the division P. C, which was located first at Blercourt, then
at Esnes. and finally opened at the famous " Crowai Prince's Dugout "
in Montfaucon on October 3. He directed that the sanitary train
move up and take position at Bethelainville. The Artillery regi-
ments were located around Esnes and the Infantry regiments in the
Bois des Hesse. All organizations were visited and the question
A. E. F. DIVISIONS. 1551
of sanitation, medical supplies, and ambulance serA'ice was taken up
Conditions were found to be satisfactory in regard to all these
matters. Sanitation was satisfactory under the circumstances and
the morale of the troops was good.
On September 30, 1918, the division surgeon directed that the
sanitary train move to Malancourt, a ruined village about 3 kilo-
meters south of the division P. C. It was at this station that the
division surgeon worked out his plans for the evacuation of wounded
and for the location of his field hospitals. He made a full reconnais-
sance of the country in the neighborhood of Very, Montf aucon, Nan-
tillois, Septsarges,* and Cuisy. The country, including the roads,
was almost completely destroyed and barren. All roads were con-
gested and harassed by shell fire. The best and least congested road
was the one to be selected.
The advance ambulance dressing station and headquarters of the
sanitary train were stationed at Montfaucon and remained there
until the 3d Division withdrew to the rest area.
Very, about 8 kilometers back of the line, easy of access from the
front and rear, was picked out by the division surgeon as an ideal
hospital center. The medical supply unit and all four field hospitals
were established there under canvas — triage, surgical, gas, sick — in-
suring prompt and specialized attention to all cases. It was the
most satisfactory arrangement enjoyed by the 3d Division during
its campaigns. It was visited by manj^ inspectors, including Gen.
Ireland, and pronounced good.
Later, when the division passed from the V to the III Corps this
center was broken up and hospitals established at Bethincourt and
Bethelainville, to be on the line of evacuation of the III Corps.
On November 1 the 3d Division was withdrawn from the Argonne-
Meuse sector and went into the Tranville rest area, where the prob-
lem Avas one of bathing, clelousing, scabies treatment, replacement,
reequipping, and training.
On November 17, 1918, the division started on its march to the
Rhine. The establishment of corps hospitals at intervals made the
evacuation of sick comparatively easy during the first 10 days. After
that the division surgeon traveled ahead and took over civilian hos-
pitals, hotels, or other buildings suitable for field hospitals, at inter-
vals of about 20 miles, moving up personnel as hospitals were emp-
tied. During the last 50 miles of the march patients also were moved
forward from one hospital to the next, as their condition warranted.
This plan worked ver}' favorably and little inconvenience was experi-
enced throughout the entire march.
SANITATION.
The division landed in France during the earW part of April,
1918, and by April 20 practically all the units except the Artillery
were in the training area at Chateau Villain, Department Haute
Marne. The Artillery was sent from the port of debarkation to
Coetquidan for training and did not join the division until the early
part of July on the Marne.
The Haute Marne is a rolling country with some moderately high
hills. When the division arrived, spring was just beginning. During
the early part of the training period there were frequent rains, but
1552 REPORT OF THE SURGEON GENERAL. OF THE ARMY.
in May there was much sunshine and dry weatlier. The whole ooun-
try was under intensive cultivation. The fanners lived in small
villages in stone, cement, or brick houses and in close proximity to
their stables. The French farmer was thrifty. His cows, horses, and
chickens were kept in the stable. The \dllages were filled with
uianure piles, the streets were verj^ dirty, and backyard privies were
the rule. In peace times, with plenty of labor, thinos were no doubt
clean, but with no one at home except old men. women, and children
the sanitary conditions were bad. Some of the viliauers Vvere in-
duced through the town major to haul out their manure, and the
soldiers helped clean up when not busy with their intensive training
schedules. The water supply was everywhere questionable.
On July 15 the 3d Division was facing the enemy along the Marne
River. The right flank of the Division rested near Moulins and the
left opposite Chateau-Thierry. Some of the troops on the inmiediate
front were lot-ated in good buildings at Blesmes, Chierrj', Fossy,
Crezancy, Parroy, Moulins, and Mezy. Aside from the hazards of
war these towns afforded comforts not usually enjoyed by troops at
the front. The water supply was abundant, and in most towns it
was furnished by the Paris Aqueduct, which ran through that region.
The regimental surgeons felt safe so far as water supply to the front
lines was concerned, but a complete survey later showed that this
elaborately protected water supply, whose source Avas a large crevice
spring flowing deeply from the side of a hill, was contaminated
somewhere along its course, and bacteriological tests showed the
presence of colon bacilli. Near Fossy a few springs and wells were
used, and it was in this vicinity that seven men of Company E and
Company F of the o8th Infantry developed typhoid fever.
On September 24 and 25 our troops began to move forward toward
the front. The Artillery moved to a sector near Esnes and went into
action. The Infantry- and machine-gun battalions were camped in
the Foret de Hesse in reserve. Good dry camp sites were selected.
Fires were built and men could dry out their clothing and shoes.
Very few sick were evacuated from here. The Artillery were farther
forward near Esnes, and sanitary conditions were very poor. Esnes
was a small village about 2 kik)meteis from the German line. It had
been shelled almost daily for four years and was in complete ruin.
Xot one building was left ^-tanding. The valley in which it was lo-
cated was poorly drained and wet. The water supph^ came from a
small streaui -near the center of the village. It was then muddy from
recent rains. A hill rose to the north, and near the foot of this hill a
row of dugouts were constructed along the road. From these ex-
tended a system of trenches reaching up to the top of the hill where
the network of the trenches was very complete. These trenches and
dugouts re; ently occupied by the French showed some sanitary care,
but the town was one mass of debris and filth. There had been some
defiling of ground. There were several dead horses in the neighbor-
hood but the weather was not so cold that their carcasses did not offer
a breeding place for flies, and they could be removed when time per-
mitted. The surgeon of the 10th Field Artillery said that he was
having some diarrhea in his organization, and strenuous efforts were
being made to use only chlorinated or boiled water. Fortunately
during the cool weather one could rely upon coffee and soup and
thereby avoid drinking any water. There was not time for police,
A. E. F. DIVISIONS. 1553
even by troops not actually engaged in fighting. The enemy had
been driven back on the west bank of the Meuse to a line running half
way between Nantillois and Ciinel. The roads up to and across no
man's land had to be repaired or rebuilt entirely.
By October -o practically ever^^ combat organization had crossed
over the old front line trench system and the intervening shell-torn
area to a point just south of Montfaucon. Our troops soon went into
line. The sanitary conditions in this area were better. There were
a few dead horses still unburied. but practically all the men killed in
action had l)een l)uried. The old German dugouts were generally
filthy and lousy. It was in these old dugouts that most men became
infested with lice. It was the opinion of some medical officers that
many men contracted influenza by visiting dugouts recently vacated
by the enemy. This opinion was given shortly after we came out of
the St. Mihiel sector, where respiratory disease first appeared among
the troops.
It was certain that most streams in this area had been contami-
nated. There were a few springs which did not show colon bacilli.
The Avater supply Engineers erected three water points in the 3d
Division area: one at Septsarges, one at Bethincourt, and one half a
kilometer south of Montfaucon. Here water was chlorinated as the
carts were filled. With the approa' h of cold weather good shoes,
socks, outer and underclothing were needed. This need was well
anticipated by the quartermaster department. Socks and under-
clothing were sent up to the front lines at different times, and this
timely supply greatly minimized the exposure. The food supply was
excellent under the circumstances and contributed greatly to the good
physic al condition maintained by the troops while subjected to hard-
ship and exposure of front line service.
Regarding prevailing diseases the following note was made in the
October sanitary report :
Influenza, bronchitis, and colds were tlie most common causes of admissions
to sick report. All surgeons followed out the policy of prompt evacuation of
severe cases. ]\Iany mild cases occurred and Avere treated in the organizations.
The influenza was of a mild type and not accompanied by high fever and pros-
tration. Enteritis was the next most common cause of admission. Part was
due to exposure and part to water supply. The men preferred to drink coffee
when chlorinated water could not be obtained in the front lines. Water to
wash hands or mess kits was scarce, and this fact no doubt contributed one-
half the cases. There were 20 cases of trench feet in the first stages of the
disease whicli developed for the most part with men of careless habits, or in
those who had lost their socks through carelessness, or unavoidable causes.
Percentage of louse infestation estimated at 75 per cent, scabies 10 per cent.
On November 16. 1918. the 3d Division started on its march to the
Rhine. Our route lay through Commercy, Vigneulles, Conglans, and
Brie5\ We crossed the border of Lorraine at Moyeuvre-le-Grand,
thence to Thianville and Remich, Luxemburg. During the march
surgeons of organizations were seen frequently. All were urged to
chlorinate their water carefully. The physical condition of the men
was excellent. The evacuations to hospitals were not excessive. By
the time the division had reached Remich a considerable number of
men, generally replacements, were suffering with chronic arthritis,
flat feet, and other foot conditions and had to be eliminated as they
were unable to march.
1554 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Close iiiqiiii\y avus kept concerning the health of the inhabitants of
the country through which we marched. At ConHans, France, a
town not far behind the old German lines, we were told that the in-
habitants had had no epidemic of any sort and had suffered only
from malnutrition due to lack of food. Their appearance bore out
this fact as they were pale and appeared much underweight. There
had been no influenza among them or among the German troops who
occupied that place. In Lorraine ever3-one seemed healthy and no
epidemics were reported. At Remich, Luxemburg, a few cases of se-
vere influenza were reported. When we reached Saarburg, Germany,
we received the first reports of severe epidemic of influenza among
the inhabitants. Here a great many deaths had occurred in the past
two months. From this time on until the division reached the Rhine
reports of small epidemics were received. In the vicinity of Rhein-
bollen a great many deaths had occurred among the inhabitants.
The German towns are compactly built and each house has a stable
with its manure pile in close proximity. The cesspool is emptied by
a suction pump and the liquid contents of animal and human excreta
hauled to the fields. Orders have been issued through the Landrat
and all manure piles were removed. The backyards were thoroughly
policed and the cesspools made fly proof. A close inspection of back
yards was made by the military authorities. Practically all towns
are well drained. There was little mud and a minimum of dampness
considering the foggy, cloudy, and not infrequently wet weather
during the winter. Kitchen sinks drained into the gutters in all
towns except Andernach. Men use the latrines in their billets. A
few pit latrines are used by the troops which are covered and fly
proof. Kitchen wastes are taken away by civilians or disposed of
by the pit sj'stem. Tin cans and bones are salvaged. Launclry work
in the area has largely been an individual affair, done by men them-
selves or by the inhabitants. A division mobile laundry has been
established at Mayen with a capacity of 3,000 pieces per day. This
is about the amount of laundry work required by a battalion for the
period of one week. Many German towns have a public water sup-
pi}", derived from deep wells or springs. While usually well pro-
tected the source may become contaminated following rains.
PULMONARY TUBEBCULOSIS.
Pulmonary tuberculosis has not played an important part among
the diseases in the 3cl Division in the American Expeditionary
Forces, due probably to the " combing out " of tuberculosis cases by
special examining boards in the United States before dej^arture for
the American Expeditionar}^ Forces. Most of the cases found were
old cases, which had existed prior to enlistment and occurred chiefly
among men not specially examined in the United States. No incipi-
ent cases have been recognized. None of the cases gave a history of
gas poisoning.
B. FIFTH DIVISION.
The 5th Division was in a more or less unique position in its form-
ative stages, in that the division, although mobilized, was never con-
centrated at any one station; the component brigades and organiza-
tions being scattered throughout the Southern States.
A. E. F. — DIVISIONS. 1555
The medical history of the 5th Division actually began with the
•assignment of Lieut. Col. R. H. Pierson, Medical Corps, as division
surgeon, oth Division, under Special Orders, No. 280, paragi-aph 78,
War Department, Washington, D. C, dated December 1, 1917. Lieut.
Col. Pierson reported for duty to the commanding general, 5th Di-
vision, at Camp Logan, Houston, Tex,, on December 4, 1917, at which
time the office of the division surgeon was officially established.
Four months of hard work in training and instruction was under-
gone by the personnel of the 5th Sanitary Train while at Camp
Logan.
During the period of training at Camp Logan no serious epidemics
were reported, and the sanitary conditions, as a whole, were con-
sidered very favorable.
It may be mentioned that during this time the process of weeding
out the physically unqualified was always in effect, and, as a result,
quite a number of discharges were recommended.
On the same date, Lieut. Col. R. H. Pierson, along with the com-
manding general, 5th Division, and other members of his staff, also
left Camp Logan for foreign service, under confidential orders.
Upon arrival of the first contingent of the 5th Division in France,
the 13th training area was taken over for the purposes of instruc-
tion and concentrating the division.
The division surgeon's office was established at Bar-sur-Aube on
May 5, 1918.
Here, for the first time, opportunity was presented for observa-
tion of the efficiency of the medical detachments of the Infantry
regiments. During the stay in this area special study was made of
the qualifications of the enlisted personnel of these units, and, as a
result, a number of reductions and promotions were made to increase
"their efficiency.
During the time the 5th Division occupied the 13th training area
there were no serious epidemics reported. There were, however,
three cases of accidental drowning reported, due to the treacherous
current of the Aube River: also one case of anthrax was reported.
The case of anthrax was attended with unusual circumstances. In-
vestigation revealed the fact that there had been no previous cases
of anthrax in this particular locality for the past 10 years; and it
was finally concluded that the probable cause for this one case was
that the soldier was quartered in a billet formerly used as a barn,
infection being contracted from contact with old straw.
The division surgeon's office was established at Corcieux on June
3, 1918.
The various regiments and line organizations Avere scattered in out-
lying areas and villages, preparatory to taking over their part of the
sector, and from whence they gradually moved into the trenches,
Telieving French organizations then in control.
The division surgeon's office moved from Corcieux to Gerardmer
on June 7, 1918.
Early on the morning of June 17. 1918, shortly after the 60th
Infantry had taken over their part of the sector, a gas-shell attack
was made by the enemy. In all, about 75 shells of the gas type were
shot over and also some of the high-explosive type. They succeeded
in breaking down a dugout in which several members of Company G,
142367— 19— VOL 2 37
1556 REPORT OF THE SURGEON GENERAL OF THE ARMY.
60th Infantry, were sleeping. Twenty-five men were severely gassed
and three were killed outright.
On June 19, 1918, the personnel of Field Hospital No. 25, otli Sani-
tary Train, arrived and were ordered to duty at French H. O. E.
Hospital 2/14 at Bruyeres, to assist the French.
The balance of the personnel of the 5th Sanitary Train arrived on
June 20, 1918, and were stationed at Corcieux, wiiere headquarters,
5th Sanitary Train, had already been established. Here, for a short
period, a course of instruction and training was undergone by the
personnel of these units.
The question of evacuation of wounded in this sector was a difficult
one. On account of the mountainous topographical condition of the
country many roads were rendered inaccessible for passage of ambu-
lance, and in a great many instances patients had to be carried in
litters considerable distances before reaching an ambulance station.
However, the sector remained quiet and the regimental medical de-
partment personnel met the needs of the situation in a fairly satis-
factory manner. The regimental band personnel w^as pressed into
service for litter-bearer work but once. Upon this one occasion it was
observed that the proper spirit was lacking, and their inexperience in
this line of work was evident.
Hospitals of evacuation were located at Fraize, Bruyeren, and
Gerardmer.
Regimental infirmaries and battalion aid stations were established
at suitable points along routes of evacuation to the rear.
Ambulance stations were located at Fraize and le Rudlin, both of
which places were at times under shell fire.
During the stay in this sector no activity of any great importance
occurred and evacuation was handled with dispatch and facility.
The sanitary condition of the line troops w^iile in this area was con-
sidered fairly satisfactory. How^ever, it should be pointed out that
there existed some scabies and other skin affections.
ST. DIE SECTOR.
Prior to taking over the St. Die sector, the troops of the 9th
Brigade withdrew from the line on July 9, 1918, to the Arches Atea.
Here the troops were allowed to rest for a short period. During this
period Sanitary Squad Xo. 24 was engaged in the work of delousing
and disinfecting of the troops of the \Nhoie brigade. Also, certain
periods were devoted to the bathing of the men.
Pursuant to Field Orders No. 19, Headquarters 5th Division, dated
July 14. 1918, 5th Division Headquarters moved on that date from
Gerardmer to St. Die. Incidentally, the office occupied by the di-
vision surgeon had a more or less historical past. Early in 1914 the
German Army, which then held the town, occupied this office for the
vrerman sanitary service. They remained 19 days, since which time
the office has alw^ays been used by the French Army for the French
Service cle Sante.
As the regiments moved up into their positions in the line various
regimental infirmaries were located at suitable points along the
routes of evacuation, with battalion aid stations and Postes de Se-
cours at more advanced points.
A. E. F. — DIVISIONS. 1557
The 5th Artillery Brigade arrived in France on June 16, 1918, by
way of England, going into training at Camp Valdahon before join-
ing the division. For the 5th Artillery Brigade various aid sta-
tions were established throughout the part of the sector held by
them. However, evacuation, for the most part, was through the In-
fantry regimental infirmaries, mentioned in the foregoing.
Field Hospital No. 29 Avas opened at St. Die on Julyl9, 1918.
Field Hospital No. 17 was opened at Kaon L'Etape on July 19,
1918.
Ambulance Company No. 17 and Ambulance Company No. 29
were opened at Raon L'Etape and St. Die, respectively.
Ambuhmce Company No. 30 and Field Hospital No. 30 were
stationed at La Salle, Avhere some of the personnel was engaged in
assisting the French in the construction of the French Army hos-
pital at that place.
Field Hospital No. 25 remained at Bruyeres during this period,
assisting the French in the care of American patients at French
H. O. E. Hospital 2/14.
Ambulance Company No. 25 was stationed at St. Die.
Field Hospital No. 163, which had been temporarily attached to
the division, remained at Gerardmer to assist the French in the care
of American patients at French H. O. E. Hospital No. 2/8. On
July 2, 1918, Field Hospital No. 163 was relieved from temporary
duty with the 5th Division, and assigned to the 35th Division.
Field Hospital No. 161. temporarily attached to the 5th Division,
was stationed at Raon L'Etape.
Evacuation from the northern part of the sector (60th and 61st
Regiments of Infantry) was to Field Hospital No. 17 at Raon
L'Etape, from which point the severely wounded and gassed were
transferred to American Evacuation Hospital No. 2, at Baccarat; the
sick and slightly injured were sent to French H. O. E. Hospital 2/14
at Bruyeres.
Evacuation from the southern part of the sector (6tli and 11th
Regiments of Infantr}') was to Field Hospital No. 29 at St. Die.
At St. Die Casual Surgical Operating Team No. 17 was stationed at
the St. Charles Hospital to care for all emergency operating cases;
( ther cases were sent to French H. O. E. Hospital 2/14 at Bruyeres.
Gassed cases were cared for by Field Hospital No. 29 at St. Die.
Lentil August 14, 1918, when 40 ambulances arrived from St.
Nazaire, for the 5th Sanitary Train, ambulance service was furnished
the division by Ambulance Company No. 161 at Raon L'Etape and
Ambulance Company No. 162 at St. Die. Ambulance Company No.
162 was relieved from temporary duty with the 5th Division, and
assigned to temporary duty with the 7 7th Division, per Field Order
No. 29, Headquarters 5th Division, dated July 25, 1918.
During the period the 5th Division occupied this sector many
medical activities of minor importance were undergone. Weeklj''
conferences of medical oflicers were resumed every Sunday at the
division surgeon's office, for the purpose of discussing various matters
and details. The division specialists were ever actively engaged in
the pursuit of their various duties. The work of Capt. Kidd. who
had been assigned as division ophthalmologist, was particularly out-
standing. It appears that competent ophthalmologists have been
scarce in this vicinity for years, and, as a result, as the news spread,
1558 REPORT OF THE SURGEON GENERAL OF THE ARMY.
daih^ clinics Avere held of civilians, as Avell as many French soldiers.
Also, by reason of having an ophthalmologist on duty here^many cases
developing within the division Avere promptly attended to and re-
turned to duty, where otherwise they Avould have been sent to the rear.
The two sanitary squads attached to the division were engaged in
the work of cleaning and supervising the sanitation of the camps at
St. Die and Kaon L'Etape. with effective results. Perusing the di-
visional sanitar}' reports, it is noted that the condition of moldy
bread still obtained to a considerable extent throughout the division,
Avith its consequent result — diarrhea. Otherwise, the sanitary condi-
tion of the command was considered favorable.
In addition to the foregoing. 74 enlisted men and T medical officers
from the 5th Sanitary Train Avere attached to the 6th Infantry for
reserA'e.
(h) Detachment 7th Regiment Engineers, 1 medical officer and 3
enlisted.
(c) 20th Field Artillery (light).
Central dressing station was located in a dugout near Vanifosse.
Near each of the battery gun positions was located two litter-bearer
squads, with litters and dressings. Three ambulances with litters
were stationed at the regimental infirmary for duty.
Ambulances with litter squads from Ambulance Company Xo. 25
and Ambulance Company No. 29 were in readiness, as follows:
Three at Dijon, 1 at Charemont, 1 at La Chapelle St. Claire, and 1
at Nayemont.
The balance of the ambulances were parked directly to the triage
hospital at St. Die, which was conducted by Field Hospital No. 29.
Casual Surgical Operating Team No. 17 had already been assigned
to duty at the St. Charles Hospital, St. Die, where there was also a
French operating team and other personnel of surgeons, nurses, and
assistants.
The attack. — At 3.50 a. m., August 17, 1918, the American batteries
opened with a sweeping barrage upon the enemy trenches, and at 4
a. m. L and M Companies of the 6th Infantry went over the top and
led the attack, assisted by detachments of the 15th Machine Gun
Battalion and a platoon of the 7th Eegiment Engineers, all sup-
ported by Company A, 6th Infantry. The enemy retaliated with
severe counterfire from their batteries. After the village of Frapelle
had been captured by our troops, the enemy batteries fired upon it
with shrapnel and gas shells.
The care of the loounded. — At 7.20 a. m. the first ambulance load
of wounded soldiers reported at the triage hospital. The dressing
of the Avounded and their evacuation Avas carried out with care and
dispatch, due to a previously well-organized plan.
But four of the gassed cases admitted on August 17 resulted from
immediate action in the Frapelle engagement; the others occurred
from gassing of dugouts in the A'icinity. During the following days
there was intermittent bombarding of the area with gas shells. This
bombardment was intensified at night. In only a few places was
there dense gas. These areas were valleys into Avhich gases had
settled.
But four of the gassed admitted on August 17 resulted from imme-
diate action in the Frapelle engagement; the others occurred from
gassing of dugouts in the vicinity. During the following days there
A. E. F. — ^DlVISIOlvrS. 1559
was intermittent bombarding of the area with gas shells. This bom-
bardment was intensified at night. In only a few places was there
dense gas. These areas were valleys into which gases had settled.
Ty^pes of gases used. — Phosgene, mustard, and lachrj^matorj^ were
recognized. No arsine gas was reported by any of the medical
officers.
Action of the gases. — This was manifested by the following symp-
toms: Conjunctivitis, bronchial irritation, vomiting, and local burns
from mustard gas.
Degree. — None of the cases were severe. No death occurred from
gas poisoning. Most of the cases showed slight bronchial irritation,
with coughing and sense of burning in the chest. About 30 per cent
of the cases had mild conjunctivitis. There were 9 cases which
showed mustard gas burns. Two cases were recorded as phosgene
inhalation. Nausea and vomiting were reported as early symptoms
in about 50 per cent of the cases.
As stated above, none of the cases were severe. Many of them
showed no symptoms whatever of gas poisoning by the time they
were received at the St. Charles Hospital at St. Die. Seventy-three
cases were returned to duty on August 21. An equal number were
returned the following day, August 22. All of them were able to do
duty within a week.
On August 23, 1918, the 5th Division was relieved from the St. Die
sector b}' the 92d Division. Division headquarters moved on the
same day from St. Die to Arches. The various organizations and
units of the oth Division were stationed throughout the Arches area.
Here, during this period, a well-deserved rest was given the regi-
ments. Also, for a while, a mild schedule of training was instituted.
On August 30, 1918, the 5th Division left the Arches Area, and
proceeded to Neuvillers-sur-Moselle, where division headquarters
was located. The 5th Division was here attached to the First Army
Corps, and held in reserve.
The sanitary condition of the command Avhile in this area was
considered fair. Water conditions and sources were investigated
by the division water inspector, and, generally, found to be non-
portable.
The 5th Division was ordered up from reserve on September 8,
1918, to take part with the First Army in the St. Mihiel operation.
Division headquarters was established at Martincourt on the same
day.
ST. MIHIEL OPERATION.
In compliance with Training Memorandum No. 43, 5th Division,
dated September 17, 1918, the following report of Medical Depart-
ment activities for the division is submitted :
This report covers the proceedings of the Medical Department
between September 12 and September 18, 1918, in the advance made
in the area extending 8 kilometers north from Regiiieville.
Preparation for the attack. — Prior to these operations, repeated
conferences of medical officers had been held, in which the functions
of each sanitary unit were defined in detail. A full outline of the
service of evacuation was published and distributed through the
message center. (See Annex No. 7 to Field Orders No. 11, par. 9.)
In this publication the duties of sanitary units were defined; the
1560 REPOKT OF THE SURGEON GENERAL OF THE ARMY.
locations of evacuation hospitals and routes to same were published;
the locations of the triage hospital, field hospitals, and first ambu-
lance company dressin^i: stations Avere designated.
On the mornincr of September 12, 1918, the advance was made;
the 6th and 11th Regiments of Infantry being in the front line. The
Medical Department personnel with these regiments advanced with
their commands. Patients from the vicinity of Regiiieville were im-
mediately littered and transported by mule ambulance to the ambu-
lance dressing station at ISIetz bridge, from where they were sent,
by way of the triage hospital at St. Jean, to American evacuation
hospitals about Toul.
At 10 o'clock the troops had advanced for a distance of 4 kilo-
meters. Orders were given to advance the Medical Department
organizations. The organizations at Domevre-en-Haye were moved
to St. Jean; the triage hospital was moved from St. Jean to Metz
bridge. Ambulance dressing stations were established at Regnieville,
at Bois de Saulx (366f-237.6), and at Vieville-en-Haye. As the
advance progressed, a dressing station was established in the old
German hospital at Bois de Gerard (367^210.5).
On September 12, 1918, and the morning of the 13th, evacuation
was considerably delayed by the condition of the roads into the Ger-
man trench zone. It was necessary to fill in trenches and clear away
obstruction before either mule or motor ambulance could pass. Dif-
ficulty was also encountered in getting an adequate number of litters
into the front zone.
In order to meet these difficulties, the following steps were taken :
(a) An advance medical supply depot was established at Metz
bridge. In anticipation of a litter shortage, 300 litters had been pro-
cured from the medical supply depot at Toul. There had also been
procured 1,000 blankets ancl a plentiful supply of surgical supplies
and dressings. These were rushed forward by returning ambulances,
by litter bearers, and other transportation which was available.
(h) The Medical Department attendants with the advancing
troops, in addition to their medical belts, carried pouches filled wdth
extra surgical dressings.
In the German dressing station at Vieville-en-Haye ancl at Bois de
Gerard there was found large quantities of medical supplies which
were promptly' utilized. These supplies consisted of tetanus anti-
toxin, manufactured in Washington, D. C, and surgical dressings
prepared by Bauer & Black at Chicago, 111. It is probable that these
surgical dressings were those captured by the Germans during the
Chateau-Thierry drive.
There were captured at the old German hospital, near Vieville-en-
Haye three horse ambulances and a surrey. These were used for
transportation of patients from place of injury to the dressing stations
and field hospitals. Litters found at the German dressing stations
were also used.
A large number of German captives were utilized for litter-bearer
work.
By noon of September 12, 1918, it was possible to get mule ambu-
lances into the front zone. As road improvement progressed, the
roads became passable for motor vehicles, which were largely used
from that time on.
A. E. F. DIVISIONS. 1561
Regimental Medical Department supplies. — It was found impos-
sible for the regimental medical cart to keep up with advancing or-
ganizations. As the vehicles could not go over " no man's land "
until the roads had been improved, part of their material was carried
by hand. The medical supplies used by the regiments were furnished
from supi^ly dumps at the various ambulance dressing stations, which
were filled at the advance medical supply depot at Metz bridge.
Food supply. — At the triage hospital and at each of the ambulance
dressing stations field hospital kitchens were opened where any
soldier wlio required it was given a hot meal. Prior to the engage-
ment, each ambulance company and dressing station was supplied
with cases of hard bread, canned roast beef, one or more sacks of
sugar, and coffee. The Young Men's Christian Association also fur-
nished chocolate for each of the dressing stations. In addition to
this, the supply officer for the 5th Sanitary Train brought up 1,000
rations from the quartermaster depot at Tremblecourt. Meals were
served from kitchens both day and night throughout the period of
activity. It is evStimated that between three and four thousand men
were fed at these stations.
This service resulted in a considerable amount of increased effi-
ciency for the fighting forces and in a material reduction in the sick
rate for troops of the 5th Division. Men who reported at the dressing
station for medical attention were told to first get a square meal and
to tell their troubles later. INIost of them, after being fed, returned
to active duty on the front line.
y^ orh of cleanng the field. — On the afternoon of each day during
the period of activity a search of the field was made in order to
make sure that no wounded were left over night without medical
attention. Searching parties also continued work throughout the
night until the field was reported cleared.
On the morning of September IT, 1918, after a night engagement,
the field was reported cleared at 8.30 o'clock. Our sanitary units,
however, remained at Metz bridge and assisted units of the 78th
Division in the evacuation of wounded from adjacent territory and
in the establishment of dressing stations, until their services were
no longer required. This work continued until noon of September
18, 1918.
In operation of our ambulances over the advanced ground of the
battle field, valuable information was obtained from road maps taken
from German officers. These maps showed roads which had been
improved by the Germans prior to this engagement over which am-
bulance transportation was easy.
Throughout the entire engagement the Medical Department per-
sonnel rendered excellent service. Their work was carried on con-
tinuously without reference to fatigue or danger.
Infoivnation and liaison. — At various times throughout the period
of activity this division was visited by medical officers from the of-
fices of the Army and corps surgeons, who were sent to coordinate
the service of the various divisions in the corps and to find out what
additional service could be given to the division by the Army corps.
These officers rendered material assistance by suggestions regarding
methods for care of wounded and evacuation, and by information
regarding the activities of adjacent organizations.
1562 REPORT OF THE SUEGEON GENERAL OF THE ARMY.
It is believed that in the future the work of the Medical Depart-
ment may be facilitated by closer liaison between the Medical De-
l^artment organizations of this division and the division or divisions
operating upon either side of us. To accomplish this a detail of two
liaison medical officers for the division is reconunended. It should be
the duty of these officers to keep the adjacent divisions informed re-
garding locations of our dressing stations and routes of evacuation,
and to keep this division informed regarding locations of dressing
stations and hospitals of other divisions. It sometimes happens that
first aid may advantageously be given to the wounded of a nearby di-
vision at one of our dressing stations. This was the case of our dress-
ing station which was located at Bois de Saulx. Liaison officers may
also conve}' to adjacent organizations information regarding routes
of evacuation as shown by captured maps and interrogation of
wounded prisoner personnel. It is also possible to make use of cap-
tured medical supplies to supply shortage for all medical units oper-
ating in the vicinity.
Division headquarters moved from Martincourt on September 18,
1918. and established at Domevre-en-Haye on the same date. The 6th
and 11th Eegiments of Infantry were brought back from front line
duty, and billeted in the area about Domevre-en-Haye. Water condi-
tions Avhile in this area were nonportable, although it was noticeable
from the many cases of diarrhea reported that recourse was seldom
made to the Lyster bag.
On September 28, 1918, the 5th Division, less the 5th Artillery Bri-
gade, 13th Machine Gun Battalion, and Companies A and B of the
60th Infantry, left the Domevre area, and established division head-
quarters at Pagn3''-sur-Meuse on the same date.
Division headquarters moved from Domevre-en-Haye to Pagny-
sur-Meuse on September 28, 1918, in which area the troops were given
a brief period of rest. The 5th Division passed into the Third Army
Corps, American Expeditionary^ Forces, on October 5, 1918, on which
date also division headquarters moved from Pagny-sur-Meuse and
established at Blercourt. Evacuation was maintained through Field
Hospital No. 29, located at Troussey. and Field Hospital No. 30,
located at Souhesme, the latter preceding the division into the area
and opening on October 4. 1918, for the receipt of sick and injured of
the command. Headquarters 5th Sanitary Train moved from Trous-
sey to Souhesme on October 6, 1918.
OPERATIONS OF THE ARGONNE, NORTH OF VERDUN AND EAST OF THE MEUSE RIVER.
Prior to the anticipated action prompt connection was entered into
with the various elements affecting the medical department of the
division. Liaison was immediately established by the division surgeon
with the Army and corps surgeons; daily consultations held, and
much valuable information pertaining to the medical situation at
hand was gained from these sources. Also, repeated conferences
were held among the medical officers of the division, plans being laid
out for the performance and coordination of their various duties.
The scheme of evacuation was as follows :
The various regiments of the division lay in reserve behind the
lines until October 12, 1918. During this period energetic efforts
were made to see that the troops were properly protected from the
'A. E. F. DIVISIONS. 1563
impending weather elements as regards new and warm clothing. In
this connection line officers responded actively in an effort to enable
their men to be furnished with woolen underwear, at least two
blankets and an overcoat. The activities of the supplj^ department
were emphasized in the procuring of these necessarj^ adjuncts to the
maintenance of good health. Therefore the men entered the strenu-
ous campaign safeguarded against exposure which otherwise would
have existed.
On October 12, 1918, the division surgeon moved forward to the
advanced post of command, located at Fayel Ferme, from which point
he continued to direct the activities of the medical department of the
division, and, at the same time, act in an advisory capacity to the
commanding general in matters pertaining to evacuation, etc. The
rear achelon of the division headquarters moved from Blercourt to
Fromerville on October 12, 1918. In order to be in closer touch with
the regiments and to facilitate evacuation problems, headquarters 5th
Sanitary Train moved from Soubesme to Bethincourt on October 13,^
1918.
Meanwhile, the line regiments had moved into position, and regi-
mental and battalion infirmaries were promptly established at suit-
able points along the lines. For the first few days the troops were
held in support positions, no attempt being made to advance, and, as
a result, the casualties reported were very light.
The first phase of the battle developed on October 12, 1918. It
continued until October 23, 1918, at which time the regiments were
drawn back from the firing line for the purpose of filling the de-
pleted ranks with replacements. During this interim, all divisional
field hospitals were closed, opening up again on October 27, 1918.
Evacuation was maintained through the triage hospitals of the 4th
and 90th Divisions, American Expeditionary Forces.
The second phase of the battle opened on October 27, 1918. and
from that time on until the signing of the armistice, on November 11,
1918, the troops made a steady advance forward. At all times during
the extensive advance made the medical department personnel of the
division kept in close contact with the advancing troops, necessitating
frequent changes in the location of the triage hospital and the other
field hospitals of the 5th Sanitary Train. A complete summary of
the various movements made during this period may be obtained bj'"
reference to the table of opening and closing of field hospitals, with
dates, which follows at a later period in this history.
It is a noteworthy fact that, during active operations, the ambu-
lance service of the division did valiant service ; always working well
toward the front; establishing ambulance dressing stations and
rendering valuable assistance to the regimental medical department
personnel in the littering of wounded. The advance of the troops
east of the Meuse Kiver was exceptionally rapid, and it was with
difficulty that liaison between the director of ambulance companies
and the various ambulance dressing stations was maintained.
The conditions under which evacuation was carried out were
very unfavorable. The site selected for the triage hospital at Bethin-
court, although situated at the most favorable point in the locality,
was very liilly and thoroughly shell pitted. The roads especially
proved a severe handicap to prompt evacuation; constant rain and
shell holes making ambulance driving a precarious task.
1564 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
At Bethincourt. while the medical detachments were stationed in
that vicinity, frequent bombing raids were carried out at night by
enemy avions. Upon one such occasion a bomb was dropped in the
area adjacent to the triage hospital, where the personnel of Ambu-
lance Company Xo. 30 was bivouacked in shelter tents along the slope
of the hills. A§ a result, seven casualties were inflicted upon the
members of that organization, killing one enlisted man, wounding
seven others: also nine animals belonging to that organization were
Idlled.
Figures of noneffectives for the action, through disease, while
assuming a relatively large numerical proportion, yet in percentage
and duration were quite favorable. In spite of the large number of
replaceinents with which this division was supplied, including many
men who had not been acclimated nor thoroughly accustomed to the
rigorous routine to which they were introduced, together with the
unfavorable climate conditions, the index of noneffectives was main-
tained at a relativeh'^ low figure. Noneffectives for a given period —
the 13th, 14th, 15th, and 16th of October— of battle casualties, were
high. Of these, a large number of the wounded showed a surprising
degree of slight severity. Respiratory diseases were prevalent, but
in order to prevent depletion in ranks through serious illness, prompt
selective measures were employed to eliminate to the hospital only
such cases as tended of a serious nature, the usual character being
that of diarrhea.
Kitchens. — At the field hospital group, during activities, the utiliza-
tion of an additional supply of the ration allowance permitted the
feeding of every patient admitted to the hospital where the ingestion
of food was appropriate. Kitchens were in operation both day and
night, and it was demonstrated that the supply of hot, freshly pre-
pared food was an important factor in enabling many men to return
to the front line who otherwise, through exhaustion, exposure, and
lack of food would of necessity have been evacuated to the rear.
Over 2,600 men were fed at the kitchens established by the am-
bulance dressing stations, together with a portion of a field hospital
personnel which acted as an auxiliary collecting station at Nantillois.
Hot foods, in the nature of soups, chocolate, and coffee, were given to
all who desired them, when the physical condition of the wounded
permitted.
It is interesting to observe the history of gas exposure. In a few
instances in which gas accumulations occurred, there were a large
number of men, who through gas exposure, manifested slight symp-
toms, and were sent to regimental or battalion aid stations. Of these,
many were returned to duty after a few hours; another proportion
of men M^ho reached the field hospital, where through the system in
vogue of careful examination and appropriate treatment, it was
possible to triage those in whom symptoms disappeared and return
them to the firing line. There is included in the table which follows
the exact number of those who were disposed of in that manner. Of
still greater interest and importance, it is noted that of the large num-
ber of men returned to duty in this way, there was in no instance
an individual who was incapacitated or who subsequently developed
symptoms referable to his previous exposure. Following is a classified
list of those returned to duty :
A. E. r. — Divisioxs. 1565
Yperite 215
, Di-phosgene 23
Chloropicrin and yperite or di-phosgene 144
Chloro-arsene 125
Malingerere 137
Total 644
With the gassed casualties, three phases of gas statistics are ob-
served. First, gas fright, or gas malingering, in those who have been
exposed to gas attack. It maj' be stated that this class of gassed cases
has grown j^rogressivelj^ less, and constitutes but a small portion
during this activity. A second class are those who were exposed to
gas, and had slight reaction therefrom. Of this number, praeti ally,
if not entirely, all were returned to duty through the rigid check kept
upon them at the battalion and regimental aid stations.
A comparatively accurate account was kept for the week ending
October 20, 1918, in which there passed through the ambulance
dressing station at Nantillois a little more than 2,100 men for treat-
ment, of which number 833 were returned to duty, from that station.
The total number of gassed cases admitted to the gas hospital from
all sources (5th Division and others) was 2,003, of which G25 showed
slight or no symptoms of gas poisoning by the time they reached the
triage hospital. Many of these (112) were mild chloropicrin in
whom there were no symptoms other than a mild conjunctivitis.
Appliances instituted during the mouth of October, 1918, for the
furtherance of health maintenance were individual clothes dryers
and an improvised sterilizing apparatus. The former appliance was
ver}' little employed owing to lack of availability through the Engi-
neers, who Avere otherwise engaged. Of the latter, use has been made
of the Serbian barrel and an adaptation of an empty cordite can.
The cordite can was particularh^ serviceable by reason of its avail-
ability in front-line areas and the ease with which it may be converted
into a practical and adequate sterilizing plant. A drawing of the
means through which these articles may be used is attached.
Division headquarters moved from Blercoiirt to Fi'omereville on
October 12, 1918 : from Fromereville to Jouy-en-Argonne on October
18, 1918; from Jouv-en-Ar£ronne to Lion-devant-Duu on Xovember
16, 1918.
Upon the date of the signing of the armistice, Xovember 11, 1918,
the various elements of the division were scattered over a wide area
in the vicinity of Dun-sur-Meuse and Lion-devant-Dun. Division
headquarters were established at the latter place on November 16,
1918. Headquarters 5th Sanitary Train were located at Dun-sur-
Meuse, as were the other elements of the Medical Department com-
prising the 5th Sanitary Train, with the exception of Ambulance
Compan}' Xo. 30, located at Milly-devant-Dun.
Xatiirally, with the cessation of hostilities, the work of the Medical
Department assumed an entirely new aspect. By reason of advancing
through reconquered territor}", which the German Army had but
shortly vacated, many new hospitalization problems were encoun-
tered. At Dun-sur-Meuse the hospital work was continued. Medical
attention was given to French civilians and refugees in the vicinity.
While in this area, it may be mentioned, that training and instruc-
tion was resumed among the Medical Department personnel belong-
ing to the 5th Sanitar}'^ Train. A competitive drill was instituted
1566 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
and a review held on Xovember 23, 1918, Field Hospital No. 25
being adjudged the best drilled organization in the train.
Also, while in this area, a strict system of bathing was in progress
for the troops of the division. Utilization was made of such bathing
plants as were available in the newh' acquired territory. In many
instances it was found that the apparatus had become unserviceable
through destruction by the Germans, and the process of bathing and
delousing was. of necessity, slow. Following bathing, a large per-
centage of the command Avas equipped with new underclothing, which
accomplished much toward a desirable condition of cleanliness.
Division headquarters moved from Lion-dcA'ant-Dun to Longuyon
on Xovember 24, 1918.
Division headquarters moved from Longuyon to Hollerich, Luxem-
burg, on December 4, 1918.
Division headquarters moved from Hollerich on December 12, 1918^
staging at Merie, Luxemburg.
Division headquarters moved from Merie, Luxemburg, on De-
cember IT, 1918, to Each-sur-Alzette. Luxemburg.
C. SIXTH DIVISION.
The 6th Division was organized December, 1917, pursuant to letter
from War Department, November 30, 1917.
Division headquarters were established at Camp McClellan. An-
niston, Ala., it being expected at that time that the division would
train and organize at this camp, which was occupied by the 29th
Division, after the dej)arture of that division for overseas duty.
Division headquarters remained at Camp McClellan until March
12, 1918, when it was moved to Camp Forrest, Chickamauga Park, Ga.
May 9, 1918, division headquarters moved to Camp Wadsworth,
Spartanburg, S. C, to the camp formerly occupied by the 27th Di-
vision, which had departed for overseas duty.
Field Hospital 20 and Ambulance Company 20 were organized at
Camp Greenleaf, Fort Oglethorpe, Ga., in August, 1917, and moved
to Camp McClellan, Ala., the latter part of December, 1917, and
joined the division again at Camp Wadsworth. S. C, May 4, 1918
Having been used at Camp Greenleaf as instruction organizations
they were complete as to personnel and well trained upon joining.
Field hospitals and Ambulance Companies 37. 38. and 40. were or-
ganized at Camp Funston, Kans., first part of December. 1917. They
remained skeleton organizations until about the 1st of April, 1918,
when they were filled up by drafted men from Camp Greenleaf, and
at time of joining the division in May, 1918, at Camp Wadsworth,
S. C, about 80 per cent of the personnel had received very little
training. The officers of these field hospitals and ambulance com-
panies from Fort Kiley were junior in rank, none having been pro-
moted to the rank of captain, and commanding officers were assigned
them from the personnel of the division.
The medical detachments of the Infantry regiments were about 35
per cent complete at the time of the organization of the division.
These detachments had been filled up three times by transfer of men
from the line, and each time had been depleted by transfer to the
base hospital at Fort Oglethorpe, Ga., under the direction of the
camp surgeon. About the 1st of April, 1918, they were brought to
A. E. F. DIVISIONS. 1567
full strength by the assignment of drafted men from Camp Green-
leaf, Ga. These men were of very low grade of intelligence and 20 of
them could neither read nor write.
The division departed from Camp Mills, Long Island, N. Y., for
overseas duty on July 7, and division headquarters arrived in France
July 22, 1918. at Harve, France, and after 21 hours rest, departed for
Training Area Xo. 9, about 17 kilometers southeast of Chaumont.
with division headquarters at Chateauvilian. Department of Haute
Marne. Training was immediately taken up under training schedule
issued by general headquarters. Instruction was very intensive, and
carried out under considerable difficulties due to lack of manuals and
necessary equipment. Units were scattered over a wide area, and it
was very difficult to collect the personnel of the various units, ex-
cepting in the sanitary train, for collective instruction. The Medical
Department had no transportation. It received four-mule ambulance
shortly prior to departure from this area, but these could not be
taken along owing to the lack of animals. Evacuation service was
performed by Camp Hospital Xo. 9, and the divisional specialists
were also assigned to this hospital for duty, all of them performing
valuable service. While in this training area the health of the com-
mand was exceptionally good, with the exception of diarrhoea. There
were no prevalent diseases.
August 27, 1918. the 6th Division moved to the Vosges Mountains,
and took over a sector from the 35th Division, division headquarters
being established at Gerardmer. Department of Vosges. This sector
had a front of about 2.5 kilometers, and the terrain was very moun-
tainous. While generally considered a quiet sector, nevertheless,
while occupied by the 6th Division tliere was considerable activity on
both sides, principally trench raids and shelling, with no change in
the military situation.
Evacuation performed in a sector of this character had many dif-
ficulties. All forms of transport were used over the mountainous ter-
rain, and included Sunl)eam motor cycles, with side litters, mule lit-
ters, mule ambulances, G. M. C. ambulances, and Ford ambulances.
Hand carry was in some places long and tedious, and in several places
as many as three or four relays had to be provided, necessitating
sometimes 16 men to transport one wounded before he could be placed
upon mechanical transport. As the division had no ambulances as-
signed there were attached U. S. A. A. S. 524 and Ambulance Com-
pany 162. a total of 32 ambulances. These ambulance- were distrib-
uted pursuant to attached scheme of distribution by the director of
ambulance companies. There was considerable difficulty owing to
the burning out of brake linings of Ford and G. M. C. ambulances
used for evacuation in this particular type of terrain.
English Sunbeam side litters were very valuable, and such a motor
cyle should be adopted in our service for this type of evacuation.
October 8. 1918, the 6th Division was relieved in this sector by the
French, and October 27. 1918. entrained for the Meuse-Argonne
region, where the division arrived October 29, 1918. and was assigned
as reserve division to First Army Corps. The division was assem-
bled in the Argonne Forest south of the road from Les Islettes to
Clermont, with Division Headquarters at Futeau. advanced post of
command at Beauchamp Farm, and sanitary train near Froides.
The third phase of the ^Meuse- Argonne offensive began on November
1568 KEPOET OF THE SURGED jST GENERAL, OF THE ARMY.
1, 1918, and owing to the large number of casualties, U. S. A. A. S.
524 was taken away, leaving the division with 12 G. M. C. ambu-
lances. Eight Avere assigned to the organizations who evacuated
their own j)atients to evacuation hospitals in the vicinity. The sani-
taiy train was without transportatioji with the exception of six mule
ambulances, without animals, and two motor trucks for their own sup-
i^lies. It was anticipated that the division would relieve one of the
front-line divisions at any time and go into action, and the division
moved forward November 5 in the rear of the 42d and S2d Divisions.
Owing to the lack of animals it was very difficult to supply the
diA ision and move it forAvard. It was necessary for the limited num-
ber of motor trucks assigned to also function as field trains with
organizations, the trucks became scattered and lost, and the troops in
moving forward had to drag macliine guns and other shell transport
by hand, but in spite of these difficulties they kept up with the other
troops and on November 7 arrived wdthin 10 kilometers of Sedan,
Avhen the jjursuit of the retreating Germans Avas given up and the
division fell back from Stonne to Grandpre, from Avhich latter place
it Av as ordered to Verdun on XoAcmber 2, 1918. During this terrific
hard march some of the troops Avere compelled to do individual cook-
ing and many did not have a hot meal for five days. Much company
proj^erty Avas left behind, including Lyster bags, and diarrhea
throughout the division Avas quite prevalent, one regiment having at
the time it reached Verdun over 600 cases.
The sanitary train, Avhile the division was in the Meuse-Argomie
offensive, was moved from its first camp near Froides to the site of
a former German hospital, about 2 kilometers north of Apremont,
Avhere it was immobilized until the division was withdrawn. One
field hospital functioned taking care of a number of diAasional sick
and from other divisions also. One dressing station was established
at the farthest point north reached by the 6th Division at Stonne,
Avhere a number of refugees and wounded from other divisions Avere
cared for.
November 12, 1918, the division was moved from the Argonne
region to Verdun and headquarters were established in Verdun. At
Verdun Field Hospital 37 Avas established at the Caserne Bevaux and
functioned as field hospital. While at Verdun the division surgeon
was notified by the French authorities of the jjresence of about 30
Avounded American prisoners of Avar who had been deserted by the
retreating Germans at Pierrepont, about 50 kilometers north of Ver-
dun. Medical officers and ambulances of the 6th DiA^ision were sent
to this place and these cases were taken care of and evacuated to
hospitals.
November 21, 1918, the division left Verdun for Training Area No.
14, in the Department of Cote d'Or, about midAvay betAveen the cities
of Dijon and Chatillon-sur-Seine. The troops marched to this area,
and by the first week of December the division had occupied the 14th
Training Area. DiAdsion headquarters, including the division sur-
geon's office, moA'ed bj'^ trucks to Chancenay, near St. Dizier, where
it was located for nine days in order to maintain liaison Avith the
marching troops, and then moved bj^ trucks to Aignay-le-Duc, Cote
d'Or, where division headquarters were established December 1, 1918.
December 8, 1918, all troops of the division, with the exception of
the divisional Artillery, had reached the 14th Training Area. Abort
A. E. F. — DIVISIONS. 1569
the middle of December, the divisional Artillery, the 6th Field Artil-
lery Brigade, joined the division for the first time.
Because of the poor shape of the English marching shoes with
which this division was furnished before leaving Verdun, there were
many cases of acute foot strain, abrasions and blistering of feet of
troops upon this march. The weather was very inclement, almost
continual rain, and the incidence of acute respiratory conditions was
rather high.
Immediately upon arrival m this area an ambulance route was es-
tablished and ambulances called twice daih^ at all stations for the
evacuation of sick and injured to Camp Hospital 48 at Recey-sur-
Ource, Camp Hospital 48 giving very efficient medical attention to
the division.
The divisional specialists were established for convenience and to
obtain their highest efficiency at Camp Hospital 48. The mobile
field laboratory was also established at Camp Hospital 48, and did
valuable and efficient work in the isolation, discovery and examina-
tion of meningitis and typhoid and paratyphoid carriers, besides
rendering valuable service to the hospital in regard to blood, sputum,
urine, and other body fluid examinations.
D. SEVENTH DB^ISION.
On October 9. 1918, the 7th Division moved up to the front, on the
Toul sector, taking over the area extending from Pont-a-]Mousson to
Vieville, known as the Puvenelle sector, relieving the 90th Division,
who had held this line approximately four weeks, i. e., since the
closing in of the St. Mihiel salient, September 12 to September 14,
1918. This line was about two weeks later extended to include
Jaulny. In effecting the relief of the medical department of the 90th
Division in this sector, which was done under the cover of darkness,
all Medical Department establishments; battalion aid, regimental
aid, ambulance dressing, triage, field hospital, and ambulance com-
pany stations formerly operated by this division, were taken over by
the medical department of the 7th Division, this in compliance with
orders issued from headquarters Fourth Army Corps.
The division surgeon, 7th Division, ac ompanied by the command-
ing officer. 7th Sanitary Train, had inspected the location of these
sanitary units prior to the transfer being effected.
The change of location in triage was made October 17, 1918, on
account of the shelling of the town of Griscourt by German artillerj-.
The change was made to Martincourt, about 8 kilometers west of
Griscourt. The location at ^Nlartincourt was on a better road, with
better protection from shell fire, and more centrally located as an
evacuating point from the front.
On November 10, 1918, a triage, with equipment (the personnel
taken from the animal-drawn Ambulan e Company No. 22), was
organized at Thiar ourt. This was the location designated for the
triage in event of the continuing of hostilities.
The animal-di'awn ambulance company was of very little use dur-
ing these operations. As road conditions were good, and the artil-
lery was easily ar-( es'^ible. the motor ambulances evacuated directly
from the battalion aid stations.
1570 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
This ainbiilrtiice company was held in reserve, but on different oc-
casions portions of its personnel were used to assist in those organiza-
tions temporarih' congested with sick and wounded ; its escort wagons
were used to carry fuel and occasionall}' rations to the different am-
bulance companies and field hospitals; and during the middle por-
tion of October its ambulances evacuated patients to the triage, first
at Griscourt and later at Martincourt. The detail work performed
by the animal-drawn ambulance company relieved the motor-drawn
ambulance companies of having to perform this duty and thus as-
sisted materially in the prompt removal of the wounded.
Truck, motor-car, and motor-cycle transportation was the most
■difficult problem confronting the Medical Department during these
operations. We were without all of these most of the time. At no
time during operations did we have more than one truck, one motor
car. and one motor cycle.
The 7th Division had only one-fifth of the motor transport au-
thorized by the tables of organization. This transportation was
pooled. The Medical Department was in the face of the enemy, im-
mobilized. The functioning value of the personnel was lowered 25
to 50 per cent on account of lack ©f motor transport. Many requests
were made without avail.
The ambulances (G. M. C.) gave excellent service in spite of the
man}' difficulties of driving them over muddy and slippery roads at
night, without chains and with no liglits.
To the intelligence, faithfulness, and fearlessness of the drivers of
these ambulances is the largest measure of success in the prompt
evacuation of wounded accredited.
The use of the triage was of distinct value in this division, and its
continuation as a sorting station is urged. In addition to affording a
station for separating of sick and wounded into classes for evacua-
tion purposes, the readjustment of splints, hurriedly applied; the
treatment of shocked, administration of food and stimulants, all add
to justify the necessity of the triage.
On November 10 the troops of this division were ordered to attack
the enemy with the view to advancing our lines farther forward.
Corps orders (Fourth Army Corps) designated Thiacourt as the loca-
tion of 7th Division triage. Thiaucourt was under constant shell fire
of the enemy. It was manifestly inadvisable to establish the triage
at Thiaucourt. It is therefore recommended that the designation
of location of triage be designated in cliAnsion orders instead of
orders of the corps.
Although this division was hurriedly assembled and had very little
divisional training (five weeks in 15th training area) the personnel
of the 7th Sanitary Train, by reason of their excellent previous train-
ing at Camp Greenleaf, Ga., where the train was assembled, was a
highly efficient organization and did excellent work.
Field Hospital Xo. 36 was designated by divisional orders to care
for nontransportable wounded. It took its position in the zone of
advance on October 10, 1918. During the first two weeks of its ex-
istence in this area the hospital cared for certain medical cases for
special reasons. The main consideration of this resort will be, how-
ever, with the strictly surgical cases.
The hospital was located at the crossroads of St. Jacques in the
Toul sector — the roads crossing at this point being the recent road
A. E. F. — DIVISIONS. 1571
cut through the Limey, and the road from Xoviant connecting- with
the Metz highway. It "was thus about 15 to 20 kilometers from the
battalion aid station and 18 to 25 kilometers from the evacuation and
base hospitals of the Toul group. The roads leading to the hospital
were uniformly rough and muddy; those leading to the rear were
in somewhat better condition. It was about 5 kilometers from the
divisional Triage at Martincourt, through which most of the cases
passed during the first days of its functioning, but later on an
arrangement was made to have cases sent directly from the collecting
stations to this hospital.
Tyye of cases. — The subjoined tabulated schedule indicates in gen-
eral the type of cases received. A word must be added, however, to
complete the picture. These cases were uniformly shocked — suffering
from exposure, cold, nervous exhaustion, and, for the most part,
showing phenomenon associated with more or less severe hemorrhage.
Having passed through the hands of medical officers at three stations
before reaching this organization, many of those who came at first
suffered from excessive manipulations and examinations not always
made under the best circumstances. Tliey had uniformly received
morphine, first-aid treatment (which included splints for fractured
cases), and many received hot fluids.
Administration. — Cases were brought from the ambulance to the
office and admitting room, where there was always a medical officer,
a noncommissioned officer, and a clerk on duty. Here the data were
taken and clinical record card begun : making note, beside the usual
information required, of the time of the injury, type of missile and
time of arrival at the hospital. The cases were divided into three
types, the acutely shocked, moderately shocked and slightly wounded.
The acutely shocked cases were sent to the ward set apart for these
particular clinical entities, antishock treatment immediately insti-
tuted b}^ the specially trained " shock team." This treatment was
that advised by the central medical laboratory- at Dijon and con-
sisted, in brief, of the application of warmth externally by means of
hot water bottles and hot blankets, hot drinks and the free exhibition
of morphine and the introduction of giun salt solution by vein.
(There were no donors for blood transfusion available at any time.)
The shock team consisted of a medical officer, noncommissioned
officer and two nurses and no case was operated from this ward until
the surgeon and the shock officer deemed it advisable. About 75 per
cent of the cases received passed through this ward and required
active antishock treatment, and it is the opinion of all officers who
observed them that this treatment was essential and that without
it the mortality would have certainly been doubled. The cases that
were moderately shocked and the post-operative cases were sent to
the first surgical ward where they received appropriate treatment.
From here they were transferred to the second surgical ward from
24 to 36 hours after operation, to await transportation to the rear.
Cases were evacuated from the hospital to evacuation and base hos-
pitals— to the former when it was believed that the prolonged
journey would not be advisable. All cases were dressed before trans-
ferred, splints adjusted, final notes made on their cards, and their
preparation for the journey supervised by the surgeon under whose
charge they had been. Considerations of transportation required
142367— 19— VOL 2 38
1572 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
that, except in emergency, cases were held until an ambulance load
was ready, but, as a rule, patients were evacuated from 24 to 48
hours after operation, except those with chest and abdominal wounds.
The operating pavilion consisted of two operating rooms separated
by a sterilizing and supply room, and an X-ra}" room at one end.
These rooms all intercommunicated and had doors on a common
porch beside ; thus a case could be carried direct from the X-ray
I'oom to either operating rooms without exposure to the elements.
The following assignments of personnel were made : Two operat-
ing teams each consisting of surgeon, commission assistant, anes-
thetist, one enlisted assistant in charge of sterilizing; shock team, as
outlined above; a noncommissioned officer charged with general super-
vision of the maintenance of surgical supplies and their issuance to
operating rooms and to the wards. He also acted as pharmacist; a
noncommissioned officer in charge of the activities of the wards and
their administration ; the admitting and office personnel as enumerated
above. Each ward had a noncommissioned officer, ward master
and three assistants. A litter squad of four men were on duty at all
times and remained in the vicinity of the ambulance stop ; this squad
was under the supervision of a noncommissioned officer; usual guard
detail, kitchen detail, and sanitary squads were maintained. All de-
tails and teams worked in reliefs. The patients were fed from the
company kitchen, but a supply of bouillon cubes, coffee and cocoa
were kept in the wards and hot drinks could be served at short
notice.
CONCLUSIONS AND RECOMilENDATIONS.
1. The necessity for existence of this type of hospital in the zone
of advance had alreadj^ been established. There are certain considera-
tions in the establishment of such a unit which should be kept in
mind. A point in the location of such a hospital, perhaps not im-
mediately obvious, is the type of roads leading to and from it. It
should be readily accessible from the front, and, if possible, the roads
leading to it should be in good condition, as many of the patients com-
plained bitterly of the suffering upon transportation over the rough
roads.
2. Personnel. — At least two capable surgeons are necessar}^ to the
proper functioning of such an organization and at least one medical
officer with experience in the recognition and treatment of surgical
shock. During the period of rush there should be at least three com-
plete operating teams and two shock teams available, so as to have the
nest work without overworking this group. The necessity for train-
ing these teams together can not be overemphasized. It is absolutely
essential that they be kept intact and that they work and rest as units.
3. Material. — The hospital could not have carried out its work
without the addition of the " Groupe Complimentaire Demi-fixe."
The sterilizers alone were essential, and the additional instruments
provided permitted cases to be operated, one after another, without
any waits l)etween as would have been necessary had these instru-
ments and sterilizers not been available. The presence of an X-ray
apparatus was of the greatest assistance.
4. Type of cases smtahle for the hospital. — The following cases
almost inevitably develop shock and should not be exposed to the
prolonged transportation necessary to get them to the rear: Head
wounds, except superficial; compound fracture of the extremities;
A. E. F. DmSIONS. 1573
sucking chest wounds : perforating wounds of the trunk ; cases requir-
ing tourniquet to be left in place and those who have had severe
hemorrhage: other cases of major injuries if of prolonged duration;
other cases showing shock. If these cases are to be saved the majority
require early antishock treatment and early operation. An average
of all cases admitted shows an elapse of time of 8 hours 16 minutes
from the moment of the injury until admitted to the hospital; 20
hours the longest and 10 minutes the shortest periods. Of the cases
that died following operation the average duration was 9 hours. In
brief, cases received more than G hours after the injury were invari-
ably in poor condition and did not offer as good risk as those received
in shorter time.
Report of Triage operations, 7th Sanitary Train. — Locations occu-
pied and hospitals to which evacuated : This report covers operations
in the Puvenelle sector, October 10. 1918. to Xovember 11. 1918. In
the first week of October the Ttli Division moved forward from billets
in the vicinity of Toul. Orders were received to relieve the 90th Di-
vision in the Puvenelle sector in the period of October 8 to 10. Field
Hospital No. 34, 7th Sanitary Train, was designated to operate the
triage, and on October 9 proceeded to Griscourt and took over triage
operations in this sector from Field Hospital Xo. 357, 315th Sanitary
Train. 90th Division, at noon, on October 10. 1918. On October 18
Field Hospital Xo. 31 was moved to Martincourt. 5 kilometers west,
and continued to operate the triage at this point until Xovemljer 11.
On the night of Xovember 10 there was formed at Thiaucoiu't a tem-
porary organization for the purpose of operating a triage. Patients
were received there on the following day. Thiaucourt had been desig-
nated for the location of the triage in the event of the continuation
of hostilities. During the period of operations covered by this report
patients were evacuated to the following hospitals :
Slightly gassed, Field Hospital No. 35, 7th Sanitary Train. Rogeville.
Severely gassed, base hospitals of Toul, Justice group. Toul.
Slight medical. Field Hospital No. 22. 7th Sanitary Train, Rogeville
(later at Monorville),
Tran.sportable wounded. Evacuation Hospital No. 1, Sebastopol ; Evacua-
tion Hospital No. 12, Koyaumeix ; Jlobile Unit No. 3, Quatre- Vents.
Nontransportable wounded. Field Hospital No. 36, 7th Sanitary Train.
St. .Jacques.
Scabies and pediculosis, to divisional bathing and delousing unit. Gris-
court (later at St. Jean).
At Griscourt a group of Adrian barracks was occupied. The
triage was operated in one. another was used as quarters for personnel,
and a third was utilized by the division urologist as a ward. At Mar-
tincourt the triage was located in a 9-room •2-story house. At Thiau-
court, in a 12-room 2-story residence.
Organization and personnel. — The triage operated at Griscourt
Octol^er 10 to 17 and at Martincourt October IS to Xovember 11 by
Field Hospital Xo. 31 had a strength of 1 officers and approximately
55 enlisted men. The remaining portion of enlisted personnel of
Field Hospital Xo. 31 was divided between Field Hospital Xo. 22
and Divisional Degassing Unit Xo. 1. The division orthopedist was
also stationed at the triage. The organization formed at Thiau-
court on Xovember 10 had a personnel of 5 officers and 60 enlisted
ftien. The officers being drawn from Field Hospitals Xo. 22 (2) and
No. 34 (1) and Ambulance Company Xo. 22 (2). The enlisted force
1574 REPORT OF THE SURGEON GENERAL OF THE ARMY.
from Field Hospitals No. 34 (20) and Ambidance Company No. 22
(40). Officers were assigned to duty as follows: One major, eom-
manding: one junior officer with special shock training was placed
in charge of shock cases. Another, AAdio had received special instruc-
tion on gas was given the care of gassed cases. The third junior officer
was designated as triage orthopedist, under supervision of the division
orthopedist. The entisted force of 55 was organized as follows:
Seven noncommissioned officers, 22 litter bearers, 10 orderlies, 8
clerks, 8 cooks and kitchen police. There was a noncommissioned
officer on duty in the dressing room day and night. Two others were
detailed to the shock rooms, and one was required for the day shift of
litter bearers, another for the night shift. Orderlies were divided
equally between the receiving and forwarding room, dressing room,
shock rooms, and officer. Six clerks were assigned to the receiving
and forwarding room, working in two shifts of three each. The other
two were assigned to the office.
General management. — In the receiving room, hot drinks, tea,
coffee, or cocoa, were kept on hand and served to all patients imme-
diately upon arrival (except abdominal cases). The patient was then
examined by a medical officer, and the field medical card made out.
Wounded, whose dressings or splints required no readjustment, whose
general condition was good, and who had received A. T. S. were
evacuated without delay. Those whose wounds required attention
were taken to the dressing room where splints were applied or read-
justed, wounds dressed and morphine administered when indicated.
The equipment of this room consisted of one chest, sterilizer, two
chests, medical and surgical, the usual assortment of splints prepared
for immediate application. The splints chiefly used were the Thornas
half-ring leg, Thomas hinged arm, wire ladder, and Cabot posterior
leg with wood coaptation splints, A. T. S. was available for adminis-
tration in this room. Patients in a state of shock were taken immedi-
ately to the shock room, where a number of shock tables, heated by
Primus stoves, were kept prepared. Gum" salt solution was kept
ready for immediate use. In handling gassed cases most of these
had been undressed and given an alkaline bath at ambulance company
dressing station, or Divisional Degassing Unit No. 1. These patients
required little or no treatment at the triage. Gassed patients reaching
the triage with gassed clothing were undressed and bathed. Bicar-
bonate solution for conjunctly al lavage and administration by mouth
was kept in the receiving room. All gassed cases were evacuated re-
cumbent. These were masked before being evacuated. All medical
cases were examined, the temperature taken, and fevers above 100° F.
were placed on litters.
Character of cases handled. — This report covers a period of 32
days, during which time there passed through the triage 3,077
patients, excluding cases sent to the division urologist, ^yhich were
handled as on a duty status and not taken up. Of the above num-
ber there were 738 wounded, 878 gassed, and 1,461 medical cases.
Numbers given under each group are more or less approximate, for
the reason that some patients were both wounded and gassed and are
classed as wounded if evacuated to a surgical hospital and as gassed
if evacuated to a gas hospital, which was done in the case of some
gassed patients suffering from slight wounds. Among the medical
cases are some in which gas was a probable etiologic factor.
A. E. F. — DIVISION'S. 1575
Gassed cases. — Nearl}'' GO per cent of these were received in the
first 10 days. The report for October 13, the hirgest for anj' 2J:-hour
l^eriod, shows 344 admissions, of which number 223 were gassed.
In the first few days the eye and skin symptoms of mustard gas
poisoning predominated among gassed cases at the time of passing
through the triage. Later, particularly in the last 10 days of action,
the symptoms of gassed cases were quite varied, and lachrymatory
and asphyxiant effects were common, in addition to conjunctival
irritation and skin burns.
Wou/ided. — The report for November 2 shows the largest number
of wounded for any 24-hour period, there being 126 in a total of 199
admissions. About 60 per cent of wounds were due to shell fire,
multiple wounds of the extremities predominating.
Medical. — For the first two weeks influenza was the chief cause
of admissions among medical cases. By November 1 the number of
admissions from this cause had greatly decreased, and continued to
decline gradually from that time.
Work done at triage. — The work of the triage was chiefly devoted
to the handling of the wounded. In handling these cases, abdominal
wounds, sucking chest wounds, head wounds, and tourniquet cases
were regarded as nontransportable. These were evacuated to the
hospital for nontransportable wounded (Field Hospital No. 36 at
St. Jacques), approximately 2^ kilometers northwest of Martincourt.
Of the transportable wounded the majority were evacuated to
Evacuation Hospital No. 1, Sebastopol, about 15 kilometers south of
Martincourt, and Evacuation Hospital No. 12 at Royaumeix, 10
kilometers southwest of Martincourt. In handling wounded at the
triage it was found that a certain percentage of admissions in a state
of moderate shock was to be expected, due to exposure on the field
after being wounded and the rather long ambulance carr}'. Litter
beds were in general well prepared, three blankets or more being
the rule. The number of patients received at the triage in severe
shock was small. The dressing of wounds was in general well ac-
complished at the battalion aid and ambulance company' dressing
stations. Tlie Thomas leg splint was used in practically every case
in Avhich it was applicable. About 25 per cent of dressings and
sj)lints were readjusted at the triage. Very few patients reached u?
without having received A. T. S. Cases received in moderate shock
responded well to treatment on the shock table. The immediate
removal of wet shoes and socks was a routine procedure in these
cases.
Mortality. — There were 6 deaths at the triage. Three of thesa
patients were suffering from compound fracture, 1 had an abdominal
wound and 2 had head wounds. All were admitted in severe shock.
There were no deaths of patients en route from the triage to hos-
pitals.
SuniTnanj. — In operations covering period of 32 days there passed
through the triage an average of 100 patients per day. A con-
siderably larger number might have been effectively handled and was
constantly anticipated. Difficulties encountered were few and the
principal one being that of admitting and evacuating patient*
through a single window of the building occupied at Martincouit
1576 REPORT OF THE SURGEON GENERAL OF THE AR.^rY.
A small imiiiber of cases received gum salt solution. Xo blood pres-
sure apparatus was available and no conclusions as to its value
are attempted.
E. TWENTY-SIXTH DIVISION.
On August 13, 1917, the 2()tli Division was conceived by telegraphic
authority of the War Department and on August 2'2, 1917, the di-
vision was born by the merging together of units and detachments of
the National Guard of Xew England as follows :
26th Divisiou Headquarters Troop — ^[ade up of Troop B, Massachusetts
Cavalry.
101st United States Infantry Regiment — 9th Massacliusetts Infantry ; large
detachment of 5th Massachusetts Infantry ; small detachment 6th Massachu-
setts Infantry.
102d United States Infantry Regiment— 2d Connecticut Infantry; detach-
ments 1st Connecticut Infantry ; 6th Massachusetts Infantry ; 1st Vermont In-
fantry.
103d United States Infantry Regiment — 2d Maine Infantry ; detachments
1st New Hampshire Infantry ; 8th Massachusetts Infantry.
104th United States Infantry Regiment — 2d Massachusetts Infantry ; de-
tachment 1st ;Massachusetts Infantry and 8th Massachusetts Infantry.
101st Field Artillery Regiment. — 1st Massachusetts Field Artillery; detach-
ment New England Coast Artillery.
102(1 United States Field Artillery Regiment — 2d Massachusetts Field Artil-
lery detachment New England Coast Artillery.
i03d United States Field Artillery Regiment.— Battery A, New Hampshire
Field Artillery; 3 batteries Rhode Island Field Artillery; 2 batteries Connecti-
cut Field Artillery ; Troop M, Rhode Island Cavalry ; detachment New England
Coast Artillery.
101st ^Machine Gun Battalion — Squadron Connecticut Cavalry ; detachment
1st Vermont Infantry.
102d Machine Gun Battalion — Companies A, D, E, Massachusetts Cavalry;
detachment 1st Vermon Infantry.
103d jNiachine Gun Battalion — Squadron Rhode Island Cavalry, less Troops
B and M ; New Hampshire Machine Gun Troop ; detachment 1st Vermont
Infantry.
101st Trench Mortar Battery — Detachment 1st Maine Heavy Field Artillery.
101st United States Engineer Regiment — 1st Massachusetts Engineers; de-
tachments 1st IMaine Heavy Field Artillery ; and New England Coast Artillery.
101st Field Signal Battalion — 1st :\Iassacluisetts Field Signal Battalion.
101st Train Headquarters and Militaiy Police — Detachment 6th Massachu-
setts Infanti-y.
101st Ammimition Train — Detachment 1st Vermont Infantry; Massachusetts
Coast Artillery.
101st Engineer Train^ — Detachment 6th JIas.sachusetts Infantry.
101st Sanitary Train — 1st and 2d Massachusetts Ambulance Companies; 1st
Connecticut Ambulance Company; 1st Rhode Island Ambulance Company; 1st
and 2d Massachusetts Field Hospital Companies; 1st Connecticut Field Hos-
pital ; 1st New Hampshire Field Hospital.
101st Supply Train — Troop B, Rhode Island Cavalry ; detachments 6tb
^Massachusetts Infantry ; and Sth Massachusetts Infantry.
Its headquarters were at Boston while its various units were as-
sembled, if not already there, at Boston, Framingham. and West-
field, ]Mass. ; at Xew Haven and Xiantic. Conn., and at Quanset Point,
E, I. There were enough and manj^ to spare, and the remainder, bit-
ter and disappointed at not being included, were later resorted. Many
of them have since seen service in France, their hopes fulfilled. Some
never had the opportunity. The transition, the breaking up of old
organizations, some with a continuous service record of over a him-
dred years, was felt with much bitterness and sadness. Cavalry
A. E. F. DIVISIONS. 1577
became machine gunners. Infantry became Engineers, ammunition
and supply train troops, military police, etc. The divisional organ-
ization required certain elements. The birth was. as usual, painful,
but highly successful as later events shall amply testifA\
The Medical Department suffered less in this respect than any
other branch. Regimental and battalion medical personnel were in
general divided among their own organizations, but the sanitary
train suffered no disturbance except in name, when on August 20 —
The 1st Massachusetts Ambulance Company, Boston, became the 1st Ambu-
lance Company, 26th Division.
The 2cl Massachusetts Ambulance Company, Boston, became the 2d Ambu-
lance Company, 26th Divisioi.
The 1st Connecticut Ambulance Company. Bridgeport, became the 3d Ambu-
lance Company, 26th Di\ision.
The 1st Rhode Island Ambulance Company, Providence, became the 4th Am-
bulance Company, 26th Division.
The 1st Massachusetts Field Hospital Company, Boston, became the 1st Field
Hospital Company, 26th Division.
The 2d Mas.sacluisetts Field Hospital Company, Boston, became the 2d Field
Hospital Company, 26th Di^^sion.
The 1st Connecticut Field Hospital Company, New Haven, became the 3d
Field Hospital Company, 26th Division.
The 1st New Hampshire Field Hospital Company, Manchester, became the
4th Field Hospital Company, 26th Division.
It was learning to walk and almost its first steps were to Europe,
for on August 20, 1917, were called to division headquarters members
of the advance party, which on August 21, 1917, left with great
secrecy for New York, sailing the next daj' on the S. S. Panonia for
Liverpool.
Training became most intensive, officers and men returned to their
commands from the Medical Officers' Training School, Oglethorpe,
(Jra., and, doubly pleased that it was the best prepared of any division
in America, and that but one, the 1st Division, had preceded it, the
26th DiAision. by sections and over different routes, beginning August
24, 1917. departed for Europe.
All ships crossed in convoys of approximately 10 to 20 vessels.
The convoy's were formed in or iiear Halifax Harbor and were con-
voyed by one or more cruisers. Xecessarily regulating their speed
on that of the slowest ship of the convo}^ and zigzagging their way
much of the time, consequently the voyage was slow. The first war
scenes appeared at Halifax, wounded soldiers, fresh Canadian troops,
shiploads of Chinamen, destined for service in France, Belgian re-
lief ships, ships of war, and Army and Navy stores.
The Xeufchateay training area was their objective, an area com-
posed of about 100 square miles, where, after a train trip of from 36
to 48 hours, arriving from Septemlier 20 to October 31. they de-
trained. They were then introduced to the billeting system and the
Adrain barracks to mud, exposure, and hardship. Their first winter
here can well be likened to Valley Forge. Here, as the advance party
of a great American Army, they established hospitals, built roads,
made their own lines of communication, the beginnings of the Serv-
ices of Su]iph% lived from hand to mouth, shirt to shirt, and shoe to
shoe. In those days salvage was unheard of. and when in rare mo-
ments an article could be replaced the old one was certainly "■' finis."
It was a cold, wet winter. Lack of sufficient clo.thing. sufficient heat-
ing, or drying facilities necessitated men staying wet day after day,
1578 REPORT OF THE SURGEON GENERAL OF THE ARMY.
caused dire predictions of a hiofh sick rate, which fortunately and sur-
prisingly did not come, with the exception of a moderate amount of
influenza, pneumonia, bronchitis, cerebrospinal meningitis, scarlet
fever, diphtheria, mumps, and measles, all of which were well cared
for. The 101st Engineers suffered from cerebrospinal meningitis and
the 103d Infantry persisted in having a large number of so-called
children's diseases.
Trench feet became common, and in spite of massaging with whale
oil. and the persistent efforts of the Medical Department, continued
throughout the entire winter. The second winter we had practically
none, even though in active campaign and exposed even more to the
elements. Why? A decent shoe which could be replaced when worn
out, a sufficiency of woolen socks, and men hardened by campaign.
Sanitation was unknown in these French towns. Manure was
piled high in front of nearly every house. The drainage from these
mixed with the deep mud. All their water supplies, usually shallow
Avells, were polluted. Their latrines were unspeakable. The soil
v\-as infected with every wound-infecting bacteria. The inhabitants
had all the prevailing diseases. Their doctors and their men folks
were either in the Arnw or victims of the war, and thev strenuously
objected at first to American methods of sanitation : but later adopted
to a great extent our example. These hard conditions made, however,
but a fitting task to prepare us for what was to come.
The divisional medical department accomplished wonders. The
line ably seconded their efforts and followed their advice. Lack of
cooperation and lack of effort on the part of both occasionally oc-
curred. They were new to the game. Graduallj^, however, the
manure was removed, the mud disappeared from the streets, water
was chlorinated, proph^dactic stations established, proper latrines
made, kitchens regulated, baths established, in fact the machine
was in motion, with errors, of course, but moving and functioning
well.
The sick received the best attention that our facilities and best
efforts could give them. Battalion infirmaries of 12 beds each were
established in good quarters, generally Aclrain barracks, and were
well equipped and oj^erated. The dentists assigned to regiments,
battalions, and field hospitals began and continued for the entire
( ampaign to do most excellent and needed work, at times even acting
in command of litter bearers in shell-swept fields, or doing first aid in
dressing stations.
Ortliopedic surgery became a most useful specialty in the care of
the wounded as well as in its function in the care of the feet. Splints
and dressings, simple but most efficient, were supplied, their usage
taught, and their usefulness later demonstrated in the minimizing
of pain and promplness of repair of fractures. These splints were
applied quickly where the casualty occurred. A special training bat-
talion for the correction of flat foot, bad posture, and other defects
was organized and abh^ operated with much benefit to its members.
War Department orders again changed the designation of the
Companies of the sanitary train as follows:
The 1st Ambulance Company became the 101st Ambulance Company.
The Sd Ambulance Company became the 102d Ambulance Company.
The 2d Ambulance 'Company became the 103d Ambulance Company.
The 4th Ambulance Company became the 104th Ambulance Company.
A. E. r. — DIVISIONS. 1579
The 1st Field Hospital Company became the 101st Field Hospital Company.
The 3d Field Hospital Company became the 102d Field Hospital Company.
The 2d Field Hospital Company became the 103d Field Hospital Company.
The 4th Field Hospital Company became the 104th Field Hospital Company.
At this time volunteers were called for from the sanitary train to
be used in experimental work to determine the mode of transmission
of trench fever, and associated information by allowing themselves
to be inoculated with trench fever which had become such a scourge
in the British. Practically everj^ man volunteered, and on Janu-
ary, 1918, the detachment selected left the division for this purpose.
The experiment later proved to have been a complete success, its ob-
ject was fulfilled, and most of the detail returned during the last
months of the war.
At first our Division was minutely subdivided among the French
troops, later organizations were given a subsector, and our line medi-
cal units, after living and working with similar French units, later
took over stations of their own. Similarly our sanitary train was
subdivided, our litter bearers with " brancardiers,'' our dressing sta-
tions parties in the triage, and our ambulances over all routes of
evacuation. These units, exposed to fire, soon learned the secret of
cover, of the efl'ects of fire, areas of burst, gas alarms, use of gas
masks, of comfort in trying situations, and their actual practice of
caring for and evacuating wounded, gassed, and sick under those
conditions. Two more lessons were learned and provisions made for
the future, the care and treatment of the gassed, and the delousing of
men.
Thousands were the lessons learned here. Inestimable benefit was
derived. Tliis was one of the strongest and best equipped sectors in
Europe, not only from a military but from a medical point of view.
Its vast limestone caves and quarries were drained, lighted, and ven-
tilated, and complete hospitals were equipped in them, carefully
camouflaged, and close to the front line, carrying on a wonderful
work. Dugouts of all kinds, depending upon exposure and terrain,
were everywhere. Camouflage was highly developed.
The French system of ti-eatment and evacuation of casualties was
working in every detail. Like the sticks of a hidy's fan, from front
lines by brancardier to the various postes des secours on litters and
then by litter and ambulance converging to the triage, where the
spokes of another fan toward tlie rear to:)k them by ambulance to gas
station, ambulance, H. O. E., hospital civile, venereal, psycho-
pathic, skin, contagious, hospital for seriously wounded, slightly
wounded, and sick, then converging again to hospital trains for
evacuation still farther to the rear. Here al-o the medical personnel
were taught their duty in gas-proofing dugouts, neutralization of
gases, and treatment of gas casualties.
The sector became comparatively active, and every phase of trench
warfare was exploited, indivir'ual' units were given their opportuni-
ties in attack and defense, and the division became a useful fighting
force, found itself and its medical department as well, much to the
surprise and delight of the French, who liberally awarded decora-
tions and commendations.
On March 18, 1918, the division was under way again, this time by
train, from Soissons and liraisne to the vicinity of Bar-sur-Aube,
where it detrained, and began a march problem which, lasting three
1580 REPORT OF THE SURGEON GENERAL OF THE ARMY.
da^'s. billeting en route, brought them into the 4th training area, a
part of which, Litfol-le-Grancl, was in their original training area, as
was also Rimaucourt and vicinity. Here the division was to rest and
obtain its leaves, but it was destined to disappointment, and on Easter
Sunday, March 31, 1918. it left this area of rain and mud and pro-
ceeded by truck to the vicinity of Toul.
This move gave the Medical Department its lesson of functioning
while coming long distances by train, by truck, and by marching,
with coincidental sanitary activities, long runs to hospitals and care
of transportation. It was well done. Here w^as shown the useless-
ness of horse-drawn transportation as compared with motor, and
liere our horse-drawn ambulances should have become a thing of the
past. The horse-drawn ambulances, which had been attached to the
Artillery regiments, proved finally to be of some value, acting as
portable aid stations in open warfare, and could be immediately used
for ambulance service over short hauls. The condition of the horses
prevented this latter use, however, except in rare emergencies.
The division, now reliant and with fine espirit wdiich had developed
under fire, immediately took over the Toul sector, relieving the 1st
American Division and accompanying French units, which had held
it for several months with little activity. A quiet sector, some neigh-
boring French area were added, the front of our sector, extending for
over 18 kilometers. The sector changed hands April 3. From west
to east the front was marked by a series of villages — Apremont, Xiz-
ray, ]Marvoisin, Seicheprey, and later. Flirey — all dominated by Mont
Sec with the German lines. Each of these villages was later to be-
come memorable by sharp combats with the enemy, while the division
held the sector.
This long front required a triage on the left, which was operated by
the 104th Field Hospital Company, first at Aulnois and later between
Euville and Vignot, and finally on Memorial Day, at the Abbey
Rongeval. The triage on the right was operated by the 102d Field
Hospital, first at Menil-la-Tour and later, on June 2, 1918, at a point
near Monorville. Farther forward the ambulance companies oper-
ated dressing stations at Gironville and T^uisville on the left, and at
IMandres and Bois de Rehanne on the right.
The regimental bands were organized as litter bearers. This sector
also developed into a comparatively active one. Even as the sector
w^as being taken over, the Boche, apparently having knowledge of it,
put over an artillery attack which gave the Medical Department about
200 casualties to care for, chiefly from the 1st Division. Mont Sec,
with its splendid observation of this entire sector, made all daylight
circulation a hazardous task. The Boche artillerymen were certainly
efficient and ambulance drivers as well as others soon found the dan-
gers of " Hell's Half Acre," " Dead Man's Curve," and " Suicide
Bend," but not one of them hesitated.
On April 10, 1918, Boche shock troops made an attack in force on
Bois Brule (Apremont) after a heav}" barrage on the 104th Infantry.
It lasted for five days ; ground was lost, but was retaken. Prisoners
were taken on both sides. We lost in Idlled about 40, in wounded
about 250, the Boche eventually retreating. His losses were very
heavy and his attack was of no avail. One hundred and seventeen
men of the 104th Regiment, including 6 of its sanitary detachment
and its colors, were decorated with the Croix de Guerre. The medi-
A. E. F. DIVISIONS. 1581
<^al service under this action was excellent, its only severe casualty
being the loss of the battalion medical cart and much of its equip-
ment, which was blown up by a shell. A detachment of the 103cl
Ambulance Company aided in the evacuation as litter bearers.
Eleven of them were cited for bravery in action.
At dawn on April 20, preceded by a three-hour intense artillery
preparation, the Boche attacked Seicheprey in force, converging on
it in a thick fog, and including in their attack the Remiere Woods on
its right. The 102d Infantry stood the brunt of the attack and lost 58
killed. 203 Avounded, and 114 missing, of which 2 killed, and 10
wounded were of its medical personnel. One of its medical officers
and 7 Medical Department enlisted men were captured, all of whom
eventually returned after the armistice. They, including the officer,
carried Avounded for the enemy during the fight, making many trips.
The S. S. U. 017, and the 102d Ambulance Company had ambulances
and litter bearers in Seicheprev at 9 a. m. the morning of the attack,
when an almost hand-to-hand fight Avas still going on. Three am-
bulances AA'ere struck by shells, tAAo of their occupants were killed
and many wounded.
Under the Avorst conditions of heavy artillerj' tire, in full exposure,
on roads, in narroAv, mud-and-water-filled communication trenches,
the wounded Avere promptly evacuated and well dressed. Six of the
101th Ambulance Company personnel were captured while dressing
the wounded. All eventually returned. A large number of gas
shells caused gas masks to be Avorn during the preliminary artillery
preparation, and the attenuated gas during the day made many
casualties, as aacII as exhausting the medical personnel, causing next
daj' the evacuation of over 50 of them. The necessity of additional
litter bearers in the regiments was apparent, as time was always
necessarily lost, and unnecessary exposure was always given to the
ambulance company litter bearers on their trip to the front lines.
The attack ended during the evening: Seicheprey and Remiere
Woods Avere still in our hands. The medical serA^ce of the division
as well as the evacuation hospitals worked at high speed and well,
those exposed to fire shoAving remarkable self-reliance and bra\^ery.
Their mettle had been tried as was the line. Each nursed its wounds
but was satisfied. Over 650 casualties passed through the triage.
During the night of May 9 ancl 10 the Boche put over a heavy shell-
gas attack on the 103d Infantr}' between St. Agnant and Apremont,
which produced a large number of gas casualties. The 103d Ambu-
lance Company evacuated them at the rate of 1 every 6 minutes for
24 hours, the hospitals aclmirablv caring for them, particularlv the
104th Field Hospital.
Now saw the beginning of an epidemic of fever in the division.
Each case was of short duration and the disease was called " three-
day fever." It turned our field hospitals into practically base hos-
pitals but influenced military operations but little, as was shown on
May 30 Avhen a large raiding party of the 101st Infantry penetrated
the Boche third line, meeting slight resistance. Although less than
100 AA'ere Avounded, moderate ^as and convalescents from " three-day
feA'er " caused many evacuations, filling again our hospitals. On
June 2, the 102d Field Hospital was about to moA^e to Minorville;
practically all of its equipment had preceded it and was stored in
1582 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
barracks, which, in some undetermined manner, became afire, destroy-
ing the whole equipment, vakied at $G0,000.
On June IG, 1918, artillery activity again burst upon us. The
rear areas were included. At da3dight about 800 Boche attacked
Zivray after a four-hour preparation. The 103d Infantry was hold-
ing this area. The light became good and the Boche was repelled
suffering severeh^ and never gaining the village. Although ambu-
lances could have gone to Zivray over good roads, they would have
been under absolute observation and permission was refused to send
them in. The evacuation of wounded was prompt but over long dis-
tances. The wheeled litters here showed to great advantage. The
cases came in from the Aid Station in splendid shape, dressings and
splints well applied, most of them having been applied by one medi-
cal officer and three enlisted men.
Here again the regimental allowance of litter bearers proved in-
sufficient, although the regimental band were acting as litter bearers
as well. The necessary delay in the arrival of assistance from ambu-
lance company litter bearers and their exposure in coming up fur-
ther showed the desirability of an increased number of regimental
litter bearers. Two ambulances were struck by shells, killing four
men. The 102d Field Hospital worked in gas masks for two hours.
The 103d Infantr}^ lost 22 killed and about 150 wounded. One of
its aid stations was blown up, but the field was cleared before dark.
A few days later the Boche made a raid on the 101st Infantry
near Firey. He left four dead in our trenches, while we lost but
one. This raid Avas made just after midnight, after the regiment
had taken over this additional front from the French, who had
removed their medical equi]Dment. The attack was resisted chiefly
by one platoon, whose available medical service in their trenches
turned out to be one Medical Department enlisted man with what
he brought in on his back. He in the dark dressed splendidly the
twenty-odd wounded and captured the only prisoner taken. When
they arrived at the aid station there was little to correct.
The weather during our stay in this area was cold and wet; prac-
tically every trench Avas in absolute view of Mont Sec. The least
change in the appearance of trenches or grounds or any daily
circulation causecl a swift result in accurate shell fire. In many of
the trenches the men were Iniee to waist deep in liquid mud most
of the time. Men occupying them often had no shelter from the
elements. Many slept in the mud on the firing steps. Sanitation
was bad when we entered the area, and not until we were about to
leave it had it become more than good, although wholesale, whole-
some attempts were made to make it excellent. Only two meals a
da}^ could be served to men in the trenches: the food carry was
long, the big marmite cans heavy and awkward to carry. Lice
■s\ere a nusiance: however, one medical officer in charge of delousing,
with generally two Foden-Thresh sterilizers, combatted untiringly
and sucessfuliy this error, adopting a complete change oi under-
clothing and a bath for each man of the reserve battalions as they
alternately returned from their trick in the trenches.
During June 25 to 28, 1918, the division was relieved by the 82d
Division, which was here brigaded with the French as were we at
Soissons. Our division was billeted in reserve for a few days, an-
ticipating a much needed rest and leave when it entrained and
A. E. F. — DIVISIONS. 1583
proceeded toward Paris, in the outskirts of which it was turned
east aoain and on July 3, 1918, found itself, as the emergency
demanded, in reserA'e of the 2d Division, which was opposed to the
apex of the Boche drive a few kilometers northwest of Chateau-
Thierry in his Aisne-Marne offensive.
CHATEAU-THIERRY AND THE AISNE-ilARNE CAMPAIGN.
From now on trench warfare was to be practically a thing of the
past and open warfare, a new book, was to be opened to the division
and real active sectors to be our lot.
Our lines in reserve ran northwest to southeast through Montreuil.
The relief of the 2d Division began and the sector passed to our con-
trol on July 8, 1918, the 2cl Division acting as a reserve. Our divi-
sion then held the line, from the western edge of Hill 210 on the
south, which was held bv the Boche. To and including Bouresches
Wood on the north, in order, 101st, 102d, 103d, and 101th Infantry,
men sheltered themselves as best they could in individual excavations,
which one ob^'iously did not leave during the daylight hours of ob-
servation, in farmhouses, water courses, and in the villages, although
these latter were excellent and often-used targets for enemy artilleiy.
The heavily-built farmhouse cellars became the best aid stations.
When these were not available stone culverts of dry water courses or
shallow, small excavations, usually covered with logs, were utilized.
The prescribed aid station's equipment was used. Supplies were re-
plenished by ambulance and l^earers and the now veteran personnel
mechanically and well functioned under any circumstances or condi-
tions. Ambulance dressing stations were established at the Voie du
Chatel (101th Ambulance Company), on the north and Villiers sur
Marne (103d Ambulance Company), on the south. The natural
drift of wounded and the greatest need made the first exceedingly
active and the other only slightly so. Comparatively midway be-
tween and just out of the main artillery zone a triage and gas station
was operated at Bezu le Guery by the 102d Field Hospital, in which
village were also located the 101st and 102d Ambulance Companies.
Ambulance heads were established as far forward as their cover from
observation allowed.
Well to the rear but not outside of extreme artillery range, as was
demonstrated for days, the 101st and 101th Field Hospitals, together
in a large school at Luzancery, operated a hospital for slightly
wounded, gassed, and sick. Several miles to the rear in La Ferte
Sous Jouarre. the 103d Field Hospital operated a station for seri-
ously wounded in a large convent which had been turned into a
completely equipped and lighted surgical hospital with 6 operating
teams and 35 female nurses. The S. S. U. 502, with their Ford ambu-
lances, evacuated from the ambulance heads to ambulance dressing
stations, divisional G. M. C. ambulance evacuated from ambulance
dressing stations to triage and divisional hospitals, and the Sanitary-
Train Provisional Truck Company, with such of our G. M. C. am-
bulances as could occasionally be spared, evacuated our hospitals to
Services of Supply hospitals.
During the evening of July 17, 1918, in inky darkness and rain,
the 102cl Ambulance Company moved up to the Voie du Chatel to
reinforce the 101th Ambulance Company as this station should be,
1584 KEPORT OF THE SUKGEOllSr GENERAL OF THE ARMY.
and proved to bo. the area of areatest activity. Litter-bearer sec-
tions -were sent to reinforce the regimental bearers. This was the
medical disposition in anticipation of onr attack. All was well and
amply prepared for that which was to come. Over 2,000 casualties
had been evacuated throuo;h our stations in the previous two weeks.
On July 18, 1918. the Allies took, the initiative and the beg^inning
of their victorious tentatives, which ended the war began. At 4.35
o'clock our division Artillery opened with a heavy preparation and
at 6 o'clock that morning the Infantry attacked and the big liattle
ATas on. I^nceasingly and for days the entire medical personnel
ATorked, resting only in short shifts Avhen a lull occurred. Wounded,
sick, and gassed, would accumulate everywhere, but for short pe-
riods only, for every element of the evacuation and treatment scheme
ATorked Avell, CA'ery member of the personnel found no sacrifice or
exertion too great, and, though many were sleepless and nearly ex-
hausted, still they carried on.
Duiing the first day 1.648 casualties passed through the triage,,
and of these, 1.'280 passed through the ambulance dressing station
at La Voie du Chatel in 18 hours.
The attack was successful and folloAving the adA^ance of the In-
fantry a dressing station was opened in Bouresches on the third
day. The division, still going forward, a dressing station was
opened a few miles farther in advance at Farsoy Farm, off the
Chateau-Thierry-Soissons road, and still later, folloAving the adA'ance
another dressing station was opened at Trugny in a farm building
in front of the famous Avheat field, then dotted with the bodies of
our own and German dead. All the ambulance companies were used
in operating these dressing stations, which were taken OA^er on the
leapfrog scheme, a company in reserve passing a companj^ operating,
which latter company closed its stations as soon as its need dis-
appeared. Modified as circumstances directed this scheme, operating
as well in retreat as in adA'ance. became established and generally
was foUoAved until the end of the war.
On July 28, 1918, the 42d Division passed through our lines and
relicA^ed ns, we remaining in this vicinity in reserve, except our
Artillery which kept on until August 4. 1918. when it returned and
joined us in the La Ferte area to which point we had Avithdrawn.
Our first fight in open warfare was over. The movement of troops
had at times been rapid. The roads had been many times filled but
neA^er blocked except rarely, and then quickly opened, and usually
only blocked by impassable shellfire. At no itime was there an un-
necessary delay in the evacuation of casualties. Ambulances found
it difficult to locate moAnng battalions, liaison could haA^e been better,
but the performance on the whole Avas A'ery creditable. Medical
supplies Avere brought in by ambulance as messages went out by
them. The information as to operations they returned with was
of inestimable A^alue, and the prompt two-hourly reports of casual-
ties from the triage kept not only the division surgeon informed
but the division commander as well, for where the greatest casual-
ties were coming from indicated the point where the greatest re-
sistance was occuring.
An advance of over 18 kilometers had been made. Bad sanita-
tion here taught the entire surrounding country a lesson which
should be recorded, and though some of its error was practically
A. E. F. DIVISIONS. 1585
correctable, most of it, under the circumstances, was not. On first
taking over this sector many unburied bodies, both of men and
animals, were found. In one wood alone over 50 were Ijuried by
us in the first few da,ys of our occupancy. Since fiohting had taken
place here the odor was frightful. Bodies buried in shallow holes,
occasionally showed a protruding extremity. Many were simply
covered up in the shallow holes they had made for shelter. Burial
parties had suffered severe losses. Men in exposed places kept
under shelter as they were in and their excreta was deposited when-
ever and wherever a comparatively safe opportunity offered. The
same conditions, but to a lesser extent prevailed in the enemy area,
which we occupied later. Such latrines as were found often contained
a moving mass of maggots, and flies, which up to this time had
been almost unknown, appeared in enormous numbers. Water was
being used from every available source, often untreated. Food, when
obtainable at all, was often sour and affected by long carries and
preparation under bad circumstances. The result was diarrhea.
Practically 100 per cent of the command had it at one time or an-
other. It was mild, often recurrent, and hardly 2 per cent of its
victims had fever or were evacuated. The French inhabitants suf-
fered even more than our troops, likening the diarrhea and the
flies to the epidemic of cholera which visited them years previous.
Coincidentally with improved sanitation the diarrhea disappeared ;
but it was noticed that commands with good sanitation suffered as
much as those with poor sanitation until we reached an area where
few flies were found. An excellent bath treatment for casualties
from mustard gas was here developed at the triage although water
and conveniences were comparatively scarce. Rows of litters cov-
ered with rubber blankets on inclined planes, made of wooden
horses of unequal height, allowing the litters to drain into a bucket
at the end of each, were placed under shelter. From overhead on
a wire were suspended douches for eyes, nose, and ears. Water was
supplied by watering pots and the attendants protected by gas-
proof clothinn- {|nd gloves. The Red Cross was very active, adding
much by passing out cigarettes, hot chocolate, and supplies for the
comfort of the casualties.
Two weeks were passed in reserve during which time the division
obtained a much-needed rest, when orders were received to move,
and we entrained on August 15, 1918, for an American rest area, the
12tli training area, in the vicinity of Chatillon-sur- Seine. This was
our first rest. Field hospitals were established at Villotte for the
divisional sick, severe cases being evacuated to Base Hospital Xo.
15, at Chauuiont.
Drills, tactical maneuvers, sanitation, sports, and entertainments
kept the division occupied for two weeks until August 20, when it
began again to entrain for the front, detraining in the vicinity of
Bai'-le-Duc and marching by night, as the front was neared to the
vicinity of Sommedieu and Genicourt, taking over a narrow sector
of the northern end of the St. Mihiel salient.
THK ST. MIHIEL DRHT..
In i)reparation for the attack which followed, a dressing station
was established on the left at Noyon by the 102d Ambulance Com-
1586 REPORT OF THE SURGEON GENERAL OF THE ARMY.
pany. A triage and gas treatment station at Genicourt by the 101st
and lOltli Field Hospital, respectively, and a station for slightly
wounded and ordinary sick at Chateau le Petit Monthairon, where
also the 103d Field Hospital, which had been operating this hospi-
tal, was in reserve. The 103d and lOlth Ambulance Companies were
in reserve at Rupt-en-Woevre.
An enormous amount of artillery of all calibers liad been assem-
bled for this attack and at 1 o'clock on September 12 a terrific artil-
lery preparation began. At 8 o'clock the Infantry went over, en-
countering little resistance, taking thousands of prisoners and ad-
vancing steadily till late afternoon, when the reserve regiment, the
102d Infantry, was ordered ahead, and in column marched down the
Tranchee Calonne to Vigneulles, their advance party waiting for and
meeting those of the troops coming from the south at 2 a. m., cutting
off the salient. No man's land, at the jumproff, was heavily wired,
had series of trenches and antitank excavations, all of which delayed
the passage of artillery, kitchens, and ambulances until roads could
be built. This was promptly done by the Engineers, but not until
the next day could Q.nj vehicle get through. This resulted in long
carries for the litter squads for the first day, through country which
had been torn to pieces by the most devastating artillery fire.
In this attack, after much previous training by the medical per-
sonnel attached to line organizations, company litter bearers (12 to
a company of Infantry) evacuated their casualties to the aid sta-
tions, an improvement in service shown to be desirable by previous
actions, the augmentation of the number of bearers and their interest
in the welfare of their own company both being factors for good serv-
ice. The 103d and 101th Ambulance Companies, in reserve, were sent
forward following the 102d Infantry and established a dressing
station at Le Cloche, about 3 kilometers in the rear of Vigneulles.
The 101th Field Hospital pushed forward from Genicourt and
opened a triage at Mouilly.
No counterattack developing, the new station had little to do; in
fact, more than 500 casualties were cared for in the entire attack.
On September 15, 1918, the division was moved to the left, holding
the northern portion of the newly acquired line. This required a
rearrangement of medical stations. A dressing station was opened
at Les Eparges on the left by the ambulance section, with one com-
pany in reserve and headquarters, the main dressing station and a
company in reserve at Dommartin, on the right. The field-hospital
section opened a triage at Vaux and a hospital for divisional sick at
Triyons, still operating the hospital for nontransportable wounded
at iVIonthairons, until later when the field hospitals were concen-
trated at Vaux, except the hospital for the divisional sick, which was
moved up to Ambly.
THE MARCHEVILLE-RIAVILLE EAID.
On September 26, 1918, one of the sharpest actions of the division
took place, although only two battalions of Infantry made the attack.
In conjunction with the big Meuse-Argonne offensive, in order to
cover and confuse the Boche as to the main attack, these battalions
were ordered to attack Marcheville and Riaville in the plain of the
Woevre, to hold them during the day and evacuate them at night.
A. E. F. DIVISIONS. 1587
This was done, but they met strong resistance, concentration of fire
and sharp counterattacks, so that for a time there was some question
whether or not they could extricate themselves. The sacrifice was
costly. The plain was level and absolutely exposed to observation.
The 101st Ambulance Company followed the Infantry into the
enemy's lines and established a dressing station at Saulx. Ambu-
lances of the 10'2d Ambulance Company did the evacuating, run-
ning into Saulx. The dressing station was almost demolished, but
the large numbers of wounded kept litter bearers, dressing-station
parties, posts, and ambulances working at top speed and top effi-
ciency as well. At 6 o'clock the dressing station was moved back to
Hannonville, the field was cleared of wounded, and the troops re-
turned under cover of darlaiess. The medical personnel of the line
troo])s involved co\ered themselves with glory. That night the en-
tire area suffered from a heavy shell, gas, and high-explosive bom-
bardment.
On October 18, 1918, the division was relieved by the Tth Division,
and marching by night began its journey to its last but not least
battle field, Verdun.
The actoi's Avere again set for the closing act of the Great War.
Line and medical organizations placed themselves to the best advan-
tage, taking what little cover there was. This was the same area over
which was fought that earlier great Battle of Verdun.
The lOJrth Ambulance Company established on the left, near
Samogneux, a dressing station. Xo cover was to be had, so it was
esta})lished in a tent, the men digging individual shelters to escape
the intermittent artillery fire. An ambulance head was established
on the right at Haumont, 5 kilometers beyond the dressing station;
another was established in Death Valley. The first dressing station
proved to be inadequate; another was established one-half kilometer
in its rear by the 102d Ambulance Coijipany, of greater capacity,
acconnnodation, and protection, closing the first station and holding
it in reserve. A station for Avalkin^ wounded Avas established at
Vacherauville by the 104th Field Hospital (detachment). The 103d
Ambuhince Company was in reserve at Caserne Bevaux, just outside
the city of Verdun, but its ambulances were being used in evacuation.
Hern also were the field hospitals, 101st for divisional sick. lOith as
a gas station. 102d as a triage, 103d in reserve.
Our first attack was made by the 104th Infantry in the Bois
Belleu. A heavy artillery preparation preceded it, but the Boche
was compelled at any cost to hold this hinge of the great turning
movement that opposed him, and the 104th retired Avith lieaA'y losses.
Day Ijy day our attacks took place. Gains Avere made and con-
solidated, occasionally but usually there Avere not enough, of each
tired l)attalion to hold the ground it had gained, and tlic Boche
concentrated his fire on every little salient made. For tAvo Aveeks this
continued, the division fighting on and on, gaining ground, grow-
ing more and more exhausted, less and less in nmnbers, gaining
a feAv kilometers. Line and ambulance heads moved on slowly
but surely. History will speak of Bois Belleu, Hill 360, Bois d'Hau-
mont. Bois d'Etrayes. Les Houppy Bois, Le Wavrille, Bois des
142.367— 19— VOL 2 39
1588 REPORT OF THE SURGEON GENERAL OF THE ARMY.
A'illo (.k'vtint C'hauniont, and Cote de Talou. Those who Avere there
will shudder in memory of the hiffh explosives and cas. of Avhole
comjianies. no member of whom could speak aloud from gas and
colds, the rain and the mud, lack of shelter, the machine-gun nests
and their spiteful bees, the sick, gassed, exhausted, and wounded,
but the spirit which kept them on. the spii-it which brought out
their wounded, the spirit that carried on continually for practically
;i inonth in this hell, will ever be a monument to the intrepidity
of the American soldier.
Until the armistice it continued, their attacks less in volume,
until after a comparative rest, one last attack was ordered for the
11th of Xovember. It started, but fate interposed, the armistice
was signed, and at 11 o'clock every gun fired its last shot and a
strange stillness pervaded the battle field, only broken by the ring-
ing of the Cathedral bells in Verdun, which had miraculously es-
caped, and which for the first time in four years rang forth, spread-
ing the glad tidings.
THE TKIP TO THE COAST.
The division remained in line for a few days longer, then started
on its journey by march and train to the 8th divisional or Montigny
area. Little of note occurred in their >tay of 58 days here, except
a sudden outbreak of a very fatal type of influenza, usually compli-
cated by bronchial pneumonia. It was confined generally to two
battalions, where it was of short duration. Sleeping head to foot,
shelter half partitions between beds, absolute sterilization of mess
kits, ventilation, quarantine, rapid evacuation of patients, all were
immediately carried out and the epidemic ceased in these battalions,
but sporadic cases continued to appear, gradually decreasing in
fatality and in numbers until we left France. Camp Hospital No. 8
at Montigny le Roi was flooded with cases, two of our field hospi-
tals set up their canvas in the mud, and relieved it and the division
of its mild types of disease until we were allowed to evacuate to
base hospitals at Langres, Chaumont, and to Beurmont.
Preparations for departure brought us into the embarkation
area south of Le Mans with headquarters at Eccomoy, where we oper-
ated a hospital for slightly sick, evacuating to Camp Hospital No.
72. at Chateau du Loir, and Cam]) Hospital No. 52 at Le Mans.
Here also the men seemed to lose much of their depression and the
once drawn faces filled out. Color came to many cheeks and dur-
ing the last two weeks in March the division departed for Brest,
embarking for home.
This history would not be complete without a tribute to the
splendid self-sacrificing services of the medical personnel serving
with the line organizations. Forced at all times to work in the
midst of dangers and discomforts, surrounded by tlie brutalities
and disillusioning influences of war. there seemed deep bedded
within them the consciousness that their service was one of kindliness,
thoughtfulness. and the self-sacrifice of the true humanitarian. War
tm]}- intensified their idealism. Throughout all the activities of the
Yankee Division, the entire medical service functioned faithfully
and efficiently. Their contribution to the successes of the Yankee
Division can never be properly recorded, but each who served may
carrv in his heart the proud consciousuess of a task well done.
A. E. F. DIVISIONS. 1589
r. TWENTY-NINTH DIVISION.
For the safe of clearness this sketch is divided into three parts:
First, the formation of the division and the activities of the Medical
Department for the calendar year 1917; second, the period covering
the calendar year January 1, 1918, to June 5, 1918, at which time
the division sailed for France; third, the activities of the Medical
Department from June, 1918, to January 1, 1919, which period
comprises the operations in the ALsace sector and the Meuse and
Argonne offensive.
The 29th Division (the old 8th Division of Xational Guard) was
composed of seasoned troops from the States of New Jersey, Mary-
land, Delaware, Virginia, and the District of Columbia. The per-
centage of urbanity in these States was high. The division was
formed at Camp McClellan, Ala.
The headquarters, 29th Division, and oTth InfantiT Brigade
left Camp McClellan June 5 and 6 and arrived at Xewport News,
Vn.. June 8. The 58th Infantry Brigade left Camp McClellan June
9 and arrived at Hoboken, N. J., June 12. During the voyage no
epidemics of any kind occurred. The division arrived overseas on
June 27 and 28, and none of the troops were retained at the ports
of debarkation for contagious diseases. The division's first station
was in the Prauthoy area (area No. 10). headquarters being estab-
lished at Prauthoy on July 2, 1918.
The division was ordered out of the Prauthoy area on July 17^
division headquarters being established at Vladoie, and organiza-
tions were billeted in and around Valdoie.
The troops in the Valdoie area were distributed throughout many
towns and long distances apart. The ambulance service from July
17 to July 25 was conducted by the personnel of the division sur-
geon's office, the ambulances making daily calls at all battalion
infirmaries. The sick were evacuated to the military hospital at
Belfort (French).
On July 25 the division was assigned to defend the center sector,
Haute Alsace (see map). This section, which covered a front of 12
kilometers, was defended by this division from the 25th of July to
23d of September, 1918. Although there were no real engagements
during this period, the enemy sent over many raiding parties and
our front was shelled daily with varying intensit3^ Gas was fre-
quently used, but it was not until September that many casualties
were caused by gas attacks. During this period the division was
operating under the direction of the 20th French Corps.
The disposition of the sanitary troops was arranged accordingly.
Thus in the front line a first-aid post was established by Medical
Department enlisted personnel attached to each company. A bat-
talion aid station was established at each battalion headquarters.
The regimental surgeon established an aid station at regimental
headquarters for the care of the personnel attached there. It. how-
ever, was not intended to establish ii regimental infirmary. Ambu-
lance service was established as follows:
For each battnlion on the front line one ambulance. Two ambu-
lances were stationed at regimental headquarters for each front-line
regiment, thus giving each regiment on the front four ambulances.
Tavo ambulances were stationed at each regimental headquarters in
1590 RKPORT OF THK SUKCJEOX GENERAL OF THE ARMY.
the rear. Emergency calls for additional anibnlances were tele-
phoned to the division surgeon. Thus ambulances were available at
all timers, and no time was lost in transporting the sick from the
front line to the field hospitals in the rear.
MEUSK-AKGOXXE OlFENSIVK.
The division was relieved from the defense of the center sector,
Haute Alsace, on the •28d September, 1918. and established headquar-
ters at Conde on vSeptember 25, at which time the division w^as de-
signated as First Army reserves. On October 1, division headquar-
ters was moved from Conde to Ville-sur-Coasances. The sanitary
train established headquarters at Rampont. On October 4, division
headquarters Avas moved forward to ISIoulin Brule. On October 7 the
various elements of the sanitary train were moved to Glorieux. The
division went into action at 5 a. m. on the 8th of October, 1918.
The general plan for handling the wounded in this attack was of
tlie simplest character. Battalion surgeons, with their attached sani-
tary detachment, followed closely their respective battalions and
established their first-aid stations as close to the front lines as the
character of terraine or dugout shelter permitted. The regimental
surgeons kept about five men in reserve for messenger service, and
to reinforce any battalion that might have a larger number of casual-
ties than the regular personnel was able to handle. The combat
equipment was taken as far to the f rt)nt as possible in the medical cart,
but these vehicles were too heav^- to be hauled Ijy one horse, and had
to be abandoned at times, the supplies being carried forward the
remainder of the way by the sanitar}^ personnel.
The triage hospital, located in the French hospital building just
outside of Glorieux village was operated by the 114:th Field Hospital
company, in conjunction Avith a company from the 33d Division,
which occupied a sector to the left of our lines. This organization
AA as relieved shortly after the beginning of this offensiA'e. The hos-
pital Avas for the reception, classification, preparation, disposition,
and recording of all patients, sick or injured, from the division. It
Avas divided up into receiving, recording, slightly Avounded, severely
wounded, gassed, and evacuation departments. The only class of
patients retained here was the nontransportable. The personnel was
reinforced Avith details from other organizations of the sanitary train,
and by six divisional specialists. avIio rendered excellent service
during the continuation of the engagement. In the period October
S, 1918. to October 29, 1918, 5,660 cases passed through this triage.
4.865 of these belonging to the 29th Division, the remainder belonging
to the 26th, 33d, and 80th American Divisions, and the 18th French
Division. All patients received hot food, their dressings Avere either
reapplied or readjusted, and splints reapplied to all fractures so that
patient Avould be comfortable during his ride to the CA^acuation
hospitals in the rear. Inquiries at the various evacuation hospitals
in the rear reA^ealed the fact that patients from this division arrived
at their destinations in excellent shape, thereby proA^ing the rapidity
of evacuation and care en route was all that could be expected under
the circumstances.
The Red Cross supplied the kitchen at the triage Avith materials for
hot chocolate, coffee, milk, soups, bread, jam. etc. Chewing gum,
A. E. F. — DIVISIONS. 1591
candy, chocolate, and cigarettes were furnished the mounded at this
place and at the dressing stations on the front. This added greatly
to the comfort of the injured and gave them the advantage of many
articles that could not be furnished other^Yise. I regard the service
rendered on this occasion as Avorthy of commendation.
The transportation of the sick and wounded from the front lines to
the triage hospital was accomplished principally through the medium
of the ambulance sections of the lloth and lioth Aml)ulance Com-
panies. This fact is regarded as little short of marvelous, and the
ambulance drivers and mechanics are entitled to the highest praise-
For three weeks these ambulances were kept running night and da}""
over roads that in places were nearly impassable, without spare parts,
to replace those worn out. or materials for making necessary repairs-
Several cars were injured by shell fire, but with the exception of one
which received a direct hit, killing three patients, all were running
again in the short space of a few hours.
At such times as the moderately wounded and slightly gassed
accumulated in such numbers as to embarrass the ambulance service
permission was secured to use annnunition and supplj'-train trucks
returning empty through the town of Florieux. These afforded an
excellent means of transportation for this class of cases and relieved
the ambulance service of considerable burden.
The casualties in the ambulance section of the sanitary train con-
sisted of 5 men killed, 9 wounded, and 28 gassed.
On the whole, the service of the entire medical department of the
division was very satisfactory after the first day. The opening day
of the engagement the troops moved forward so rapidly that the
regimental and battalion surgeons in several cases lost touch with
their organizations and it took some time for them to get up in
their proper places. The medical cart used for handling the battal-
ion combat equipment is entirely too heavy to be hauled by one
horse, and in many cases could not be dragged across countrj^ This
necessitated supplies being carried upon the backs of the men.
During the Meuse-Argonne offensive the division is credited with
the followinir engagements: October 8. 1918, battle of Malbrouck
Hill; October 10, 1918, battle of Molleville Farm; October 11, 1918,
attack on Bois D'Ormont; October 16, 1918, battle of Grande Mon-
tague; October 23, 1918, capture of Etraye Ridge; October 26, 1918,
attack on Bois Belleu. This division was relieved on October 29,
1918, and marched to the Bar-le-Duc area, division headquarters
being established at Eobert Espagne.
In this area the Medical Department was chiefly concerned with
delousing the soldiers who had just returned from the front-line
trenches. The first examination for vermin showed a total of 809
cases in the division. Portable baths, under the charge of a medical
officer, with the aid of Medical Department enlisted men, were moved
from regiment to regiment, and men were bathed and issued new
clothing throughout. This procedure succeeded in reducing the
number of cases of lice in a week to 365 cases for the entire division.
The sickness in this area was limited to acute respiratory infec-
tions, there being no epidemics of contagious diseases. Contrary to
expectations, very few men were sent to the hospital with trench feet.
1592 REPORT OF THE SURGEON GENERAL OF THE ARMY.
O. THIRTY-SECOND DIVISION.
The 32d Division was organized at Camp MacArthnr, Tex., in
Auffust, 1917. When the division began to assemble (August 25,
1917), the camp was still under construction. There were 7,000
laborers engaged in the construction of the shacks for the accommo-
dation of troops and of the base hospital, Camp MacArthur. The
weather was hot and the civilians in camp were the victims of in-
testinal diseases, gastro-enteriti. The base hospital was unfinished
and could not be occupied as such. Under instructions of the divi-
sion surgeon Field Hospital Xo. 1, of Wisconsin, was established
in some warehouses at the side of the base hospital, and took care
of the emergency until the base hospital could be opened.
Extraordinary efforts in clearing up. and the destruction of refuse
and fly-breeding places were made, but this could not be accom-
plished in time to avoid a short epidemic of gastro-enteritis among
the newly-arrived troops. This epidemic of intestinal disease lasted
approximately six weeks and affected a very large proportion of the
troops brought into camp.
On January 7, 1918. the first unit of the division left Camp Mac-
Arthur for port of embarkation, and division headquarters left on
Januarv 14, 1918, and proceeded to embarkation camp. Camp Mer-
ritt, X.' J.
The first unit of the division sailed about January 24 on the
trans}wrt Tii.^cnnku and comprised the 107th Engineer Train, one
section of the 107th Supply Train, and two sanitary squads. This ship
was torpedoed off the coast of Ireland about February 6. when ap-
proximately 18 men of the division were lost," including 1 sergeant
and 4 men. Medical Department. Divisional headquarters sailed
January 31, via England, and arrived in the 10th training area,
headquarters at Prauthov. Fel)riiary 24, 1918.
The 10th training area had not j^reviously been used and the
villages were for the most part in an extremely insanitary condition
and required much labor to put them in a satisfactory condition for
the housing of American troops.
On May 14 the division began entraining for transfer to the Alsace
front. Xo American evacuation or base hospitals being conven-
iently located, all sick and wounded were evacuated through French
hospitals of evacuation. For the purpose of instruction in war sur-
gery, medical officers from the division were assigned in turn to the
various French hospitals in the vicinity of Belfort. These officers
also acted as a means of liason between the French and the American
medical service.
Due to the long tour of duty in the trenches, necessitated by the
extremely long front, the entire division soon became infested with
vermin. Two French delousing stations at Sentheim and Yaldieu
were made use of by American troops. These with two portable
outfits obtained in the 10th training area gave adequate facilities
for delousing. for laundry work, and for the treatment of scabies,
which was carried out in conjunction with the treatment of venereal
diseases by the officers in charge of the labor detachment. Our occu-
pation of the Alsace sector was marked by a sinffularly low sick
rate and absence of epidemic diseases, aside from the appearance of
an occasional case of diphtheria.
A. E. F. DIVISIONS. 1593
The division was relieved on July -21 and ordered to the Chateau-
Thierry front, arriving there July 29. The following suminarv
covers the operations of the medical and sanitary service. Julv 29
to August 7.
Wounded were transported In- litter bearers, regimental sanitarv
personnel members of band, details from the line and bearer sections
of ambulance companies as required, from aid stations to ambulance
heads and dressing stations, in most instances, and by ambulance
from ambulance head and dressing stations to hospitals. " On July 28,
Field Hospitals Xo. 126 and Xo. 127 were established at Ecole Jean
Mace, Chateau-Thierry, one for gas and one for nontransportable
wounded. Field Hospital Xo. 125 Avas held in reserve near Chateau-
Thierry. Field Hospital Xo. 128 was established for sick at Azt.
Ambulances in some instances Avent as far forAvard as battalion aid
stations.
Awaiting developments of attack, eight motor ambulances Avere
assigned to each Infantry brigade and four horse-drawn to the Artil
lery brigade. When the attack commenced, dressing stations were
established as far forward as possible, and ambulance heads were
pushed forward in front of these dressing stations as indicated.
Dressing stations were advanced as dictated by moA^ement of troops.
Under orders at the beginning of the attack, evacuation was through
Hospital Jean Mace at Chateau-Thierry to Jouy-sur-Morin and
Coulommiers. The triage at Chateau-Thierry was being operated by
a field hospital of the 12d Division, which Avas not in position to leave
in accordance with orders at the time we arrived. On August 2.
Field Hospital Xo. 12.5 was established at Jaulgonne. acting as a
triage, and receiving nontransportable wounded. Evacuation of
transportable wounded continued to Coulommiers, and a hospital
train was run into Chateau-Thierry and many cases sent direct to
these points. At this time EA^^cuation Hospitals Xos. 5 and 6 were
in operation at Chierry, 2 kilometers east of Chateau-Thierry, We
evacuated to that point. On August 1 Field Hospital Xo. 127 was
advanced to Reddy Farm and acted as triage for nontransportable
Avounded and gassed. Evacuation facilities on August 1 were ample,
there being two eA'acuation hospitals at Chateau-Thierry, trains as
needed, as well as transportation by boat.
Practically all wounded went through field hospitals. Those
needing immediate attention were given attention. Those needing
immediate operation were operated upon. Those not needing im-
mediate attention Avere transported directly to evacuation hospitals
and hospital trains. Three hundred and fifty-eight were operated
upon. There Avere many multiple wounds. Approximately 10 per
cent of the casualties were treated at our field hospitals and 60 per
cent passed through direct to hospital trains or evacuation hospitals,
or were handled by the field hospitals of other diA^sions.
From the firing line back to the field hospitals, medical personnel
and transportation was sufficient. On one or two occasions we called
upon G-1 for trucks, on one occasion for as many as 12. These Avere
furnished. We used, in addition to our ambulances, some of the
trucks belonging to the sanitary train. We tran>i)orte(l many casual-
ties of otherdiAnsions. From July 29 to August 2, inclusive, evacua-
tion to the rear was insufficient. The CA^acuation hospital at Chierry
1594 lUirOKT OF THE SURGEON CEXERAL OF THE ARMY.
was not thoroughly established and the liaul to roulonnniers Avitli
our own transportation was too long.
Medical supplies of all kinds Avere ample and promptly delivered.
On July 28 and 29 this division furnished 19 ambulances for service
of other divisions, and previous to August 1 we furnished three op-
erating teams to the evacuation hospital. From July 28 to August 2
our operating teams assisted the 12d Division. On August 6 and T
we called upon the 28th Division for a few ambulances. The divi-
sions on our right and left cooperated in every way in the care of
the woimded.
AVe need better liaison between the advanced and aid stations and
ambulance heads and dressing stations. This must be developed.
The Medical Department must be furnished with maps and better
information in order to improve the service.
The men came down from the front with surgical dressings Avell
applied and fractured well splinted. This was most gratifying.
Many of the dressings had been applied by enlisted men.
The division, on being relieved from support position, proceeded
to the vicinity of Yic-sur-Aisne and entered an offensive with the
10th P>ench Army. The following summary of operations covers
the period August 25 to September 5, inclusive :
On arrival in this area provisions were made for the care and treat-
ment of the divisional sick by established Field Hospital No. 128. at
St. Etienne, August 25. The Medical Department, having no infor-
mation at that time as to the probable point of attack, could make no
provision for the establishment of an evacuation hospital. Tender
direction of the chief surgeon, 10th French Army arrangements were
made for evacuation to French H. O. E. at St. Remy. near Villers
Cotterests, and two medical officers with sufficient enlisted personnel
were temporarily attached to this hospital to assist in caring for any
American wounded who might be sent there. This arrangement was
a temporary expedient until the most favorable site for the establish-
ing of an evacuation hospital could be determined. Twenty-seven
patients in all were hanclled by this hospital up to and including
August 27. On August 27 Evacuation Hospital No. 5 was estab-
lished alongside of the French hospital at St. Remy, after which our
evacuation was to this point or to hospital trains as indicated below.
On going into action regimental aid stations, as required,, were es-
tablished at or near regimental headquarters, and battalion aid sta-
tions were established well forward under cover and in caves, dug-
out, or behind protecting banks convenient to the battalion posts of
conmiand, where first aid could l)e most easily and speedily rendered.
In some instances regimental aid stations were operated in the im-
mediate vicinity of advanced ambulance dressing stations. Adequate
medical supplies were on hand at all times. The litter-bearer details
working between regimental and battalion stations and the ambulance
liead were supplemented by 50 men from Ambulance Company 128
(horse drawn), which had been held in reserve, a detail of 30 men
from Ambulance Companies 125 and 127, from the personnel of the
bands and details from the line as necessary. In some instances
there was some difficulty in promptly meeting the demand for litter
bearers, and at the same time avoid depletion of the firing line by
withdrawal of combatants for that dutv.
A. E. F. DIVISIONS. 1595
The triage kept accurate records of all casualties and reported same
every six hours. It is l)elieved that this Avas of great aid to the divi-
sion statistical office. The professional skill and judgment shown
by the medical officers on duty at the triage is indicated by the deaths
to date of 10 out of a total of 1.G15 casualties evacuated.
Field Hospital No. 127, operating as an advanced surgical hospital,
was located about 200 yards from the triage at Chateau Montois. Its
function was the surgical treatment of the very seriously wounded
Avho could not be transported any further without grave danger to
life. During the period of the offensive there were 281 admissions,
7 of these were dead on arrival, of the remainder 40 died before opera-
tion, and 39 died after operation. Considering the very serious nature
of the casualties admitted to this hospital, the majority of them being
multiple wounds involving the head, chest, belly, or extremities, this
is an unusually good record. On the evening of August 27 the per-
sonnel of the hospital was increased by the addition of Naval Surgical
Team No. 1 and Shock Team Xo. 116. In addition to the above five
surgical teams were organized from the medical personnel of the
division, and all did excellent work under the immediate direction
of the divisional consulting surgeon.
Field Hospital No. 126 received 460 gassed cases, with no deaths.
The Avork here was very well done. In striking contrast with the last
offensive, practically all of these cases presented one or more physical
evidences of having been gassed. Some were rather severely gassed.
The slighter cases, where there was a possibility of return to duty
within a few days, were transferred to Field Hospital No. 128 for
further treatment.
Field Hospital No. 128 admitted 498 cases, with 1 death. These
cases were sick, slightly gassed, psychoneurotic, or had slight acci-
dental injuries. To date 202 men have been returned to duty, a
majority of the remainder will be returned within a few daj's.
The following extracts are quoted from the report of the consulting
surgeon :
The placing of the triage entirely separate from and slightly in advance of the
operating station for seriously wounded enabled the officer in charge of the same
to send only nontransportable cases to that station. Abdomen, sucking chests,
serious heads, cases in shock or apparently standing transportation poorly, and
those sliowing evidence of hemorrhage were the only ones sent.
The total number of wounded was 1,758 up to the time of writing
this report, September 3. Of these 256 were sent to the hospital for
seriously wounded: 41 were so seriously wounded that they died
within two hours after admittance. Blood transfusion, intravenous
injections of gum, and other methods used to combat shock failed to
be of benefit in these cases. In addition 7 deaths were charged to the
hospital, the deaths occuring en route to the triage, the bodies being
brought so that our burial squad could attend to them.
Evacuation of w^ounded from front line was accomplished by litter
bearers of the regimental medical units, by bearers designated from
ambulance companies as required, and by details of litter bearers
designated for this purpose by the commanding officers of line or-
ganizations. Wounded men were littered to battalion, regimental,
and ambulance dressing stations. In many instances, however, and
wherever possibile, ambulances went forward to regimental and bat-
talion aid stations. All wounded were transported to the field hos-
1596 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
pitals in divisional ambulances and evacuated from field hospitals to
hospitals designated in corps orders by evacuation ambulance com-
pany furnished by the corps, supplements as was necessary by our
own ambulances, by trucks of the sanitary train, or trucks furnished
by the quartermaster department as required.
Evacuation from the front was- unusually prompt and satisfactory.
Evacuation from field hospitals to evacuation hospitals designated
in corps orders was delayed in some instances by conditions of traffic
to the rear and at times by lack of sufficient ambulances, but no
unusual or extraordinary delay occurred, and generally evacuation
all along the line was satisfactory.
At regimental and battalion aid stations, wherever possible, provi-
sion was made for hot drinks, food, and rest and many sick and ex-
hausted men were returned directly from these stations to the line.
H osjntallzation. — In accordance with instructions, the advance
hospital for gassed and sick, Field Hospital Xo. 126, the triage and
advanced surgical hospital, Field Hospital Xo. 127, were in close
proximity throughout the action.
The equipment and personnel of all four hospitals were used inter-
changeably as required. The triage plan heretofore used was again
put into successful operation and worked smoothly and satisfacto-
rily, giving at the end of each period correct figures on numbers and
correct information on individuals handled.
During the period covered by this report there were 1,193 casual-
ties, 32d Division; 2,589 casualties of other American units, 107
French, and 50 enemy handled by the Medical Department. This
makes a total of 6,939 casualties. In addition to this number, 235
casualties, 32d division, were handled by sanitary personnel of other
divisions. Of these 4,228 casualties, 32d Division, reported to date,
there were:
Officers. Men.
Seriously wounded 15 629
Slightly" wounded 48 2, 110
Neurosis , 4 26
Gassed 17 515
Injured 61
Sick 40 964
124 I 4,304
On cessation of hostilities the entire division was transferred
across the Meuse River. On Xovember 19 the division started on its
march toward the Rhine as a part of the army of occupation. Am-
bulances followed each column of Infantry, and field hospitals were
established for the reception of cases.
Evacuation from field hospitals to corps collection stations was
by division ambulances. There was little sickness on the march, but
a very large number of cases were admitted for treatment on account
of sore, bruised, and lacerated feet.
The division crossed the Rhine on December 13 and Field Hospital
Xo. 128 was established in the town of Saj-n, which was later turned
over as a billeting area for the entire sanitary train. Billeting being
insufficient and men unavoidably crowded, respiratory infections
became prevalent in some organizations. A survey of the entire
'
A. E. F. DIVISIOXS. 1597
area was therefore carried out by the Medical Department, each
house inspected and every room reported as to dimensions, ventiha-
tion, heat, and recommendation made as to the number of sokliers
it could accommodate.
II. THIRTY-THIRD DIVISION.
The debarkation of division headquarters from the U. S. transport
Mount Vemon, at Brest. France, on May 24, 1918, included the
landing of certain units of the Medical Department, viz, the division
surgeon's office, the division medical supply unit, and the personnel
of four camp infirmai-ies. The subsequent arrival of division head-
quarters at Huppy, Department of the Somme. a few days later,
marked the beginning of the reorganization of the Medical Depart-
ment, in order to conform with British tables of organization and
in order that British equipment, which would be used in the British
sector, could be utilized.
The medical detachments of the Infantry regiments, the machine-
gun battalions, and the 108th Engineers arrived with their respec-
tive organizations and plans were made to fully equip them with
British equipment.
Upon the removing of the division to the training area of Eu, the
scheme for changing the methods of the Medical Department to con-
form with the British plans continued.
On the 2d of June, 1918, the division, minus its artillery, am-
munition, supply, and sanitary trains, moved to the Long area and
the Molliens-au-Bois district.
In order to utilize British equipment for the sanitary train, it was
neces'^aiy to reorganize it so that it would function after the manner
of the corresponding sanitary unit in the British Army, the field
ambulance. By combining an ambulance company and a field hos-
pital, the resulting organization was so similar to the British field
ambulance that, after receiving the British equipment, it was able
to function in an efficient and satisfactory manner. Therefore, Field
Hospital 129 and Ambulance Company 129 were combined and
formed the 129th Provisional Field Ambulance, under the command
of Maj. . Likewise, Field Hospital 130 and Ambulance Com-
panj' 130 were combined, under the command of Lieut. Col. .
These two organizations were completel}^ equipped with British field
ambulance equipment. '
The medical detachments of the Infantry regiments and the
machine-gun battalions also gained much experience while in the
British sector. This was especially true of the detachments of the
66th Brigade. These units engaged in their first offensive operations
on July 4, 1918, when companies of the 131st and 132d Infantry
attacked with the Australians and won the victory of Hamel. As a
result of the splendid work of th6se men in the front line, dressing
was promptly done and evacuation carried out with the greatest
possible speed. Two members of the Medical Department particu-
larly distingTiished themselves in this operation and were later
rewarded for their heroism b.y the King of England, who himself
decorated them, with other American soldiers of the 33d Division at
the Chateau Grounds of Molliens-au-Bois on August 12, 1918.
1598 KKPOKT OF THE SUECJKOX (iKNERAL OF THE ARMY.
In the attack on Chii)ill_v Kidiije and Grassiere Wood, the medical
detachment of the 131st Infantry established dressing; stations at
nnmerons places in the wake of the advance. During this pej'iod
one member of the detachment was killed, one officer and fiAe men
were slightly gassed, and one was slightly wounded by high explosive.
August 'I-i the division began to leave the British sector, and
August 24 division headquarters entrained at Vagnacourt. In the
three months from the landing of the division headquarters to the
departure from the British sector the Medical Department had made
gigantic strides and had gained invaluable experience, and at all
times had acquitted itself in a maner which was highly creditable.
Upon the arrival of the division in the Franco-American sector
on August 26-27, 1918, word v»'as received that the balance of the
108th Sanitary Train had been ordered to return to the division.
Division headquarters Avas located at Tronville, Department of the
Meuse.
The billets occupied in the new sector were highly insanitary
from the American viewpoint on sanitation, but great efforts were
made to clean them. Bathing facilities were somewhat limited.
Despite the long trip to the new sector, and the change in billets,
however, the health of the division remained excellent, as it had done
ever since coming to France.
On September 7 the division again moved and division head-
quarters were established in Blercourt, Department of the Meuse.
A few days later it moved to Fromereville and the 108th Sanitary
Train was located at that place and in Sivr^^-la-Perche.
From September 7 to September 10 the 33d Division relieved the
157 and 120th French Divisions, in the Mort Homme and Hill 304
sectors. The 129th Infantry and the 132d Infantry took over the
front lines and the medical detachments of these regiments accom-
panied them into the trenches. The division was attached to the
I7th Corps of the Second French Arm}^
On September 21 the boundaries of the 33d Division were
changed. The two battalions of the 129th Infantry which were
holding the ]\Iort Homme and Hill 304 sectors were relieved by one
battalion of Infantry from the 80th American Division and one bat-
talion of Infantry from the 4th American Division. The eastern
boundary of the division w-as extended to the Meuse Eiver. This was
the position of the 33d Division on the 26th .of September, whien the
American offensive from the ISIeuse to the Argonne Forest was
begun.
Upon the opening of the advance the following method of evacua-
tion was used : By carry to battalion aid post by battalion litter bear-
ers. Thence by carry to nearest car post by ambulance company
bearers. By motor ambulance to triage. Walking wounded to Marre
and by trucks to triage. The evacuation from the triage to the
evacuation hospitals was carried out under corps arrangements by
evacuation ambulance companies. During this attack it was clearly
demonstrated that the medical detachments of the Infantry regi-
ments could not function in the dressing stations and carry litters
at the same time, and that it was necessar}^ to have the required
number of men furnished by battalion commanders to act as litter
bearers in order to secure prompt evacuation.
A. E. F. DIVISIONS. 1599
In spite of the fact that the division did not have its full quota
of ambulances, evacuation was carried out satisfactorily, due to the
splendid and untiring efforts of all ranks of the sanitary train. In
addition to the wounded of the 33d Division, wounded from other
divisions were handled through the triage, and many German
wounded were attended and evacuated to the rear.
The medical detachments of the Infantry regiments did excep-
tionally good work for several days and nights without cessation.
Following closely in the wake of the advancing troops, they estab-
lished dressing stations and dressed wounded under the heaviest of
shell fire from three sides. Numerous casualties were sustained by
the medical depai-tment during these engagements.
September 28-29 the 65th Brigade relieved the 80th Division in
the sector they were then holding. The 66th Brigade had advanced
and had taken all its objectives.
On the 3d of October the 80th Division and the 4th Division at-
tacked and the 33d Division protected the east flank. Our troops
suffered but slight casualtieg in this attack. The 132d Infantry was
then relieved from the subsector Forges and placed as corps reserve.
On the 8th of October the 17th French Corps attacked on a front
from Beaumont to the Meuse. The 132d Infantry crossed the Meuse
in the vicinitj'^ of Consenvoye and Brabant on the 10th and reduced
the Bois de Consenvoye, captured Consenvoye, and pushed farther
nortli and east. Again the medical detachments performed excellent
work, and the process of evacuating the wounded, which was a diffi-
cult one, was carried out promptly. On the 9th of October the 132d
Infantry continued the exploitation of the territory and reduced the
Bois de Chaume and the Bois Platchene to the ravine du-Plat Chene.
As a result of the advances made by the 132d Infantry, a secure
footing was secured on the east bank of the Meuse above Consenvoye,
and therefore the following medical arrangements were prepared to
care for the evacuation of our troops from the new sector:
On the night of October 11-12 the 6()th Brigade and the 65th Bri-
gade relieved each other. In crossing the river the bridge at Consen-
voye, which had been built by the 108th Engineers, was used. This
crossing had no effect on the medical arrangements, except that the
location of the battalion and regimental aid posts were changed with
the changing of the locations of the troops of the brigades.
On October 16. 1918, the 29th Division took over the triage at
Glorieux and Field Hospital Xo. 132 was relieved, but continued to
operate the gas de])artment.
October 21 the 15th Colonial Infantry Division. French, began
the relief of the 33d Division.
The record of the medical department of the division while in the
advance of the First American Army in the Argonne and to the
Meuse was highly satisfactory. During the advance 3.639 patients
were handled. Of these 1.006 were wounded. 1,625 were gassed. 113
were injured. 17 suffered from psychoneurosis. 848 were sick, and 32
died. Over half the sickness was due to gastro-enteritis. Evacuation
was carried out promptly and dressing in the front area was done
at all times under the most trying circinnstances. In the first part
of the attack the forward positions were subjected to shell fire from
three sides. Xumerous casualties were sustained among the members
of the medical department.
1600 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
The mobile Jaboratorv followed the advance of the division care-
fully testing- all Avater supplies. The work of this unit Avas of a very
high character throughout the advance.
The physical condition of the men of the division was becoming
poor toward the end of the period of the occupying of the sector.
The}' had been in the forward area for many days and had engaged
in numerous attacks upon the enemj', had gained all objectives, and
had held their positions under the most trying circumstances; had
l)een subjected to shell fire for a long period of time from three sides,
and had been forced to endure cold and rainy weather without proper
protection. In spite of this the morale of the men was not impaired
in the slightest, but many became exhausted and others were attacked
with gastroenteritis. None of the cases were particularly serious,
however, and the general health of the division remained fair, in
spite of adverse circumstances.
On the 8th of Xovember, due to the fact that the division had en-
larged its sector and held a larger portion of the front line than it did
when it first took over the sector, the medical arrangements were
changed in order to cover the territory more thoroughly and to pro-
vide more lines for the evacuation of the wounded.
In the period of nearly six months that the division had been in
France it had engaged in numerous attacks, and at least three large
offensives, on the Somme, on the Meuse, and in the Woevre. At all
times the Medical Department rendered efficient service and per-
formed in a creditable way.
Xumerous departments not mentioned before in tliis history did
excellent work. Among these was the mobile laboratory. Avhich made
innumerable tests of a delicate nature Avith the most primitive appa-
ratus. While Avith the British this organization Avas stationed with
a British mobile laboratory and receiA'ed instruction there. Upon
the departure of the division from the British sector the laboratory
Avas equij^ped with American equipment and continued its work of
testing Avater supplies and making bacteriological tests to detect dis-
eases. Whenever a contagious disease Avas suspected the patient was
examined and tests made to ascertain whether or not the suspicions
Avere correct. The water supply in each area occupied by the division
Avas carefully tested and impure Avater carefully labeled in order that
troops would not drink it. dilorination of Avater by detachments of
the Medical Department before troops were permitted to drink it Avas
carried out without exception during the entire period of the stay of
33d Division on French soil, and only the water first marked safe by
the mobile laboratory Avas allowed to be chlorinated. In this Avay, by
taking all precautions, numerous sources of Avater supply of danger-
ous character were kept from the troops and the good health of the
division Avas thus maintained.
The health of the division Avas ranked Avhile in the Ignited States
as the best of all the divisions of the ArmA% and this enviable record
Avas Avell maintained Avhile the division was conducting operations in
France. Casualties were CA'acuated with speed and dressings AA-ere
made at times under the most trying conditions, while the stretcher
bearers and other members of the ^Medical Department in the Infan-
trv detachments and machine-gun l>attalions detachments Avorked
often under the heaviest shell fire and machine-gun fire, and did ef-
fective Avork. The Medical De]:»artment of the 33d DiAision made a
A. E. F. DIVISIOXS. 1601
creditable showing throiiohoiit tlie six months of operations conducted
b}' the division.
During the month following the signing of the armistice, the
33d Division passed from the Second Army Eeserve to the newly
formed Xinth Corps and from there to the Seventh Corps of the
Third Army. On December 7 the division started its move for the
area of the Third Army.
Previous to making this move, the entire area occupied by the
33d Division was cleaned up and thoroughly policed under the
supervision of the medical officers, and was fully inspected b}' the
division sanitary inspector before the move was made. Xot only
were villages well policed, but also all the adjoining territory, and
when the division left its area the sector was in excellent condition.
On December T the division started on the first stage of its journey,
Avith Conflans as its first stop. Conflans. 50 kilometers from Troyon,
was reached in two days. On December 10 the division headquarters
was located at Aumetz in the northern part of Lorraine, and on the
12th. Division Headquarters was established in Esch, in the southern
part of Luxemburg.
The following medical arrangements were prepared by the division
surgeon and carried out under the direction of the commanding offi-
cer of the 108th Sanitary Train:
Ambulances patrolled the roads in the rear of the marching
columns, evacuating to the field hospitals soldiers who were forced
to drop out. During the first two days of the march, Creue and
Conflans served as the stations for the field hospitals which fimc-
(ioned as triages. Field Hospital Xo. 129 remained at Creue on the
7th and 8th of December and evacuations for the first half of the
two days' march Avere made to this hospital. During the latter half
of the march. Field Hospital Xo. 131 was the evacuating point, at
Conflans. This hospital moved from the Farm de les Palameix on
the 7th of December.
In like manner. Field Hospital Xo. 130 opened at Briey on De-
cember 10, 1918. and as the march progressed toward and beyond
that point, received evacuations there. Field Hospital Xo. 129
closed on December 9, and moved to Ottingen and opened there on
the folloAving day as a sick-collecting i:)ost and as the march
progressed, evacuations Avere made to that point. Upon the estab-
lishing of division headquarters at Esch. the 108th Sanitary Train
was situated Avith headquarters at Schifflingen and the remainder of
the units at Ottingen. Avith the exception of Field Hospital Xo. 130,
Avhich Avas still at Briey.
The approximate length of the march from the Troyon sector to
the Esch area was 98 kilometers. The actual days of marching were
six. During this period the Medical Department functioned Avith
such efficiency that only 135 evacuations from field hospitals Avere
made from the entire division, and this notAvith^tanding the fact
that practically the entire march Avas made in unfavorable Aveather.
as the roads were a sea of mud and rain Avas continuous throughout
the period of the journey.
While at Esch orders Avere receiA'ed transfei-ring the 33d Division
from the Seventh Corps of the Third Armv to the Second Army
Reserve, and. as a result, troops of the divi^^ion which had pushed
1602 REPORT OF THE SURGEON GENERAL OF THE ARMY.
farther towiud the original destination of the division, and had
crossed the Luxemburg-German border, were ordered to return to
the Esch area. Four days were then spent in the Esch area, while
on the 16th. proceeding under new orders, the troops marched to-
ward the Gravenmacher area, in eastern Luxeniburg. On the 18th
the march was continued and by the 20th the division had entered
its new area, with Diekirch as division headquarters. This area was
located in the northern part of Luxemburg.
I. THIRTY-FIFTH DIVISION.
On September 9 the 35th Division was in First Army Reserve in
the vicinity of VigneuUes. In compliance with orders from the First
Army Corps, the division moved north to the vicinity of Tomblaine,
Jarville, and Maron on the niglit of September 10-11 (Field Orders
Xo. 35). The march was continued (Field Orders No. 37) on the
night of September 11-12 to the Foret de Heaye, where the division
went into concealed bivouac. The division then moved by bus and
marching (Field Orders No. 38) to the region of Charmontois, the
movement starting on the night of September 15-16. Here the divi-
sion was attached to the Third Army Corps and under the Second
French Army for tactical control and supply. B}' order of the Sec-
ond French Army, the division was placed under the command of
the general commanding the Groupement Mordacq. and on the night
of September 19-20 (Field Orders No. 41) the 69th Brigade moved
to the vicinity of Auzeville. On the next night (Field Orders No. 42)
the rest of the division changed station to the neighborhood of
Grange-le-Comte Fine, and the woods east of Beauchamp.
The period of inactivity, in concealed bivouac, in the Foret de
Ilaye was one of hardshii). The troops Avere in shelter tents and
Avere not permitted to move from under cover of trees during the daj^
Rain was almost constant and fires were limited to the minimum
necessary for cooking. Diarrhea was general throughout the
division.
The medical officers and Medical Department personnel of the
line units Avere in shelter tents; no dispensaries or infirmaries Avere
possible. The needs of the troops were supplied from medical chests
and medical belts.
F'ield Hospital No. 137 Avas established at Les Cinq Tranches, on
the Nancy-Toul road in huts belonging to the French, to act as a
triage and to care for emergency cases; seriously sick and injured
were evacuated to the Justice group of hospitals at Toul.
On the night of September 15-16, the divisional Infantry and
machine-gun units were moved by trucks and busses to the Char-
montois region. The wagon trains with the kitchens, as well as the
medical equipment Avere separated from the troops, having been
previously started. These trains, progressing more slowly than the
motors, did not rejoin the division in the region of Grande le Comte
Fme until the 22d of September. The troops Avere without hot food
during this period.
The greatest secrecy was maintained as to the time of the attack,
and every effort was made to conceal the presence of American
troops; French infantry was held in outposts to screen the Ameri-
cans: the division surgeon was not permitted to send the ambulance
A. E. F. DIVISIONS. 1603
company, litter bearer or dressing station sections north of Auzeville,
and as few ambulances as possible were permitted to be used north
of that town. Eeconnaissance of the front and a survey of roads
was, however, made by small details of ambulance company per-
sonnel. In spite of all the secrecy and lack of information from
United States sources, the division surgeon was informed most
casually by a French sergeant that we were to attack on the 26th.
With this unofficial information every effort was made to prepare
for the attack on that date, though with all ambulance companies
and field hospitals jammed in the woods, on narrow, muddy, slippery,
wood roads, already blocked by skidding and wrecked trucks, and
with only enough transportation to move the hospitals forward in
relays.
The medical cars joined the units in the woods, but were not up in
time to reach the advanced battalions, nor were they permitted to
accompanj' the remaining units as they went forward on the night
of the 25th. Some of the battalions were cut from contact with their
regular supplies from September 15 until after the Argonne action.
Had medical carts, or even pack mules, been permitted to accompany
the units into action the carts could not have crossed the trench
lines nor could the pack mules have kept up within reach of the
troops during the rapid advance under heavy artillei-j' and machine-
gun fire, hence the regimental and battalion sanitary detachments
went into action with their medical belts and such extra dressings,
shell dressings, and antitetanic serum as they could carry on their
person. Not having H. C. pouches, carriers for dressings were im-
provised. Empty gas-mask cases and grenade sacks were filled and
carried by both officers and men. The supply of the front-line units
therefore fell entirely on the division supply officer's stores and on
the field hospital's reserves even during the days preceding the jump
off.
SANITARY ORGANIZATION.
(//) Battalion aid stations and regimental aid stations will be
established by regimental surgeons. In no case will a battalion or
regimental aid station be located at the same place as the regimental
post of command. So far as possible wounded will be collected at
these points by the regimental sanitary personnel, where they will be
reached by ambulances and ambulance company litter bearers. In-
formation must be sent out to the division surgeon as to the location
of the first-aid stations and wounded groups.
(5) A sorting and advance dressing station (triage) will be estab-
lished as follows:
Neuvilly. — This station will be located off the main-traffic route,
preferably just outside of the town. This to avoid traffic congestion.
It will be located west of the main-traffic route, so that it may be
reached by the prescribed one-way roads when the main route is
closed for repairs.
Regulations governing evacuation from triages will be as pub-
lished in ^femorandum G-1-48, headquarters First Armv Corps.
September 3. 1918.
With roads blocked and Avith less than one-third of trucks neces-
sary to move the sanitary train, the work of the field hospitals and
ambulance companies during the trying night of September 25 in
142367— 19— VOL 2 iO
1604 EEPOET OF THE SURGEON GENERAL OF THE ARMY.
getting out of the woods without lights and over slippery, jammed
roads under intermittent artillery fire, and in the forward sector
under practicallj^ constant enemy fire directed along the traffic
routes and crossroads was most commendable. Too much credit can
not be given the truck drivers; their driving under most difficult
conditions was almost beyond belief. It must be said that not one
truck of tlie sanitarj' train was ever out of service during the entire
Argonnc section.
The night of September 25 spent at the dressing station at Auze-
ville was one of unforgetable anxiety. With the knowledge that the
troops were to jump oif at 5.30 a. m., that the hospitals and ambu-
lance companies were not up, and that they were possibly hopelessly
blocked in the Avoods in the rear, combined Avith the fact that the
station was being shelled, the Boche trying constantly for the cross-
roads near which the station was located and for a railroad gun and
field batteries which were sent close to the station, the night was a
most trying experience.
September 26. — After an artillery preparation lasting three hours,
the Infantry jumped off at 5.30 a. in., following a rolling barrage at
the rate of 100 meters in four minutes which lasted from 5.30 to 7.40
a. m. The day was very foggy, making the maintenance of liaison
very difficult.
Vauquois Hill, strongly fortified and garrisoned, and Bois de Ros-
signol, another strong point, were attacked from the flanks, the special
battalion detailed for the purpose of " mopping up " after the lead-
ing battalions had passed.
Owing to the dense fog there was some intermingling of units, both
Avithin the division and with other divisions, but the attack proceeded
past Vauquois Hill, Bois de Rossignol, Cote 221, and other strong
points under heavy machine-gun and artillery fire. As the fog
lifted the eneni}'^ fire became more and more effective, artillery fire
from the sector on the left being particularly harassing. Finally
the attack was sloAved down and temporarily stopped before the
strong enemy positions at Varennes, on the left flank, and at Cheppy
on the right. Heavy losses were suffered, particularly in front of
Cheppy. Tanks Avere brought up and after a heavy figlit both
Varennes and Cheppy were captured. The operations above de-
scribed lasted until about noon.
In the meantime the Artillery had been attempting to move for-
Avard, but without much success, due to the condition of the roads
and the character of the terrain. The 129th Field Artillery started
to move forAvard at 8.30 a. m. and one battalion of the 130th Field
Artillery at 8.25 a. m. and the other tAvo battalions at 10.15 a. m., the
128th Field Artillery starting to moA'e at 9 a. m. HoAveA^er, for the
reasons noted above only one battery of the 129tli Field Artillery
was able to reach its forAvard position on that day.
Many of the company commanders and field officers had become
casualties in the morning attacks, and it Avas necessary to reorganize
the regiments. The division commander made a personal recon-
noissance of the situation and gave personal directions to brigade and
tank commanders to start another advance. This carried the line
to 11 kilometers south of Charpentry on the left and 1 kilometer
north of Very on the right. This advance was made under heavy
artillery fire, but Avith less machine-gun resistance than in the earlier
A. E. F. — DIVISIOISIS. 1605
attack. At 4 p. m. the leading elements received the order to dig in,
the other units disposed in depth. The night was passed in this
position under intermittent artillery fire.
All the regimental and battalion detachments worked on the same
general plan; that is, 2 medical officers, 1 dental officer (if available),
and approximately 12 men with each battalion. Two men were
assigned to each company for immediate first aid. The battalion
surgeons followed closely their battalions and established such col-
lecting stations as conditions of terrain, fire, and location of wounded
demanded. Classical aid stations were not possible; most often the
aid station was nothing but a collection of wounded grouped in any
kind of cover close to where they dropped. Such stations were in
dugouts, ravines, behind hills, in woods, in ditches, in houses, barns^
and in one instance in a drain culvert 3 feet high, 4 feet wide, and 3(>
feet long. It was not possible to carry other than the most essen-
tial dressings, shell dressings, morphine, and antitetanic serum.
Splinting with Thomas or wire splints in the battalions was impos-
sible. Splints were improvised of rifles, pieces of wood, etc., and the
wounded were made as comfortable as possible. Splinting was done
by the advance litter bearer sections of the ambulance companies,
who were able to transport splint material by pack mule or ambu-
lance.
Blankets were policed from Boche dugouts to cover wounded ; rain-
coats and coats were also policed from the dead Boche to protect the
wounded from cold and rain.
The divisional dental officers all worked as medical officers during
the action; at Gerardmer all the dentists in the division had been
sent to our field hospitals for a week's training in first aid, splinting,
administration of serum, etc., so that they were all able to perform
duties of unit medical officers in action. The dentists with the field
hospitals functioned as if they were medical officers of the staff.
The regimental surgeons established at times independent stations,
and at times worked with their battalion surgeons, and they main-
tained liaison between the battalions, regimental headquarters, and
the ambulance companies.
The 137th and 138th Infantry regiments bore the brunt of the
fighting on this day; the losses were relatively heav3% especially
about Cheppy, a pivotal point in the Hindenburg line, where 76
machine-gun nests were taken, and at Very on the right flank. The
casualties, contrary to expectancy, were light about Vauquois Hill,
that strong point, supposedly impregnable, having been almost
blasted off the map by the preliminary artillery barrage.
The road situation was always our greatest trial. Practically all
roads were hopelessly blocked immediateh' after the action started,
j The nonsurfaced roads through the woods were jammed with artil-
lery and skidded trucks, the main road was impassable because of
[ the large mine hole south of Boureuilles. The roads of the 28th and
\ 91st Divisions were also blocked. For the first 30 hours the work
; was done with no usable road across the trench lines. The theoretical
southbound road on which our triage was located was converted
into a northbound road, and that soon was hopelessly jammed. Our
animal-drawn ambulances over the trench lines were our only hope.
Sejyteviber 27. — In accordance with Field Orders No. 47, the divi-
sion renewed the attack at 5.30 a. m. on the morning of the 27th.
1606 KEPURT OF THE SURGEON GENERAL OF THE ARMY.
The division commander had issued orders for the attack to start at
8.30 a. m. after consultation with the Artiller}^, as only by that hour
could sufficient Artillery get forward to give effective support to the
Infantry. . But at midnight orders from the First Army Corps
were received to attack at 5.30 a. m. Field Orders No. ^7 were
accordingly issued, and in order to prevent a possible mix-up owing
to the change of time, the division commander went in person to see
the brigade and regimental commanders at their posts of command
betAveen 1 and 4.30 a. m., thus assuring liaison and coordination.
A passage of the lines was effected and the attack made with
the 70th Brigade in the lead, two battalions in each regiment being
in the front line and one in support. The 69th Brigade was in sup-
port, each regiment being in column of battalions. A machine-gun
company was attached to each front-line battalion. Tanks were
assigned to the front-line Infantry, to be used as determined by the
brigade commander after conference witli the commander of the
tank corps. The 128th Machine Gun Battalion was attached to the
69th Brigade in reserve. The rolling barrage to cover the advance
was very thin, as only one battalion of the 129th Field Artillery
was in position at the hour of the advance. Very heavy artillery
fire was encountered as soon as the advance was started, and it was
stopped by heavy machine-gun fire from Charpentry. The tanks
were sent for and another attack launched at noon, but little advance
was made, as the tanks were driven back by the fire from artillery
and antitank guns. Finally nine more tanks reported along the Very-
Charpentry road, and at 5.30 p. m. a new attack was launched.
Charpentry was captured and the advance carried beyond Baulny.
It was difficult to maintain contact between units in the night ad-
vance over difficult rough terrain, and finally the main body dug in
for the night be^vond Baulny, with advanced elements beyond the
Montrebeau Woods. Artillery fire was heavy at intervals during
the night over the entire divisional sector.
OPERATIONS OF SANITARY TROOPS.
(a) Amhulancc cotnpanies. — Ambulances, principally Fords, of
which a few had managed to crawl through the road blockades dur-
ing the night as far as Cheppy, some of G. M. C.'s, with loads of
wounded, who had been littered back to Boureuilles and the mined
hole in the road at the trench lines, and a few of the animal-drawn
ambulances which had gathered patients from the Vauquois-Manelon
Blanc area, as well as trucks returning along the main route, began
filtering into the triage during the afternoon and night.
Ambulance Company No. 138 continued to operate: the triage at
Neuvillv until 2 p. m.. September 27, when it was relieved by Field
Hospital No. 138.
The triage at Neuvilly was operated at all times under canvas,
ward tents being assigned to each department and otliers pitched as
required.
Effort was made to sort the cases for evacuation to the different
classes of evacuation hospitals, but with the limited transportation
it was very difficult under pressure to sort the cases as accurately
and as exactly as the evacuation hospitals demanded.
A. E. F. DIYISIOXS. 1607
111 anticipation of an advance beyond Baulnv dnring the day
the 138th Triage Ambulance Compam' "was relieved, its equipment
packed in trucks, and liekl ready to jump forward as ^oon as ordered.
The other ambulance companies in the meantijue were pushing
forward with their litter bearer and dressing stations sections, main-
taining contact with the advancing troops, collecting, dressing, and
splinting the wounded, gathering them in groups for evacuation.
S. S. U. 649. with the Fords, did splendid work, going well forward
all day and all night, working from the triage to the wounded groups,
dressing stations, and in some instances up to the regimental aid
stations.
The transport sections of the Ambulance Company No. 138 and
Ambulance Company No. 41. with the G. M. C.'s, worked through the
road jam on the main road.
FIELD HOSPITALS.
The section of Field Hospital No. 140 established as the rest and
medical section of the triage continued to operate. Cases of exhaus-
tion did not begin to appear in any number until the latter part of the
engagement, but from the beginning there were the cases of so-called
shell shock and light gas. These patients gave us always a good deal
of trouble. It Avas desired to save all possible men for return to
the lines. Strong efforts were made on this point from the beginning,
ifet it was not desired to send back any of the supposedly light gas
cases, who might turn out to be dangerously gassed with phosgene.
Hence as long as we had room in the rest section of the triage all
uncertain cases were held until the diagnosis could be cleared up.
Later in the action, when the congestion was terrific, it was necessary
to clear rapidly, and for this reason, no doubt, cases were sent back
that might have been saved for immediate return to the lines. How-
ever, orders were issued that in cases of doubt the benefit of the doubt
should be given to the soldier.
Field Hospital No. 138 relieved the 138th Ambulance Company
during the afternoon. The special triage teams were divided and
augmented by personnel from the reserve field hospitals. Part of
the teams remained with the field hospital triage and others, those
that had worked all during the day and night before, were ordered to
rest and be ready to go forward with the ambulance company triage.
Patients began to pour in during the day, from the 28th Division,
from the Army and corps troops, from the attached tanks. French,
and other units as well as our own division.
Field Hospitals No. 137 and No. 139 were held in reserve; the per-
sonnel, however, being sent in as needed to assist and relieve the
triage.
GENERAL CONSIDERATIONS.
The advancing regiments having run short of supplies on the 26th,
since they had no means of transportation for the medical chests or
reserves, every ambulance returning to the front carried dressings,
blankets, and all the litters that could be spared. Pack mules were
sent up to the advance dressing stations to assist in carrying sup-
plies to the battalions.
1608 KEPORT OF THE SURGEOX GEXEK.VL OF THE ARMY.
Fortunately the ambulances and pack mules were able to get
through the roads during the night so that before the attack at 5.30
a. m. the Infantry and machine-gun units had sufficient supplies to
carry them over the day. The Artillery regiments, being able to
transport their chests and reserves, had no shortage of supplies. The
supply problem was always one of prime importance throughout the
engagement since evacuation to the rear was made mostly by trucks.
The trucks from our own sanitary train returned from the evacuation
hospitals with an exchange of splints, dressings, blankets, and litters,
but foreign trucks, i. e., those belonging to corps, Army, the French,
or other divisions carried large amounts of supplies out for whicli
there was no return. To balance this constant loss the medical-
.supply officer sent his trucks back to the medical depots and to the
hospitals for loads, and at one time during the engagement it was
necessary to send medical officers back to the evacuation hospitals
to assure an exchange of supplies for our ambulances.
The road jam continued throughout the morning and well into the
afternoon. The engineers had constructed a new driveway around
the mine hole at the trench lines, but during the day the road was
again blocked by the explosion of either a delayed action or a contact
ndne in the Boche trench area near Boureuilles. This blew up as
one of our 155-millimeter guns was passing over and caused further
delay.
The enemy counter attacked at 6.30 a. m. from the JMontrebeau
Woods, but the attack was repulsed. An attack was organized in
the left (west) sector against the woods, which were filled with
machine-gun nests. The advance had to be made over open fields,
with direct enemy observation from the hills beyond Exermont and
in the face of heavj^ machine-gun fire. Apremont. on the left bank
of the River Aire, had not yet been taken by the division of the left,
and a flanking battery from the Argonne Forest just bej^ond caused
heavy casualties. The advance proceeded, however, and a footing was
gained in the Montrebeau Woods, which still remained in the hands
of the enemy. At 9.45 a. m. another attack in the right sector was
started, assisted by tanks. This attack was also met with very heavy
Artillery resistance. It proceeded slowly forward and finally reached
a position about 500 yards north of the L'Esperance-Chaudron Fme
Eoad, with its left directly north of Chaudron Fme. The tanks were
not as effective in this attack as they had been in the original advance
against Cheppy as the artillery fire over open sights proved to bs
too strong for them to stand. The machine-gun fire from the Montre-
beau Woods and the strip of woods running east from the northern
edge continued. Artillen- fire both from the front and the left bank
made the advance exceedingly difficult. The day ended with our
troops in partial possession of the Montrebeau Woods and dug in
on a line to the east. Man}- of the companies had lost all their officers
and junior officers were in charge of battalions, and the successive
attacks through fog, in woods, and at night had resulted in an inter-
mingling of units which made a well-coordinated advance difficult.
Septemher 29. — At 5.30 a. m., in accordance with Field Orders No.
48, an attack was ordered, with Exermont as the objective. Enemy
artillery and machine-gim fire was increasing steadily in intensity,
new machine-gun positions having been organized north of Montre-
beau Woods. At three different times during the day small bodies
A. E. F. DIVISIONS. 1609
of troops were pushed up to Exennont but in each cix^e ihev were
met by artillery fire from both flanks, as well as from the front, and
enemy machine gunners worked around to their rear on the flanks,
making a withdrawal necessary. Finally the order was given to
retire to the line of resistance north of Baulny which had been pre-
pared by the 110th Engineers. The withdrawal was successfully
accomplished by night, the wounded being taken back from the woods
and from Charudron farm, the advanced dressing station. An enemy
counter attack was repulsed by the covering troops in Montrebeau
Woods and the general line L'Esperance-Chaudron Farm-Cote 231
was organized.
Ambulance Company No. 138 : This company, supplemented by the
special teams, continued to work at the dressing station (triage) at
Cheppy, always under high pressure dressing, treating, and evacuat-
ing the steady streams of wounded that poured in, not only from the
front, but particularly from the 91st Division on the right as well.
Returning ambulances, trucks, wagons, all came down loaded. "Walk-
ing wounded came through in a steady procession. Extra details of
military police were necessary to assist in the control of the heavy
traffic about the station. Many cases of so-called shock, light gas,
and exhaustion soon filled the rest hospital to overflowing. Accord-
ingly the regimental surgeon of the 110th Engineers was instructed
to take over dugouts farther east of the station to care for the over-
flow of ambulatory cases. At noon, he reported dugouts ready for
200 cases. These filled at once. At noon, in spite of strenuous efforts
toward evacuation, the station was swamped with nearly a thousand
cases. All buildings, tents, and dugouts were full, the ground about
the tent and dugout entrances was covered with litter cases, and
the road for a hundred j'ards was lined with litter cases, three deep.
And then the Boche began to increase his artillery fire, which had
been more or less constant, from light, to the proportions of a bom-
bardment, presumably directed at the batteries which were on both
sides and behind the station. Many shells struck directly in front
of the triage, in the soft ground bordering the little creek, throwing
mud into the station and all over the recumbent wounded. With
news from the front that our lines were falling back, that tlie enemy
was running short of ammunition, and that there was a possibility
of the enemy breaking through as far as Cheppy, the situation looked
serious.
Extraordinary efforts were made to get the wounded out. The
commanding officer of the military police as well as the commanding
officer of Division G-1 rendered every possible assistance in getting
trucks. In addition Army and corps trucks were policed and all
available ambulances were utilized.
A column of walking wounded of about 250 was organized. Won-
derful spirit was shown by the men when call was sent out for all
men able to walk to fall in: at least 25 men shot through the feet,
lungs, thighs, or so badly wounded that transportation was absolutely
essential were taken out of the column. In every case they wanted
to walk and give place in a truck to some one wounded more severely.
Between 3 and 5 o'clock over 750 patients were evacuated to tlie
field hospital at Xeuvilly and at the same time over 500 were sent
direct from Charpentry to Xeuvilly. The congestion, was. for the
1610 REPORT OF THE SURGEON GEXP:RAL OF THE ARMY.
tinic. lolioved. :uul aftenvardji we were able to keep the evaeuation
rate up above the intake.
Fortunately there were no direct hits in the station, though shell
fragnnents occasionally came in. There were many narrow escapes.
On account of the seriousness of the situation it was deemed advisable
to send most of the special triage teams l^ack to the field hospitals at
Xeuvilly after the congestion had been relieved.
Ambulance Company No. 138 kept at its unremitting work in the
station at Cheppy. Although the men and officers were almost drop-
ping in their tracks from fatigue, they went on cheerfully and with-
out complaint. It is desired to make of official record the following
extracts from an article by Arthur Ruhl in Collier's Weekly of Jan-
uary 11, 1919, entitled "Last Offensive," in which he describes the
station at Cheppy as it appeared on the night of September 29 and
during the day of September 30 :
When the 35th Division Infantry was withdrawn by corps orders from Exer-
mont sector most all the wounded were carried or sent back. About 225 were
collected at Chardnm Farm. Lieut. * * *, then on duty with the 2d Bat-
talion, 139th Infantry, receiving information that a number of wounded were
left at the farm under guard and that a medical officer was needed, proceeded to
that place of his own accord and accompanied by his enlisted assistant. During
the afternoon of September 29 he worked continuously, dressing and evacuating
patients, constantly under heavy fire of high explosives and gas. Twice during
the day the Germans attacked the dressing station and Avere driven back from
the very walls by a detachment of the 139th Infantry. At 10 p. m. September 29
there still remained 95 litter patients. The guard had suffered heavy losses, and
in spite of requests no aid had been received. Lieut. * * * was informed
that the main line had fallen back a half mile behind this station, and that there
were only 25 men between the station and the Boche. To secure assistance,
Lieut.- *' * * voluntarily procured a mule which was in the barn of the
farm, bareback, and with aVope halter started back through heavy artillery fire
and machine-gun fire for help. Lieut. * * * arranged for assistance by
ambulance, litters, and litter bearers. He then started back to the station,
always under shell fire, with the ambulances and litter bearers. Believing, how-
ever, that all of the wounded could not be removed before daylight, and knowing
that' the Infantry protection was inadequate, Lieut. * * * again mounted
his mule and proceeded under fire to Artillery headquarters to procure a protec-
tive barrage in front of the station. Knowing that the Infantry guard might be
out in front where the barrage had been ordered to be placed, Lieut. * * *
ran his mule back through Charpentry and through the fields and hills to the
station, which was at this time a half mile in front of the front lines, and suc-
ceeded in getting the Infantry back just before the barrage started. At daylight
on September 30 there were only 12 men of the Infantry guard left and a number
of wounded men still unevacuated. Lieut. * * *, therefore, again made a
trip back to procure more litters and litter bearers and with Lieut. * * *
took the men and litters up over the hill toward the station under a most violent
shell fire. He continued with his work until every soldier, as well as five Ger-
man prisoners, had been evacuated and the station entirely cleared.
The village, or what was left of it — it was a few miles west of Hill 304 —
was black, as all things near the front must be at night, and blacker still under
the low-hanging clouds and rain. Not a light, scarcely a glimmer except that
which seeped through the hospital tents or flickered momentarily fi-om the
camp kitchen when the canvas curtain that was supposed to shield it was
pushed aside. It lay in a pocket in the hills, down into which the never-ending
trafiic from the front ground ceaselessly, and close by this procession of motor
trucks, lurching foi'ward without lamps, in dugouts left by the enemy, and
tents hastily set up in the mud, was the triage, or soi'ting station for the
wounded, and the field hospital.
It was not a good place for a hospital — neither easy to evacuate from, nor
safe. The one road to the rear was choked for miles. Two blown-up bridges,
which the Engineers had not yet contrived to repair, had been replaced by
rough cut-offs, running down into hollows and out again. The huge trucks
plunged down these, skidded off the narrow way, sagged into mud holes.
A. E. F. DIVISIONS. 1611
Idcked wheels with those coming up — loads on which men and gmis depended
were a whole day covering 3 or 4 miles. Down through this mess the am-
hulance drivers had to fight their w^ay. Then the front line just over the
hills : all about were batteries banging away, and likely at any moment to
draw the enemy's fire.
This was one of the batteries firing just above and in front of the hospital.
The vicious darkness was lit constantly by their flashes only to become the
blacker as the pale flare w^ent out. Enemy shells had fallen several times in
the village during the afternoon — there was no particular reason why the
dripping little pocket in the hills might not at any moment be filled with gas.
Meanwhile, out of the dark and rain and tangle of motor trucks, the am-
bulances came in and discharged their four stretchers each of wounded. Out
of the dark, too, soaked, mud-plastered, helping eacli other and hobbling alone,
came the " walk-in cases " — men with scalp woinids. fingers shot off, slightly
gassed. All had cards pinned to their tunics, giving their names, units, and
nature of their wounds, and all — the " stretcher cases " as w^ell — had to pass
the receiving clerks and have these facts taken down. Then they w^ere sorted —
surgical cases here, gas there, " shock " in another ward. In the dark and
the mud. stumbling over tent ropes, helped out now and then by somebody's
flashlight, they landed finally in their various tents.
Many had already passed three other stages in the long journey from the
firing line back to the base hospital — the battalion aid station, almost in the
fighting itself, the regimental aid station, a bit farher back, in the lee of some
hill, perhaps, only occasionally visited by harassing shells ; then the ambulance
dressing station, the nearest point to w'hich it was practicable for motor am-
bulances to go. A day or so later I passed one of the ambulance dressing sta-
tions from which some of these wounded had come. It was in an abandoned
liouse beside the road, the yard in front heaped- with blood-stained bandages,
liroken splints, helmets, shoes. A bare foot, or what had been a foot stuck
up from this pile, and there was a scalp lock with something clinging to it.
The young doctor in charge, unshaven, haggard after his three days and nights
running, motioned toward it wearily. " There's a bit of some lad's knowledge,"
ho said.
A good many of the droves of wounded that kept ebbing back to the triage
station were minor gas cases, and needed only a little rest and something
warm to eat and drink, to return presently to the line. Everybody in this
open fighting through woods and ravines is likely to be gassed. This stuff
sticks to verdure and earth, especially when they are damp, hangs for days
in hollows and thickets — there's no dodging it. In the dim light of the gas
tent a long line of men waited to be looked over, coughing, shielding their
tear-filled eyes. Some were helpless for the moment and had to be led like
blind men. A calm, clear-headed young doctor turned each one toward the
light. "What's the matter with you, lad? Gas? How do you feel? Um — Yes.
Go and get .some coffee and a good night's sleep. You'll be all right to-morrow."
For those who needed it, he ordered a neutralizing wash for their eyes, and
if thpy wM-e seriously burned, a bath, new clothes, and a hospital farther back.
The tent filled, and stretchers, covered as vv-ell as might be for the moment,
were set on the ground outside. The icy water gathered in pools about them ; it
trickled under the edges of the tent and. unnoticed in the dim candlelight, soaked
the blankets of men too worn out to change their position or protest.
Some had lain 48 hours before being picked up or waiting in the aid stations
until stretcher bearers could get iip to them. None had been really dry, or
warm, or clean, or out of the fear of death for days. Dirt was gi'ound into
their hands and faces : they were thirsty and hungry and, under the soggj- wool
of their uniforms, crawling with lice. Here and there a boy lay, eyes closed,
half asleep, shivering like a wet dog with each convulsive breath.
Down the length of the long evacuation tent, where they lay in two closely
packed rows on straw, the canteen workers and their own sanitary corps men
went with cups of soup and cocoa and coffee. A little length of rubber tube went
with each cup, so that those who could not sit up might suck up something with
that. Some shook their heads and closed their eyes again : some drank greedily
to the last drop and muttered, " God I That's the first warm thing I've had in
a week ! " From time to time, with a rush of cold air. the tent flap opened and
new stretchers came in or others went out to the ti'ucks. Xob^Hly complained,
nobody said much. It was too soon for that. A few compared notes with men
on adjoining stretchers.
1612 REPORT OF THE SURGEON GENERAL OF THE ARMY.
It was into the shock \\ arc! that those were brought, men who for 4S or 72
hours ou end, perhaps, without sleep and ahnost without food or drink, had been
the steel point of the division's spear thrust into the center of fire and finally
withered in its breath.
A low concrete room, with a roof of logs and several feet of broken stone, had
been built into tlie hillside. Safe from almost anything when the Germans had
used it for some sort of headquarters, it now faced the wrong way, but was a
shelter nevertheless. The room was filled with stretchers set on sawhorses, and
under some they had set candles and, ^Milling the candles in with blankets, con-
trived little makeshift heaters. Over these heaters they laid the stunned and
weakest. The insistent thing was to start their circulation to make them strong
enough to stand the journey farther back.
An inspector experienced in nervous disorders sorted them at the door — for
ill the hurry of the aid stations " shock " is almost as easy a diagnosis as
" gas " — and admitted only those who could not be taken care of elsewhere.
" What's wrong with you, my lad? Wounded? No? Gas? You're all right;
just a little tired out, that's all. We'll give you something hot and a place to
sleep and in a couple of days have yoi; back with your company." The " back
with your company " idea was accented at once. The notice of the interior and
a long period of convalescence was not. if it could be prevented, permitted to
get a start. Even men quite unstrung were treated — if not wounded and able
to stand it — in the same heroic fashion. The idea was to get the paralyzed
machine functioning normally as soon as possible — not to let tlie soul sickness
become chronic.
One boy came in trembling like a terror-stricken horse, jerking his
hands and arms. He had almost lost the power of speech. " What's your
name, son?" the doctor demanded briskly. The boy stared wildly into space
and made no reply. " What is your name?" repeated the doctor severely
" Come, come, you've got a name !" The boy pulled himself together and ex-
ploded, rather than answered: "Johnson." " W'hat's your name? You've got
a first name. Come, out with it !" Tlie boy made another effort, and finally
articulated, " William." The doctor went on from question to question — not
because the information was of any importance, but merely to get the machine
gun running again. An hour later the same man stood in line with a lot of
others, waiting for " chow " and coffee — not quite himself again, for he started
when anyone came up behind him, but talking with the man next to him and
well on the way.
But the motionless figures in the dim candlelight of the ward itself were not
to be cured so easily. Some, shot through the stomach or intestines, had, at
best, probably only a few hours or days to live. These always thirsty were
not allowed to drink for fear of internal hemorrhage, and they kept moaning
for water. The doctor in charge — physician, nurse, and stretcher bearer, all
in one — for the time being — smoothed their foreheads, tried to quiet them,
gave them sometimes a bit of damp rag to draw between their lips. One sud-
denly broke the muggy silence with a delirious cry : " Send for Dr. * * *^
of Kansas City !" They were all Missouri and Kansas men.
Out in the dark, lighted every now and then by flashes from the near-by bat-
teries, the traffic still went grinding by without lamps. A curious monster, with
the look of a steam roller, rumbled vaguely past. It was a huge tractor-drawn
siege gun, and as one of its crew lighted a cigarette you could see them riding
astride it like elephant drivers, slouched in their dripping slickers. Behind
us the curtain of the shock ward opened and released a misty shaft of light
and a couple of orderlies carrying a stretcher with a dead man on it covered
with a blanket. They set their burden down beside a row of similar shapes,
lying there imnoticed in the dark, with a flash lamp found a stray "shelter
half " on a salvage dump, spread it over the stretcher and returned to the ward.
It was warm there, at any rate, and after a time I joined the doctor who
did the sorting and shared with him the top of an unoccupied box. For long
spaces the room would be almost still except for the constant moans for w^ater.
Once a boy, apparently asleep, suddenly stirred, and, as if awakening from a
dream, cried out: "An' all them poor boys still alying back there!" The
ward doctor came over, felt his cheek, asked him if he wanted anything,
tucked his blankets in more snugly. " Be quiet now, Buddy, and go to sleep !"
he said. " Don't worry about the boys — they'll all be taken care of."
There was a strange, mummylike figure which had lain in the center of the
room since earlier in the night, its hands, black with many days of unwashed
dirt, clasped on top of the blanket, its head so wrapped in bandages that almost
A, E. F. DIVISIONS. 1613
uothing showed but the tip of the nose. The man had made no sound then,
though one could see that he breathed. The doctor, touching him as he passed,
stoppetl and laid his hand on the man's neck, underneath the bandages. He
leaned closer for a moment, and then beckoned to two of the orderlies. With-
out distui'bing the men on either side, they lifted the stretcher and carried
it out, and laid it beside the others in the rain.
Very quietly, from this man to that, wherever he could seem to be of any
use, went one of the division's chaplains. He was a Jesuit priest, though with
his square jaw, calm, kind, humorous, and understanding gaze from behind a
pair of spectacles one might as well have thought him some young professor or
college-bred business man. Sometimes knelt clo.se beside a wounded man, the
two talking together almost inaudibly for long minutes at a time. In that
dim little room, where the flesh was so weak and der.th seemed so near and
so natural, men's souls were naked, if they ever could be ; yet not everyone
would have had his gift of drifting, as it were, into the spiritual tide on which
each of these different, troubled spirits were floating.
Outside the open door of our dugout the rain spattered tirelessly. Suddenly
there was a quick swooping whistle and a dull chug, not a crash of the ordinary
shell. Somewhere out in the dark a horn snarled the alarm and one heard cries
of "Gas!" "Gas!"
It was not a pleasant sound, there in that pocket in the hills with all those
wounded. It could be easily filled with gas, and in weather like this the stuff
would lie there for days. We fumbled for our masks and pulled them on ; out
in the hospital tents they got the men ready as best they could. But only two
or three shells came over, and after a bit we took our masks off again.
Morning came at last, sodden and more than ever cheerless. We shook our-
selves together, splashed through the mud to a " chow " line and a tin of coffee,
and another day began. The rain still drizzled — on the sagging hospital tents,
on new gangs of " walking cases," squatting where they could until the trucks
should come; on the row of silent shapes covered with blankets and shelter
halves, still lying in the hospital yard.
And was this rain and cold and mud and suffering to drag on into another
night like the la'^t one, and so on without end? It probably seemed so to the
woniout doctors and the men shivering on the stretchers and the boys still left
up In the line. And those whose business it is to watch such things knew that
it would seem .so and had given orders accordingly. For the division was
'• u.sed up," as they say. Not destroyed, for you would scarcely have noticed
the losses had it marched in from the front ; but it had burned up its freshness,
suffered heavily, and the human flesh and nei-ves of which it was made had
been sti-ained to a point beyond which furtlicr strain would not be tactically
prolitabl?. Already strange yoimg staff officers, curiously smart and fresh
looking, were in town looking for headquarters' billets, and presently the word
went round, "The th's relieving us! We're going out to-night!"
.T. THIRTY-SIXTH DIVISION.
On July 1. 1918, the division was preparing to leave Camp Bowie,
Fort Worth. Tex., for overseas service with the American Expedi-
tionary Forces, after having been in training there for 10 months.
On Jnly 4, 1918, the division surgeon left Camp Bowie with the
advance party of the division en route overseas. The movement of
the division itself began on Julv 8, and embarkation began on
July 17.
The division began to arrive in France at the ports of Brest and
St. Xazaire on July 31, 1918. Very little siclaiess was recorded dur-
ing the voyage, though on several transports sporadic cases of
measles and mumps made their appearance, beginning in every in-
stance among casual troops on board.
After two or three days' rest at ports of debarkation, the division
began its movement to the 13th training area.
On the night of October 6 and day of October 7, the 71st Brigade
relieved Marine and Infantrv brigades of the 2d Division, less one
1614 KEPOKT OF THE SURGEOX GENERAL OF THE ARMY.
battalion from each of the hitter units, in the line on the Chanii)agne
front. Elements of the 2d Division just named did not move out
until the lOtli of October. The 72d Brigade relieved the Tlst Bri-
trade October 10, in advance and sup23ort, the Tlst Brigade going
into reserve of the division.
The initial attack of the division was begun by the Tlst Brigade
on the morning of October 8. During that day and the succeeding
one the enemy was driven out of. his positions; line generally east
and west from the village of St. Etienne-a-Arnes to Medeah Farm,
from which line the action began.
A high rate of casualties characterized the activities of the 8th,
and a lesser but not inconsiderable number the activities of the fol-
lowing day. These were handled with creditable facility by the
medical detachment of troops in action, and evacuated by them to
triage ^d Division at Somme-Py. The greater proportion of these
casualties were the result of shell, shrapnel, and machine-gun fire.
The relatively large number of gas casualties evacuated during these
two days and for a time subsequent was i^robably due to the inex-
])erience of the various medical officers with gas casualties; and in
part was undoubtedly the result of intensive training in gas defense
and a consequent exaggerated anticipation of the effects of gas
poisoning. Many of these cases were caused by high-explosive gas
from shell bursts, rather than true cases of gas poisoning.
On October T the ambulance section of the 111th Sanitary Train,
including S. S. U. No. 586 (attached) , began to function, evacuating
through the triage of the 2d Division. The latter continued to
operate until the evening of October 9, evacuating a total of 626
casualties from this division. The triage of the 36th Division, 143d
Field Hospital functioning as such, was established on Suippes-
Somme-Py Road, 1 kilometer south of Somme-Py, and began operat-
ing at T.30 p. m., October 9, functioning conjointly with the other
three field hospitals of the 111th Sanitary Train. This triage was
moved up as the action progressed to its final location, 1 kilometer
south of Dricourt. Field Hospital No. 141 was established at
Aulney-sur-Marne for treatment of sick of the division. Field Hos-
pital No. 14 was established at same location with triage for care of
nontransportable surgical cases. On October 10 Field Hospital No.
142 was established near Suippes Farm for care of gas cases. Am-
bulance companies. 111th Sanitary Train, with attached unit, handled
cviicuations throughout.
The T2d Brigade, having completed the relief of the Tlst Brigade
on the night of October 10. attacked the retreating enemy and drove
his forces to the Aisne River, capturing the towns of Machault,
Dricourt, Vaux-Champagne, and others in this sector.
The troops of the division having advanced to the Aisne River
headquarters of the division were established at Dricourt October 13.
From this date until October 2T casualties were relatively few,
consisting mainly of sick cases. The last offensive operation of the
division occurred on October 2T, when the Tlst Brigade drove the
enemy from the territory which he had held up to that time in the
loop formed by the River Aisne north of the village of Roche. This
action was accomplished with few casualties — 8 killed and 12
wounded.
A. E. F. DIVISIONS. 1615
The gas casualties of October 25, 26, and 27 were all burns from
mustard gas, which the enemy used in large quantities on those dates
in and about the towns of Chufilly-Roche, Roche, and Le Chateau
Mery. The 3d Battalian, I42d Infantry, were the troops upon which
these casualties were in the main inflicted.
On the night of October 28 the division was relieved from front-
line duty, its sector being taken over by French troops. The division
began its movement back to rest area by marching. The sanitary
train, however, continued to function until November 1 and then
joined the division on the march.
After one day's rest at Camp Montpelier, near Suippes, the divi-
sion continued to march, reaching the area around Conde-en-Barrois
November 2 and 3. On this march one motor ambulance was as-
signed to each battalion. Very few evacuations were found necessary.
Replacements were received while in this area, and a schedule of
training was carried on. Billets throughout were inferior and living
conditions adverse to health of the troops. Prevalent diseases, how-
ever, wei'e confined to slight respiratory infections, and these were
treated for the irost part at improvised infirmaries within the or-
ganizations. Field Hospital No. 141 was established at Charmontois-
I'Abbe as a divisional hospital. Bathing and delousing were pro-
vided, individual treatment of lice cases being the method employed
for the latter in absence of better facilities.
The division meanwhile had been transferred to First Army,
American Expeditionary Forces.
The division remained in this area until November 18, when it
began moving by march to the 16th training area. Ambulances were
assigned to all organizations for the march. Health status of troops
during this movement was characterized by the high rate of evacua-
tions to hospital on account of foot affections. These were traceable
in the vast majority of cases to the uniformly low physical standard
of the replacements that had lieen received in the area just vacated.
While the incidence of these affections was reduced in some organiza-
tions to the lowest rate consistent with the physical welfare of troops
by vigilant attention and prompt treatment, in other organizations
it became so marked as to seriously threaten the mobile effectiveness
of the entire command. Some sporadic cases of mumps were evacu-
ated, as well as a relatively inconsiderable number of graver respira-
tory cases. The loci of infection in these cases were chiefly, if not
entirely, among the recent replacements.
The movement to the 16th training area was completed by Novem-
ber 30. Divisional headquarters had meanwhile been established
at Tonnerre November 18 and moved to Tronchoy and Cheney No-
vember 21. Sanitary train was located at Epineuil, Field Hospital
No. 113 being established as skin and venereal hospital for the
division, and Field Hospital No. 141 established as divisional
hospital for treatment of mumps cases. Camp Hospital No. 50,
Tonnerre, was assigned to the division as divisional hospital for all
other cases.
Training of troops was immediately resumed in the new area.
Billets were uniformly fair. Many deficiencies in living conditions
which existed at the beginning of this period were gi'adually cor-
rected.
1G16 REPORT OF THE SURGEON GENERAL OF THE AR.AIY.
Systematic lice disinfestation Avas begun during the month ot
December and continued throughout the stay in the area. Mobile
delousing plants were sent in turn to all organizations, and all cases
of infestation were treated, including all occupants of billets in which
a single infestation existed. After the entire division had been
thoroughly disinfested in this manner a mobile plant was main-
tained in continuous service throughout the area, visiting and operat-
ing in all places where reinfe-tation occurred. In addition, a sta-
tionary delousing plant was established at Camp Hospital No. 50,
Tomierre. Bathhouses were improved b}^ being made weatherproof
and comfortable, and individual treatment of all infested cases
were given in bathhouses by enlisted men of the ISIedical Depart-
ment at such times as the facilities of the delousing plants were not
available for immediate serA ue. Service of mobile plant was later
discontinued, and stationary plants Avere installed at Epineuil and
ErA-y, to which all infestations Avere sent immediately on discovery.
Diseases chiefly pre\^alent during period in IGth training area,
December 1. 1918, to April 15, 1919, were respiratory. A'enereal.
scabies, and mumps. At no time did any disease assume epidemic
proportions, and the majority of all cases were " quarters •' cases of
less than three days' duration.
141 ST KEGIMEXT OF INFANTRY.
The presence of an infectious febrile disease became apparent on
August 18, 1918. It resembled influenza in on^et and symptoms, but
Avas of shorter duration. The prostration attending it was con-
siderably greater than the height of the fever or the duration of the
disease should cause. Coryza and signs of inflammatorj'^ conditions
in the upper respiratory tract were marked. Skin eruptions were
absent. There were no intestinal symptoms.
The causatiA'e organism Avas apparently A'er}^ active and virulent,
for the disease spread rapidly. It first appeared in that section
of the town Avhich was occupied by Company B. Two days later it
appeared in Company A, about GOO yards from the point of first
appearance. The spread was rapid, but in Company A it Avas
most pronounced in both rapidity and Airulence.
Pneumonia appeared about two clays after the influenza like infec-
tion. It has manifested itself both as a complication of the grippal
condition and as frank lobar pneumonia Avith typical onset, symp-
toms, and signs.
The situation here as it was found August 24 was as follows:
There were 47 patients in the battalion infirmary, all but 1 of which
were suffering from the epidemic infection. Eight had already been
transferred to the Camp Hospital No. 42. Patients with pneumonia
Avere transferred to the above hospital as soon as possible after the
diagnosis was made.
Against the infectiA^e agent itself Ave had no means of instituting a
direct attack, so we were forced to try to oAcrcome the factors which
contribute to its spread. Overcrowding was the rule in every billet.
Ventilation, which was often poor at best, was usually less thorough
than it should have been, because windoAvs and doors were frequently
left closed. Unnecessarily croAvded arrangement of "bunks" was
common. The billets Avere too dusty. They had apparently ncA'er
A. E. F. DIVISIONS. 1617
been sprinkled. All of these points were noted at a personnel inspec-
tion of all billets by the medical officers. This inspection Avas made
after the men had gone to bed, as this is the onlj^ time when a satis-
factor}^ idea of the sleeping arrangement can be formed. Consider-
able rearrangement was necessary in every billet.
The hours of training prescribed by the present training schedule
are too long for unseasoned troops. This schedule allows sufficient
lime for sleep, but not enough is allowed for that recreative relaxa-
tion which is so necessary to overcome fatigue. The men come in
from the day's training fatigued. They look and act " fagged."
Their condition is therefore such that any infection is easily con-
tracted. It is the new men, those who have enlisted since May 1,
1918, who are contracting the infection. All of the cases of pneu-
monia have occurred among these recently enlisted, and therefore
unseasoned, men.
In addition to not having the physical endurance of the average
well-trained soldier these recruits have been extremely careless about
their personal habits. Going to sleep on the floor without preparing
the " bunk," h'ing down on the ground after getting warmed up at
drill, going swimming while still hot and tired, and exercising no
care about preventing others from coughing in their faces, etc., are
some of the evidences of carelessness.
142D REGIMEXT OF IXIANTRY.
Entrained at Bar-sur-Aube morning of September 29, arriving at
Oiry-Mareuil afternoon of the same date. Troops bivouacked near
village that night and marched to new regimental area (headquar-
ters, Champignuel) on the 30th, Divisional headquarters were estab-
lished at Pocancy. The division meanwhile had been brigaded with
the Fourth French Army, Gen. Gouraud commanding, and was then
in the reserve of the Army.
Training of all troops was resumed in this area, subject to precau-
tions against enemy observation and espionage. Particular advert-
ence was directed to further instruction of medical troops and litter
bearers from the line in work of such troops in the field. Billets
throughout the area were poor and overcrowded, consisting chiefly of
stone barns and outhouses, but despite these conditions the general
health of the command was good and very few evacuations were
necessary.
Orders covering the movement from the divisional area (Pocancy)
were received about 5 p. m. October 4. Troops left Champignuel 8
p. m. that date and were met by a convoy of camions (French) about
1 kilometer outside the village at 11 o'clock that night. Entrained in
camions and were carried by way of Chalons-sur-Marne to Somme-
Suippes, arriving at the latter town about 1 a. m. October 5. After a
tiresome search billets were secured and an infirmary established.
An emergency casualty having occurred during that day. the utmost
difficulty was experienced in getting ambulance transportation for
the patient, repeated efforts being made to obtain this from all
sources, French and American. The case was finally evacuated by
American ambulance some hours after its occurrence.
Troops rested in Somme-Suippes and adjoining comitry during
the day of the 5th. The surgeon was called at 3 o'clock the mom-
1618 REPORT OF THE SURGEON GENERAL OF THE ARMY.
ing of the Gth. unci on reportino- to re<>iniental lieadqua iters was told
that the regiment would move out that morning. The field order
covering the movement was explicit in the statement that no trans-
jjortation would be available for any purpose. This became a matter
of immediate grave concern. No information had been given of
medical organization, equipment, or supplies at the stations which
we were to occupy in the lines. We knew that we were destined to
go into action within 48— possibly within 24 — hours. We knew that
we would have to function as a medical department of an Infantry
regiment in action. We knew that we would have some casualties,
and -feared that we would have many. The situation was not im-
proved by the circumstance that we were unadvised of the provision,
announced to all other organizations, for leaving records and office
equipment at Somme Suippes in care of the respective company or
detachment clerks. (We learned this two days later.) The only
apparent solution of the problem thus presented was to devise some
method of transportation from the means at hand. A carrier was
made of a bamboo litter, and on it was stacked a load of about 350
pounds, consisting of " one field desk complete," detachment records,
one snowshoe litter, one box of emergenc}'^ medicines, one Lyster bag,
surgical dressings, bandages, splints, etc.
The headquarters detachment of the medical unit at this time was
composed of the regimental surgeon, Capt. B ; the regimental
dental surgeon, Capt. W ; and six enlisted men.
The headquarters detachment marched out of Somme-Suippes
about 9 o'clock a. m.. October 6, 1918. with the Headquartei^ Com-
pany of the regiment. The officers of the detachment carried a mini-
mum of indispensable equipment, and this made a maximum load —
about 75 pounds each. The enlisted men carried, each one, full
packs, reserve rations included, making about a 75-pound pack; be-
sides this, taking turns in carrying, they had to carry the added load
of 350 pounds of supplies on the litter. In this manner the detach-
ment started out from Somme-Suippes, following seasoned line
troops on a forced march, of how many miles we did not know. The
line was repeatedly asked for details to relieve the medical personnel
or to alternate Avith them in carrying the load of supplies. All
assistance was refused. The surgeon, at length, after the load had
been carried for about 9 kilometers, and after all endeavors to secure
even the slightest aid in its transportation had failed, seeing that the
men had already labored near to the point of exhaustion, and that
further effort, if not physically impossible, would only deplete them
of the energy essential to the trying tasks that awaited, ordered the
supplies left by the roadside, with the sergeant to guard them as long
as a reasonable hope for transportation existed. This was about 11
a. m. The sergeant remained with the supplies until about 1 p. m..
when an officer of artillery passing by ordered him to abandmi them
and rejoin his organization. About 4 p. m. the sergeant reported
to the surgeon who had taken the detachment forward with the
troops. The regiment was then resting on an eminence about 4 kilo-
meters south of Somme-Py, having marched about 24 kilometers
since that morning.
The march to stations in the lines was taken up about 7 p. m.,
the headquarters medical detachment, with the surgeon in command,
following the communications group of regimental headquarters.
A. E. F. — DIVISIONS. 1619
Guides had been appointed from the 2d Division (whose troops we
were to relieve) to conduct us to our stations, and the relief was to
have been completed during that night if possible. We set out on
a highway already congested with troops and wheel transportation
of all kinds and after about four hours of threading our way through
the almost inextricable confusion of traffic reached the town of
Somme-Py. Leaving here about midnight we resumed our forward
movement. The guide of our group became bewildered and lost.
Marching and countermarching on roads and pathways, through
fields and ravines, under shell fire, we blundered, until, about 3 a. m.,
our guide, on a pretense of searching for information to correct his
course, deserted us. The medical personnel meanwhile had been
carrying full packs on the march throughout the night. The line
troops, by orders, had stripped themselves to " over-the-top " equip-
ment before beginning the night march. These orders had not been
communicated to the surgeon and were learned by him through
inquiry only too late to be of benefit to our already exhausted men.
After our guide had decamped and the f iiiitlessness of further effort
to find our stations had become evident the line officer in command
of the group with which we were marching directed that we retrace
our route to Somme-Py and beyond to rest for another attempt to
reach our positions by daylight. We marched back to a point about
3 kilometers south of Somme-Py, arriving there about 9 a. m., Octo-
ber 7 and weariedly rested there until noon. At this hour we went
out again and reached the approximate point we were to occupy
about 3 o'clock that afternoon, a battalion post of command and aid
station of the 6th Marines. Capt. Hanson, Medical Corps, surgeon
3d Battalion our regiment, had already tentativeh^ established a
battalion aid station at 266.2-280.7 (map Rethel) for the troops of
his battalion, but moved forward with them the following morning.
He gallantly went over the top with the assaulting waves and was
killed in action near the town of St. Etienne-a-Arnes the morning
of October 8, 1918. Pvt. Joseph P. Lantosh, of the 3d Battalion,
medical detachment, was also killed in this action in heroic per-
formance of duty.
The strength of the regiment before battle was approximately
2,600 officers and men; of these, about 1,900 were rifles. Morale of
all troops was excellent. It was anticipated, however — and subse-
quently developed as a fact — that shortage of food and water, oc-
casioned by lack of transportation and failure to bring up water
carts and rolling kitchens, would diminish resistance to shock. The
morale of the troops was affected by this circumstances only, and
not to a serious extent.
The surgeon directed the location and establishment of battalion
aid stations to correspond with disposition of troops for the attack,
which was to begin on the following morning. The regimental aid
-tation remained for the night at 266.2-280.8. All considerations,
including those of proximity to action, combatant organization, con-
venience for evacuation and bringing forward of supplies, protection
of stations from direct fire, and liaison between elements were enter-
tained in defining locations for aid stations. It was directed by the
surgeon that local aid posts be established for each company in ad-
vance, and support to move forward with these organizations to the
positions they might successively occupy. The personnel of these
142367— 19— vor. 2 41
1620 REPOET OF THE SURGEON GENERAL OF THE ARMY.
local aid posts were to consist, each, of two enlisted men, medical
department, and a detail of litter bearers from the line companies.
During the first day's action the detail from the line consisted of
8 men from each company. After this, when the line companies
had been considerably depleted of strength, the detail from each
company was reduced to 4 men. The detail of litter bearers was
increased, howeyer (beginning October 10) by 24 men assigned to
the detachment for such duty by Ambulance Company 144, 111th
Sanitary Train. This detail from Ambulance Company 144 re-
mained on duty with the detachment until October 22. when it was
relieyed b}' a detail of 10 men from Ambulance Company 142.
The 3d Battalion aid station, haying moyed forward with its
line unit on the morning of the 8th, the surgeon established regi-
mental aid stations for the pending action about 400 meters west of
the regimental post of connnand (205. 8-280.8, map Rethel) in a
group of buildings originally used by the enemy, and then serying-
as a battalion aid station for the 6th Marines. Supplies in abuncl-
ance were found at this place. These were replenished as needed by
requistion from ambulance regulating stations during the remainder
of period at the front. Our detachment used this station conjointly
with the Marines during October 8 and 9, taking it oyer entirely on
the 10th. The dugout at the station was used only for sleeping pla?e
by the reliefs off duty. All work was done aboye ground, it being
found thoroughlj' impracticable to take wounded in and out of dug-
out for treatment. Daily yisits to battalion aid stations and fre-
quent visits to local aid posts were made by the surgeon to ascertain
condition of organization, equipment, and supplies at such places and
to correct any deficiencies existing. These inspections were con-
tinued throughout activities in the zone of operations. Liaiscm be-
tween medical elements was maintained by detail of runners (enlisted
men, Medical Department) between separate detachments and regi-
mental aid stations, which functioned as center for purposes of
liaison. These runners also served as ration and water details.
Supplies were sent forward from regimental aid stations by ambu-
lance to battalion aid stations, by litters, returning to advanced posts
after having brought wounded to rear, or, in emergency, by runner.
Battalion medical carts were not found practicable for transporta-
tion of supplies during period of action.
At frequent intervals searching parties, consisting of litter bearers
under charge of enlisted men of Medical Department, were sent out
through the regimental sector to discover any casualties who might
remain unattended in obscure places or concealed from any but the
most searching observation. In this manner the entire zone of action
was thoroughly covered.
The Infantry offensive of our troops began about 8 a. m., October
8, following a prolonged artillery barrage. The first casualty of the
action reporting to the regimental aid station (a walking case, 6th
Marines) came about 8.15 a. m. Occasional straggling cases fol-
lowed this one during the next hour, but by 11 a. m. the volume in-
creased to such an extent that our personnel became then and con-
tinuously remained employed during the remaining hours of the day.
and well through the night and following day.
The more serious casualties handled during these activities w^ere
shell, shrapnel, and machine-gun bullet w^ounds. Antitetanic serum
A. E. F. — DIVISIONS. 1621
was administered wound cases at battalion aid stations and regimental
aid stations. Fractures were splinted with Thomas ring or half-
ring splint where practicable; otherwise appropriate splints Avere de-
vised. Many purported gas cases reported for aid. These, in the
main, were held for a few hours rest and recuperation and given
such nourishment as it was possible to furnish. They were then sent
back to their organizations for duty. It is estimated that this method
of handling these cases in question saved the services of more than
300 men to the line at a critical time. It was the judgment of the
surgeon, vindicated by after experience, that the physical signs mani-
fest in a vast majority of such cases were the result of battle environ-
ment ; contributory factors being hunger, thirst, cold, exhaustion, the
mental state incident to first exposure to fire, psychopathic conditions
induced by overemphasis on certain phases of training in gas defense
which were causative of fear-impelling anticipations, etc., compli-
cated in some instances by high-explosive gas from shell bursts. A
few serious gas cases were evacuated. The evacuation of a relatively
large number of " slightly gassed " casualties, who might possibly
liave been treated at aid stations and returned to their organizations
for duty after rest and nourishment, was accounted for by the inex-
perience of medical officers in gas poisoning and their unacquaintance
by observation with its symptomatology. Evacuations for sickness
were at a minimum. (Further reference is made to gas casualties
■\i that part of narrative covering Oct. 26-27.)
On October 10 regimental surgeon, 144th Infantry, and head-
quarters medical detachment, that unit, with other details from the
detachment, reported to our station (regimental aid station) for in-
structions on relief, the troops of that organization relieving the
142d Infantry during the 10th and lltli. The surgeon and a detach-
ment of six enlisted men remained with us until the 11th. observing
our organization and methods. On the evening of the lOth (abou^t
9 o'clock) the 3d Battalion, 144th Infantry, having moved forward
for relief of an element of our regiment, sustained about 35 casual-
ties m the near vicinity of regimental aid station from shell fire of
the enemy. Practically all these cases were handled by the personnel
of our detachment.
About 8 p. m. October 11 we received orders to move forward
with the troops of our regiment on the following mornino-. The
regiment was then in support of the 144th Infantrv, which hSd com-
pleted the relief and begun a harassing action ajza'inst the retreating
enemy. We left regimental aid station 7 a. m. October 12 (battalion
detachments accompanying their respective units) accompanied by
an ambulance, this having been assigned to us for carrying forward
supplies, establishing new lines of evacuation, maintainino- "communi-
cations with triage, etc. We marched through St. Etienne-a-Arnes
' and Machault to a point about 1^ kilometers southeast of Dricourt
arriving there about noon and going into bivouac. The ambulance'
haying left Machault in advance of our troops, took the wrono- road'
going to Leffincourt. The driver reported with ambulance the next
day about noon at our bivouac, unloaded our equipment and sup-
plies, represented that he had been directed to report back to the
triage, and the services of an ambulance on our march therewith
ceased. The salvage department afterwards took up the property
which we were thus forced to abandon.
1622 r.EPOET OF THE SURGEON GENERAL OF THE ARMY.
We left our bivouac about 2 p. m. October 13 and moved forward
with troops, arriving about 5 p. m. at Vaux-Champagne, where
reo-imental post of command was to establish. We found already
established there regimental aid station, 143d and 141:th Infantry.
We located in their joint station tentatively until the new disposi-
tion of our troops could be ascertained. The regiment having been
assio-ned a sector, battalion aid stations for all battalions were estab-
lished, respectivelv. in advance, support, and reserve. The surgeon,
141st Infantry, with headquarters medical detachment, that unit,
having moved into the station already jointly used by three regi-
ments''as regimental aid station, surgeon 142d Infantry, with his
headquarters detachment, moved to the eastern end of the village
and located regimental aid station in a building which had just
been vacated as an aid station by medical detachment 132d Machine
Gun Battalion. . t ^•
On the afternoon of October 22 we received orders directing a
«ide-slippin2 movement of the regiment to he effected that night for
the relief of'^French troops on our right. The headquarters medical
detachment was divided into two details for this movement (bat-
talion detachment accompanying their respective units) ; one, under
command of the surgeon, to accompany headquarters company and
wa^^on transportation, and the other, under command of a medical
officer to follow " communications group " of regimental headquar-
ters. At about 3 a. m.. October 23. we arrived at our new station—
Chardeny. The surgeon provided for establishment of regimental
aid stations and battalion aid station. The former was located m an
old stone dwelling near regimental post of command. Facilities were
verv poor, but were soon made adequate.
Very few evacuations were necessarv during the first two days ot
our stay at this station. During October 25, 26, and 27, about 35
cases reported to resimental aid station for treatment of burns trom
mustard gas. The Injuries had been sustained chiefly by troops of
the 3d Battalion; mustard gas having been freely used by the enemy
in the forward area occupied by our troops. The larger ])roportion
of these cases (approximately 75 per cent) were superficial burns on
the back, varying in this general location from the shoulders to the
buttocks. In no cases were burns or irritations found in the axillary
refyion, on the perineum, or about the genitalia. The next consider-
able proportion of cases showed affections of the respiratory tract,
and finally there were a few cases of marked conjunctivitis. In no
instance were thev characterized by gi'ave physical distress or de-
bilitv However, "^precautions were taken to guard against further
exhaustion or exposure of patients; and after treatment, they were
promptly evacuated to the hospital. (Some of these cases had been
previouslv treated at 2d Battalion Aid Station.)
The attack began about 5 p. m., after an intensive machine-gun
and artillerv barrage. The enemv was driven out of strong points
north of Roche and south of Rilly-aux-Oise in the loop formed by
the River Aisne. A few enemy prisoners— casualties— were treated
after the engagement. The total of casualties handled during and
after the action was relatively small— about 20. Regimental aid
station moved back to Chardeny (272.8-295.9, Map Attigny) about
4 a. m., October 28, and prepared for relief that night.
A. E. F. DIVISIONS. 1623
Orders had been received nioht of the 27tli directing relief of the
regiment from duty in front lines, to be effected night of the 28th,
The necessary provisions were made for disposition of medical per-
sonnel in accomplishment of the relief, and for transportation of
suj^plies by battalion medical carts.
Tlie health of the command during the movement concluded here
above normal for troops on sustained march. As a natural outcome
of the continued demands on strength and endurance, caused by the
protracted ordeal, many latent physical disabilities, particularly
among our replacements, became evident. The policy of watchful-
ness, and early and immediate treatment, for foot affections, which
had been adopted on the previous march, was directed and strictly
exercised throughout the moA'ement. A few more serious cases were
evacuated to the hospital. However, this disposition of such cases
was made only when it was manifest that they would not respond to
aid possible to be given during the troop movement, or when it be-
came evident that emergency and temporary treatment would enable
them to continue in the performance of duty at the cost of permanent
disability.
Lice infestations increased, it being practically impossible to pre-
vent the spread of vermin while troops were in mobile status. An-
other important factor in the increase of infestation was the method by
which the blankets of the marching troops were handled. Each sol-
dier carried one blanket in his pack ; two other blankets for each one
being tied in bales of 16 at morning and transported by truck to the
place where the troops were to billet for the ensuing night. These
blankets were then redistributed to the men, at the conclusion of the
day's march, for their use that night. It was inevitable that such
promiscuous intermingling of infested with noninfested blankets,
and their daily redistribution without regard for prior possession,
would result only in the widest possible infestation. The riddance
of these infestations became a problem involving much tedious labor
in the solution later on.
Billets in the area were uniformly good; the town of Lignieres
showing the greatest number of deficiencies in billeting accommoda-
tions and surroundings. These deficiencies were chiefly : Lack of ven-
tilation and light in some billets; general inadequacy of fuel supply
(throughout the area) for heating and for drying clothes; and, in
the beginning of the period, an insufficient number of bunks. The
billets, were, for the greater part, stone barns and dwellings ; Adrian
barracks being used only for a small proportion of the troops. Bed
sacks, and straw for filling them, were put in possesion of all men.
The cubicle sj'stem for separation of individual sleeping spaces was di-
rected and carried out. Latrines, mostly of the open-pit variety,
were provided and assiduously cared for to prevent their becoming
sources of contamination. All drinking water was ordered chlori-
nated, as had been the hard and fast rule since arrival in France,
for prevention of infection from this source. Garbage and waste,
deposited in receptacles especially devised for the purpose, were given
to French civilians to be hauled to their farms ; or, lacking these
facilities, were buried. Soakage pits were dug for disposal of waste
water. The condition of clothing and equipment was gradually im-
proved, until, on January 1, 1919, the regiment was, by physical
check, 95 per cent equipped in essentials. This improvement was,
1624 REPORT OF THE SURGEON GENERAL OF THE ARMY.
]n no biiuill measure, due to the repeated inspections of medical offi-
cers to detect the existence of shortages prejudicial to the health of
the troops, and to their reports of same, with emphatic recommenda-
tions of the surgeon that deficiencies be corrected. Mess halls and
kitchens were directed to be sheltered, and were promptly put under
cover. Ration allowances for troops were investigated, and dispar-
ities between authorized and actual issues were insistently represented
to the responsible officers. A uniformly good standard of ration-
ing of troops was soon attained,
14 4TH REGIMENT OF INFANTRY.
On October 6 the regiment moved forward, by marching, en route
to the front, reaching Ferme de Vadenay that night. Part of the
command found shelter in some Adrian huts, others bivouacked. On
the morning of the 7th the march was resumed, passing through
Suippes and reaching destination for the day about 4 Icilometers
north of Suippes. Rain and' .muddy roads were encountered, the
troops were bivouacked in shelter tents excepting that a number had
located dugouts and took advantage of them. The command re-
mained here until October 9. Health was good, food was plentiful,
water supply was good.
On the morning of October 9 the regiment moved forward to
relieve the 2d Division of Marines, who were in support, relief being
completed at about 11 p. m, that date. Two cases of sickness within
this regiment were evacuated at this time. On the night of the 10th
this regiment took up forward positions at Mont Blanc. The medi-
cal detachment was divided among the battalions with appropriate
number of medical and dental officers and enlisted men with each
battalion. The regimental surgeon with a number of enlisted men
established and maintained a regimental aid station near regimental
post of command at Mont Blanc. There were casualties as follows :
26 gunshot wounds, 7 gassed. 8 sick, 2 killed, and 2 from other
causes; 1 French sick. Hereafter all casualties mentioned are Ameri-
cans and of this regiment except as otherwise stated.
On the morning of the 11th our troops went " over the top " at
Mont Blanc. Casualties : 8 killed. 37 gunshot wounds, 15 gassed.
There were about 60 slightly gassed cases in addition to those just
mentioned; these were suffering from high-explosive shells bursting
close, principally; they were observed for a period of 3 to 6 hours
and returned to duty. On the night of October 11 the command
slept in dugouts improvised. Next morning the regiment started
north again in battle formation, passing through Dricourt at noon
and reaching objective for the day about 4 p. m.. about 5 kilometers
south of Ferme de Moscou. No enemy troops encountered ; no cas-
ualties. Camped at this place for the night, and the next morning,
October 13, marched north to Ferme de Moscou. In the afternoon
contact with the enemy was gained and an encounter ensued which
lasted from 4 p. m. October 13 to about noon October 14. On Oc-
tober 13 casualties were as follows : 28 killed. 40 gunshot wounds, 7
gassed, and 1 sick, 5 French sick. Gunshot wounds as spoken of
herein include shrapnel and shell wounds ; the gassed are those which
were affected to the degi'ee of warranting a wound chevron. Several
cases suffering from the effects of high-explosive shells bursting
A. E. F. DIVISIONS. 1625
close were treated; these were observed for appropriate periods and
returned to duty, exceptinof. of course, those who warranted other
disposition. The Medical Corps personnel attached to the battalions
served their respective battalions; caring, of course, for the casual
from other battalions or units coming to their attention. Battalion
aid station was established at French division at Ferme de Moscou
about 4.30 p. m. on the 13th. On the 14th, the regiment still defend-
ing sector north of Ferme de Moscou, casualties were as follows:
1 killed, 60 gunshot wounds. 6 gassed, 6 sick, 4 from other causes;
1 French sick. The regimental aid station remained farther in the
rear, maintaining contact as far as possible with regimental post of
command, which was difficult on account of the rapid advance of the
troops. Capt. George C. Skinner, Medical Corps, was evacuated
October 13, suffering from the gaseous effects of high-explosive
shells.
IIITH SANITARY TRAIN.
From the 1st of January, 1918. until the 30th of June of that year
the story of the lllth Sanitary Train was uneventful in the main,
but extremely important. Hard and conscientious work on the part
of all was given with a view of bringing the organization to that
point of efficiency required for overseas service. During tlie first
week in July, 1918, it became apparent that the organization was
very shortly to leave Camp Bowie. Tex., where they had been sta-
tioned since their original organization during the previous October.
On the morning of July 13, 1918. a final inspection by the inspector
general at the port of embarkation was held. On July 16. 1918,
orders were received for embarkation. On July 17. 1918, the entire
command left Camp Mills for the port of embarkation. Hoboken.
N. J., and embarked at 4 p. m. on the U. S. S. George Washington.^
which remained at her pier overniefht. The transport sailed at 2.01
p. m. July 18, 1918.
The voyage across was relatively uneventful, and in the early after-
noon of July 30, 1918, the vessel steamed into the port of Brest
(Finnisterre), France. At 6 a. m., July 31, 1918, debarkation com-
menced and was rapidly completed, being accomplished with the
aid of lighters. After a very slight delay the command marched
through the streets of Brest and to the rest camp located just outside
of the walls of the historical Pontanezen Barracks.
The stay at Bar-sur-Aube amounted to a little over a month, dur-
ing which time a strenuous program of intensive training was in-
augurated. The equipment of the sanitary train, with the exception
of transportation, was complete upon departure from Camp Bowie,
Tex. The unit equipment and a great deal of the company property
was lost or salvaged en route between Camp Bowie, Tex., and Bar-
sur-Aube, France. At Bar-sur-Aube all medical, ordnance, and
quartermaster property, with the exception of transportation, was
replaced. At this time considerable difficulty was being experienced in
obtaining transportation, probably due to the St. Mihiel drive, which
took place at this time and required all available transportation.
However, while at Bar-sur-Aube we received 5 Dodge touring cars,
12 G. ]M. C. ambulances. 5 motor cycles with side cars, 12 escort
wagons, and 24 draft animals.
1626 REPORT OF THE SURGEON GENERAL OF THE ARMY.
While at Bar-sur-Aube, Field Hospital No. 141 established a tem-
porary hospital for the care of class C men of the division, who were
to be sent elsewhere. Field Hospital No. 143 established a skin and
venereal hospital for the division.
On the evening of September 25, 1918, preparatory orders for a
movement were received and the motor ambulances began the evacua-
tion of the divisional sick, evacuating them to Camp Hospital No,
42, which was located at Bar-sur-Aube. At 7.30 on the morning of
September 27, 1918. the entire command, less the motor transporta-
tion, marched 23 kilometers to Brienne-le-Chateau, where they en-
trained and proceeded to Avize (Marne), detrained and marched 7
kilometers to Plivot. The motor section, under command of Lieut.
Col. John J. O'Rielly, proceeded overland direct to Plivot. Here
we received 29 additional G. M. C. ambulances, 24 cargo trucks, and
1 additional motor cycle.
At this station Field Hospital No. 143 established a skin and
venereal hospital, with bathing facilities for the division. Field
Hospital No. 141 was ordered to transport its personnel and equip-
ment to Aulnay, there to establish convalescent hospital for the
division.
On October 4, 1918, S. S. U. 586. commanded by First Lieut.
Arthur B. Kinsolving, 2d, was attached to the train. This unit con-
sisted of 20 Ford ambulances and had been in the overseas service
for about 15 months, but heretofore had served only with the French
Army.
On the afternoon of October 7 the 36th Division trains mobi-
lized at Plivot and marched in a northeasterly direction into the
advance zone. Upon arrival at Cuperly the division surgeon
joined the command with orders from divisional post of command
releasing the sanitary train from control of the command of trains.
The remainder of the march was under command of Lieut. Col.
to Somme-Suippes.
Orders had been received at Suippes for S. S. IT. 586 to report to
the director of ambulance companies of the 2d Division immediately
upon arrival. This they did on the morning of October 8. Shortly
after arrival at Somme-Suippes orders w^ere received for 24 G. M. C.
ambulances to report to the director of ambulance companies, 2d
Division. In the meantime the 71st Infantry Brigade had taken over
the sector lying directly north of Somme-Py which was commonly
known as Mont Blanc and were advancing rapidly with heavj'^ losses.
Our division by this time had completely relieved the Marine Brigade
of the 2d Division, but as yet the evacuations were under control of
the sanitary train of the 2cT Division. The triage of the 2d Division
was located in the ruins of the church at Somme-Py. S. S. U. 586
was at this time working from the battalion aid stations to the triage
in conjunction with the units of the 2d Division.
On October 9, 1918, the field hospital section was ordered into
action, one company to immediately take over the work of the 2d
Division triage. Field Hospital No. 143 was ordered to establish
behind a small hill 1 kilometer south of Somme-Py and just east of
the Somme-Py-Suippes Road. This company moved from Somme-
Suippes with trucks late in the afternoon and set up and was clearing
patients at 7.30 p. m., handling those from the 36th and 2d Divisions,
as well as French and Germans. This night and about f oiir succeed-
A. E. F. — DIVISIONS. 1627
ing gave the section more casualties to handle than any other period.
On the night of October 9 Field Hospital No. 143 was operating as
above south of Somme-Py. Field Hospital No. 142 and Field Hos-
pital No. 144 were in reserve at Somme-Suippes, and Field Hospital
No. 141 was operating for tlie sick of the division at Aulnay. The
next morning, the 10th of October, Field Hospital No. 144 was set
1113 adjacent to Field Hospital No. 143 to take care of the nontrans-
portable wounded — the surgical hospital — and Field Hospital No.
142 was opened at Ferme-de-Suoppe, 1 kilometer south of Suippes,
ond the Suippes-Chalons Road, to treat the gas cases of the division.
The work of the field hospitals was as follows: Field Hospital No.
143, the triage, received all the wounded, gassed, and sick of the divi-
sion, making a record of the cases, giving antitetanic serum, and
sorting the casualties. This hospital retained no cases; all were
evacuated immediately, as follows: Nontransportable wounded to
Field Hospital No. 144, gassed cases to Field Hospital No. 142, and
all others to Evacuation Hospitals No. 3 and No. 5.
Owing to the advance of the division, the triage, still operated
by Field Hospital No. 143, was moved forward on the night of Octo-
ber 12, 1918. It was located behind a railroad embankment 1 kilo-
meter north of Machault, on the west side of the Machault-Leflincourt
Eoad. The next day Field Hospital No. 144 was ordered forward
to take care of the nontransportable cases.
Owing to the few gas cases. Field Hospital No. 142 was ordered to
evacuate its patients and move up in reserve on October 13. It went
into camp near the triage.
On October 13 the triage was again moved forward, as Field Hos-
pital No. 143 had been working night and day since October 9, and
as the gassed cases had become practically negligible Field Hospital
No. 142 was ordered to operate the triage. Field Hospital No. 143
going into reserve. The triage operated by Field Hospital No. 142
was established then a kilometer south of Dricourt, behind a hill just
south of the Leflincourt-Mont St. Remy Road, where it remained
until the division came out of action. Here also Field Hospital No.
144 was set up.
On October 14 Field Hospital No. 141, having evacuated its pa-
tients at Aulnay, was ordered to establish a hospital for the sick
of the division in the woods about 2 kilometers north of Machault,
300 3'arcls west of the Machault-Leffincourt road. From this date
until the division came out of action the location of the field hos-
pitals was unchanged — the triage and Field Hospital No. 144 south
of Dricourt, Field Hospital No. 141 operating the hospital for the
sick in the woods north of Machault. and Field Hospital No. 143
in reserve where it had last operated, just north of Machault. Dur-
ing this period the casualties were comparatively light.
On October 26 Field Hospital No. 141 was ordered to return to
duty or evacuate to the rear all its cases and to close.
On October 29, 1918, our division having been relieved by a French
unit, the march to the rest area began. Field Hospitals Nos. 141
and 143 had already marched out on October 27. On the morning
of October 30, 1918, the last troops of the 36th Division having gone
to the rear and all casualties having been evacuated, Field Hospitals
Nos. 142 and 144, with the train headquarters detachment, moved
out and marched to Ferme-de-Suippe, there joining the remainder
1628 REPORT OF THE SURGEON GENERAL OF THE ARMY.
of the train. The train bivouaced at Ferme-de-Suippe, remaining
there for two days. On October 31 a march was made to Somme-
Yevre (Marne), on November 2 to area Villotte-devant-Louppy, and
on November 3 to area Charmontois-L'Abbe (Meuse).
The 3Gth Division has been, roughly speaking, in the area of the
American Expeditionary Forces for eight and a half months. Disre-
garding the period in which the command occupied the lines, it has
been stationed in four billeting areas and for a very short period in
the rest camps of Brest and St. Nazaire. One unit was located in a
rest camp near Bordeaux for three weeks.
About 85 per cent of the division debarked at Brest, but fortu-
nately remained at that point but a very few days. Conditions at
the camp near and the buildings in Pontenazean Barracks were
almost inconceivably bad. Men were crowded into unfloored tents,
12 to 11 often being assigned to one pyramidal tent designed for
eight men at the most. Latrines were of either an open straddly
trench or a galvanized-iron can type — also open — and in some cases
not over 100 feet from kitchens. There were swarms of flies so
thick as to be a positiA'e menace. Drainage was universally bad;
heavy rains had reduced the camp to a sea of mud. Water was dif-
ficult to obtain and badly polluted.
The division, less the Artillery Brigade, which never rejoined the
command, concentrated in the 13th training area, of which Bar-
sur-Aube is the principal town. In this area a condition which
was to follow the division from place to place was first encountered.
There is a tendenc}^, it seems, to order into areas a number of troops
vastly greater than it is possible to accommodate with any degree
of comfort. In the 13th area this is particularly noticeable in the
section about Verpilliers and Fontette, which was occupied in oui
case b}' the 11:1st Infantry. The overcrowding of billets was with-
out doubt one of the predisposing causes of a severe epidemic of
influenza and the resultant pneumonia, which occurred beginning
about the 25th of August, for description of which, together with
the measures taken to combat it, see Exhibit A of the present history.
Generally speaking, however, the area was satisfactory. Men were
billeted in French houses and barns, which were in the greater part
of stone. While ventilation was in most cases satisfactory, the light
was in almost all instances very poor. Wooden bed frames had been
constructed by troops previously in the area, and in very few
instances were the men required to sleep on the floor or ground. All
men were provided with bed sacks and adequate straw. The water,
though abundant, was unfit for human consumption without ster-
ilization, and was in all cases chlorinated before being used for
drinking. Straddle-trench latrines were used, and were well cared
for. Garbage was hauled away by French civilian population.
Bathing facilities were almost nil : during the early part of the stay
some streams and ponds were available, but with the advent of cold
weather this form of bathing became ill-advised.
The second area to be considered was of the type called by the
French " Zone de passage," and as such only intended to be held
by an organization for a few days. It was but a few miles behind
the lines, lying between the cities of Epernay and Chalons-sur-
Marne, extending along both sides of the Marne River for about 8
miles. It had been occupied by troops of every one of tJie Allied
A. E. F. — DIVISIONS. 1629
nations as well as those of the enemy. For four 3'ears regiments had
come and gone, with the inevitable result that the billets were
filthy and lice infested. It had been planned to accommodate a
French division, the strength of which is veiy much smaller than
ours. This resulted in acute overcrowding. In one instance an
organization of somewhat over 1,000 men was placed in a town, the
capacity of which was 550. The division remained here six days,
leaving at the end of that time for the front lines.
Upon being relieved from the lines the division, less the Engineer
Regiment, proceeded by a series of marches to a rest area located
north of Bar-le-Duc, known as the Conde-en-Barrios Area. This
area was only fairly satisfactory in the matter of housing the troops.
Although large geographically, the number of towns was small and
again overcrowding was the result. Bathing facilities were found
in the greater number of villages, and improvised in the remainder.
The entire command was bathed at least once and clean underwear
provided. Having but recently come from the lines there were a
large number of infestations of lice, and the bathing and delousing
was a big factor. The villages were all very small and no oppor-
tunities for amusement were found, nor were fields for drills and
maneuvers conveniently located.
Upon arrival at the 16th training area, late in November, 1918,
widely varying conditions were found. The larger towns of Flogney
and Tanlay were excellent from almost everv point of view, while
some of the towns in the northeastern section were possibly the
worst found during the stay of the American Expeditionary Forces.
Billets were small, poorly ventilated, very dark, the surrounding
yards muddy, and on the whole undesirable to a marked degree.
No facilities for entertainment were available. The blanket allow-
ance of three blanlvcts per man was far from sufficient, considering
the fact tliat many of the men were forced to sleep in lofts over
barns, under leaky roofs, and in many cases without sides. No
lights were furnished and men had to go to bed immediately after
the evening meal for lack of something to do.
A vigorous campaign was instituted at once to overcome these
unfavorable circumstances. Permission was obtained to put troops
in other villages than those originally assigned. The town of
Chaorce was included, together with a number of smaller villages
in its vicinity, thereby relie^ang much congestion. Walks were built
of crushed rock leading to mess halls and billets. When the division
arrived a few barracks of a modified Adrian type were found. The
majority of these were used as mess halls, although in a few cases
men were quartered therein. They were augmented by a consider-
able number of similar structures which were built by the divisional
Engineers who rejoined the division upon arrival at this area.
Buildings were rented and remodeled as entertainment halls. The
wood allowance which was entirely inadequate at first was increased,
but was never sufficient to meet the minimum requirements of the
troops. Although the towns were very small the moral tone was
found to be quite high, there being practically no prostitutes in the
area. Venereal disease was therefore very low, indeed, at first.
Shortly after arrival a few prostitutes began to come to Er\^ and
Tonnerre from Paris and Troyes, particularly the latter, by train.
About the first of the year an extensive series of leaves caused a
1630 REPORT OF THE SURGE02^ GENERAL OF THE ARMY.
marked increase in the incidence of venereal diseases. However, to
date there have been but an infinitely small proportion of such
infections which have had the origin in the divisional area.
Water was about the average French water. Chlorination was
necessary and required by all troops. Onh' one case of typhoid
fever occurred during the four and a half months of occupancy.
"With the coining of warmer weather an etfort to control flies was
begun. It is almost impossible to achieve satisfactory results in
this, as the custom of the inhabitants of acquiring large piles of
manure in close proximity to their houses where soldiers are
quartered, together with the promiscuous location of the native
latrines, are a great handicap in this effort. However, material has
been secured for inclosing latrines used by American troops and
scrupulous cleanliness of kitchens is the rule.
A careful watch has been kept by the sanitary inspector of the
geographical location of sickness, with especial reference to respira-
tory diseases. As cases are reported they are marked upon a map
of the area, and when any station shows an abnormal condition a
personal inspection and investigation is made. From the day of
arrival in the area the arrangement of sleeping spaces, known as.
the cubicle system, has been rigidlj' enforced. This has been found
entirely satisfactor3\ as is testified to by the low rate of respiratory
infections. Semiweekly inspections of all billets has been required
by the station medical officers under instructions of this office; tliis
has been for the purpose of determining whether or not the men were
using the required cubicle. Thase inspections are held between 10
o'clock and midnight.
K. THIRTY-NINTH DIVISION.
The commanding general of the 39th Division and a portion of his
staff arrived at St. Florent on August 30, 1918. It had been previ-
ousl}'^ learned that this would become a depot division. The area
selected for the division is about 31 miles long and 10 miles mide,
the town of St. Laurent being at the extreme northern end and the
village of La Celle-Conde at the southern end. The principal towm»
in this area are Mehun, St. Florent. Reuilly, and Charost. The roads
are excellent. Water is all contaminated. Billeting facilities are
fair in small villages and farm buildings. No suitable permanent
buildings for camp hospital or classification camp are available.
A small French military hospital of about 150 beds is operated in
Mehun, and a small post hospital of about 150 beds is at the Engineer
camp near Marmagne, some 2 miles distant from Mehun. Camp
Hospital No. 14 is located at the aviation field near Issoudun. The
153d and 154th Infantry, with headquarters at Reuilly and Mehun,
resi^ectively, had arrived a few dnjs prior to division headquarters.
L. FORTY-FIRST DIVISION.
The 41st Di^^sion was organized in August, 1917.
It was originally proposed to locate the division at Palo Alto,
Calif., for training, but owing to a disagreement with local author-
ities about plumbing and drainage, the site was abandoned almost
as soon as selected, and Camp Greene, N. C, chosen in its stead.
A. E. F. DIVTSIONS. 1631
During the month of Septembei, 1917, organizations were as-
sembled at Camp Greene for the purpose of forming the division.
At this time the 1st North Carolina Engineers and one bakery com-
pany garrisoned the camp. The personnel of the 41st Division was
made up of the National Guard from the Northwestern States, with
the exception of the division staff, which was composed almost en-
tirely of officers of the Regular Service.
The States furnishing troops for the division were Washington,
Oregon, Idaho, North and South Dakota, New Mexico, Wyoming,
Montana, and the District of Columbia.
About the 15th of September, 1917, the 1st Idaho Field Hos-
pital arrived with full personnel and about 25 per cent equipment.
The field hospital was immediately installed in one or two com-
pleted buildings of the camp hospital, and the camp hospital began
to function. In about two weeks' time regular camp hospital per-
sonnel and equipment were received and the field hospital company
relieved. Maj. , Medical Corps, assumed command of the
camp hospital.
The 1st Washington Field Hospital had now reported. This, to-
gether with the 1st Idaho Field Hospital, formed the nucleus of the
sanitary train. Two additional field hospital companies and four
aml^ulance companies were organized from the personnel of the 2d
North Dakota Infantry. Maj. . Medical Corps, National
Guard, was designated director of field hospitals, and Maj.
, Medical Corps, National Guard, director of ambulance com-
panies. Requisitions were immediately made for equipment, and the
training of the sanitary train commenced.
October 26, 1917, the division was ordered to Camp Mills, N. Y.
It arrived at that place during the month of November.
The division left Camp Mills for France in three sections.. The
advance section, consisting of one regiment of Engineers, mobile
laboratory, the field battalion signal corps, and one sanitary squad,
embarked November 26. 1917. Division headquarters and the
greater part of the division embarked December 12, 1917. The
third section embarked about Januarv 20, 1918. Division headquar-
ters sailed on the U. S. S. LincoJn, arriving at Brest December 30,
1917.
On shipboard, due to overcrowding, a great many cases of acute
infectious disease appeared. The seriously sick on shipboard were
placed in the sick bay where they came under the control of the
naval medical officers. They received excellent care. On the Lin-
coln there were 30 cases of pneumonia and 1 case of meningitis.
The sick baj^ held about 100. It was full to capacity most of the
time. There was only 1 fatality, namely, a case of chronic pul-
monary tuberculosis.
At Brest it was learned that the division would be converted into
a depot and replacement organization. Individual regiments were
scattered throughout the lines of communication of the American
Army in France. Division headquarters and about one-fourth of
the division, including two field hospitals and two ambulance com-
panies, were ordered to La Courtine for station. The division ar-
rived at that place January 2, 1918.
At La Courtine the weather was bitterly cold, buildings were un-
heated, wood was scarce, and there was an entire lack of sanitary
1632 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
apparatus. No motor or animal-drawn transportation was to be had.
The hospital consisted of an empty barrack. It had been possible
to bring from the port of debarkation a small portion of the medi-
cal-combat equipment. With this a camp hospital was started. The
acute infectious diseases which had been prevalent on shipboard per-
sisted at La Courtine. Many cases of pneumonia developed; there
were several deaths from this disease.
On January 24, 1918, the division left La Courtine for station at
St. Aignan-Noyers, arriving January 25, 1918.
The change of station from La Courtine to St. Aignan-Noyers had
an immediately beneficial effect upon the health of the men. St.
Aignan is warmer and in every way more comfortable than was La
Courtine.
Prior to the departure for St. Aignan a detachment had been sent
ahead to provide quarters and supplies. The troops were billeted in
barns, lofts, and empty buildings. There were of course no hospital
facilities. A small amount of medical supplies had been brought
with the troops; more were purchased locally.
A long empty building (part of a French convent) was hired and
here a hospital was started. Attached to the convent there was a
hospital ward containing 10 beds, which was i^laced at the disposal
of the Army. At various points throughout the area buildings were
hired for hospital purposes. Here, the sick were placed upon litters
or bed sacks. Although the facilities were few, the men were made
comfortable, and received good care. The sick w^ere not numerous
at first and not seriously ill.
The health of the command shortly after arrival in St. Aignan
became greatly improved ; the acute infectious diseases became fewer
in number and in a short time the pneumonia became negligible.
The billeting area of St. Aignan covers about 250 square miles.
Troops were billeted in small training detachments throughout the
entire area. For purpose of medical administration the area was
divided into 3 districts: District No. 1. headquarters, St. Aignan;
District No. 2, headquarters, Montrichard ; and District No. 3, head-
quarters, Selles-sur-Cher. At each district there was placed a dis-
trict surgeon and a district sanitary inspector. Each district was
provided with an infirmary of 50 beds. The principal infirmary was
placed at District No. 1. This infirmary rapiclly grew in size ; near-by
buildings Avere rented, so that finally it accommodated nearly 200
patients and began to assume the function of a central camp hospital
for the area.
The function of the division was chiefly to receive, classify, equip,
and train troops for combat divisions. The casuals from the United
States and patients discharged from base hospitals were forwarded
through this organization.
It became necessary to change the organization of the medical de-
partment in order to meet the special requirements of the division,
which was different in its function from a purely combat organiza-
tion. It became apparent that the chief functions of the medical
department of this division were as follows:
Medical officers were stationed at the classification camp, where
incoming troops are received. Here each man on his arrival was
given a physical examination. Those physically fit were passed
on: the unfit were sent to the hospital for treatment or to the disa-
A. E. F. — DIVISIONS. 1633
bility board for classification into A. B. C, and D class men. The
disability board was stationed at Camp Hospital No. 26.
In order to meet the sanitary requirements of the increasing area
it soon became necessary to increase the size of the sanitary squads
by details from the line. This took troops from their companies and
interfered with their training. To rectify this condition sanitary
squads were entirely reorganized. The original squads were greatly
augmented by men classified as B and C. These classified men
were transferred to the medical department for the period of their
service in sanitary' organizations. The sanitary squads now took
over all the police work of the area except the care of kitchens
and billets. Their work included cleaning of the streets, care of
latrines, disposal of wastes, etc. The procurement and super\dsion
of Lyster bags and shower baths was taken over by these squads.
Many interesting sanitary problems arose.
Owing to the scarcity of fuel it was difficult to provide an abundant
supply of hot water for the washing of mess kits. Tavo large con-
tainers of hot soapy water and one container of clear boiling water
were provided each company. The mess kits were first cleaned and
scraped over a garbage can, then washed in the soapy water, and
finally dipped into the boiling water for scalding.
Owing to the inability to dig latrines in populated cities galvan-
ized-iron cans having specially constructed seats were provided for
the billets. These cans were emptied daily by the sanitary squad.
As it was a matter of great difficulty to enforce proper sanitation of
the towns the Medical Department took complete control of all police
work except that of the billet and kitchen. The sanitary squads
collect ancl dispose of garbage, feces, and manure. It cleaned the
streets of the towns and constructed sanitary appliances. In order
to protect the water the distribution of Lyster bags and chlorine was
taken over by the medical department. The medical department
controls the distribution of shower baths and operates them.
Owing to the greatly increased number of casuals passing through
the area (sometimes as many as 4.500 a day), the problem of quaran-
tine for infectious diseases became difficult. To prevent great delays
in the movement of troops and overcrowding of the area, the usual
system of quarantine for infectious disease had to be abandoned.
First Lieut. , Medical Eeserve Corps, was appointed di-
vision epidemiologist, April 7, 1918. He was given authority to
issue necessary orders in tlie name of the commanding general.
Under the orders of the epidemiologist cases of infectious disease
among casuals Avere sent to the hospital ; onl}^ the immediate contacts
isolated. In epidemics occurring in the permanent personnel the
usual quarantine of companies, etc.. was followed when necessary.
Many of the casuals arrived in a dirty condition, owing to their long
journey from the United States and to lack of bathing facilities en
route ; some of the men were infested with lice. To meet this condi-
tion a delousing station was established in a local mushroom canning
factory; portable shower baths were erected in the building. The
clothing of the men was steamed under pressure in the large mush-
room vats.
July 22, 1918: Thirty-five cases of typhoid fever were detected in
a replacement organization just reporting from Camp Cody. Men
1634 REPORT OF THE SURGEON GENERAL OF THE ARMY.
liavinir the disease were sent to Camp Hospital No. 26 ; contacts were
placed in an isolation camp near Contres. The chief surgeon and the
director of laboratories, American Expeditionary Forces, were
notified.
Previous mention has not been made of a camp which Avas estab-
lished in the division for the treatment of cases of venereal disease.
On Jul}' 1-i. 1918. Infirmary Xo. 3, at Selles-sur-Cher, was con-
verted into a detention camp for the care of venereal diseases. At
that time there were about 150 cases in the division. As the experi-
ment was successful and the results were so encouraging, a few weeks
later ground was secured for the establishment of a large camp. The
camp Avas designated " Venereal labor camp."
Xot only the venereal cases belong to the division proper were
treated at this camp, but all casuals passing through the division, who
after being examined Avere found to have venereal disease, were also
sent to this camp. Here a systematic course of treatment Avas insti-
tuted ; men requiring rest in bed or surgical procedure were sent to
Camp Hospital No. 26; all others Avere treated in the camp. Those
in the camp were placed on a duty status and required to do such
physical work as their condition warranted ; some were sent on labor
details, building roads, etc. ; others were assigned to light duty, such
as work in carpenter shops, gardening, etc. The camp now contains
950 under treatment. The greater part of them are in tents, but
semipermanent buildings are gradually being constructed.
The designation of the venereal labor camp was changed October
11, 1918, to medical labor camp, as the former designation was objec-
tionable as the mail address of the patients and personnel.
During September and October, 1918, an epidemic of influenza
prcA^ailed in the division. Many cases Avere complicated by a graA^e
form of pneumonia, which gave a high mortality. It is not thought
that the disease originated in this area, but was introduced by troops
Avho Avere infected prior to arri\'al. The hospital records show that
the aA'Crage case was in the division 2.3 daA^s prior to admission.
The folloAving steps Avere taken to combat this epidemic: (1) All
troops upon their arrival were giA^en a physical examination. The
seriously sick Avere immediately transferred to the hospital. The
slightly sick were placed in barracks at the classification camp, which
were set aside for that purpose. Here they were kept under the ob-
serA^ation of a physician and ward attendants. If they were well in
a day or two, they were sent to their organizations; otherAvise, they
were sent to the hospital. This measure had for its object the segre-
gation and observation of cases before the actual onset of the disease.
(2) Wherever it was practicable to do so, troop trains passing
through the area for other destinations were stopped; the men on
board taken off and given a medical examination, permitted to dry
their clothing, and given a hot meal. The men of the command show-
ing slight symptoms were carefully observed ; men wdth slight coughs
segregated in separate billets. (3) DiA'isional orders were issued re-
quiring that troops sleep head to foot. Twenty square feet of floor
space was the minimum alloAvance, but provisions were made for 40
square feet in cases where this could be done. Officers of the day
were required to inspect billets at night and to see that proper A^enti-
lation was provided, and that the men were sleeping head to foot.
A. E. F. — DIVISIONS. 1635
M. SE\'ENTY-SEVENTH DIVISION.
The advanced section of the 77th Division arrived in Pas de
Calais April 2. 1918. and proceeded to the Hazebroiick sector for
training with the British. The other units of the division arrived at
various ports — Liverpool. Brest, Calais, and St. Nazaire — completing
the movement from the United States to France, with the Artillery
and ammunition train arriving at Brest May 4, 1918. From this point
the Artillery proceeded to Bordeaux (Camp de Souge) for training.
Tlie 308th Field Hospital, due to an accident at sea. was detached from
the sanitary train and arrived at St. Xazaire. This unit functioned
independently, first with the suply train at Fays-Billot. Haute-Marne,
from which point the organization proceeded to Camp Hospital Xo. 9,
Chateauvillain. Haute-Marne, relieving units from the sanitary train
of the 3d Division. The organization remained at that place from
June 1 to June 22, 1918, at which time it proceeded to the Lorraine
sector, joining the division.
In April, the numerical strength of the division was 12,454; in
Ma}' 20, 302. All organizations, with exception of the Artillery
Brigade, supply and ammunition trains, and 308th Field Hospital
were with the division at this time.
Troops were distributed in the British sector for purposes of train-
ing. The country in this section is of a rolling nature, good roads,
and highly cultivated. Forests are few as compared with other sec-
tions. On approaching the front, at that time occupied by the British,
the terrain is noticeably flat and continues so for miles. The troops
were quartered in farm houses, barns, and stables, with the smaller
organizations in Xisscn huts. When billets were not available, shelter
tents were utilized.
During the months of October, November, and December, 1918,
quite a few cases of mumps appeared. These cases were removed to
the hospital as soon as they were detected and no particular measures
were instituted in the organizations to combat any further outbreak
other than insisting upon the i-equired floor and cubical air space
in the sleeping quarters and encouraging the men to remain in the
open air as much as possible. In OctobeF and November, 1918. and
in January and February, 1919, influenza assumed the proportions
of a small epidemic. The measures taken to prevent the spread of
the disease, as well as other sanitary precautions, are included in the
reports attached to this communication. All recommendations in
these reports Avere followed throughout the division. In October, No-
vember, and December. 1918, bronchitis was prevalent, and was at-
tributed chiefly to the exposure entailed at that time as a result of
battle conditions, etc. Such cases seldom proved serious, and upon the
patient's entrance to the field hospital or camp hospital, where he
gained proper rest and nourishment and received medication, the
condition rapidly disappeared. In August, October, and November,
1918, dysentery and enteritis appeared. The cause of these outbreaks
was attributed to battle and extreme insanitary conditions met with
in the Vesle and Argonne sectors. Enforcement of disciplinary meas-
ures relative to disposition of waste, excreta, and burial of the dead,
etc.. removed the cause, and ultimately the number of infections occur-
ring. In November and December, 1918. and January. 1919. typhoid
fever made its appearance, and in one regiment assumed the propor-
142367— 19— VOL 2 42
1636 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
tions of an epidemic. Enforcement of the measures contained in
the attached report of the typhoid epidemic was responsible for the
disappearance of this disease.
No cases of trench foot have appeared among the troops of this
division. The men M'ere encouraged at all times to pay particular
attention to the hygiene of the feet, and the}' were advised along the
following lines:
"Frequent change of socks, frequent bathing of the feet, with use
of fcot powder. They were advised against the tight wrapping of
the spiral ])uttee. The supply officers at all times exerted every effort
to supi)ly the men with the proper size shoe. There were times when
this couid not be done, but the conditions were remedied as soon as
the proper sizes were available. No extraordinary effort was needed
to induce the men to follow out any suggestion offered. Frequent
inspections of the feet were made, also frequent inspections of the
billets at night and all other sleeping quarters of the men, particu-
larly when they were compelled to use their shelter halves or sleep-
ing in places where the ground was the only spot available for a bed.
They were instructed at these times on taking off their shoes to
keep their feet off the ground during the night.
To date, 829 cases of venereal disease are included in the reports
of the division surgeon's office, 226 of which are reported as new.
The -control of this situation was governed at all times by strict ad-
herence to general orders, bulletins, ancl memoranda on the subject.
The division has at all times maintained a venereal camp, at which
all cases received treatment. In the Lorraine sector this camp was
placed as close to the front as was possible for safe operation, in-
fected cases being sent there on special duty and detailed to organi-
zations for road work, etc. When the division proceeded to more
active sectors, venereal cases were sent to their organizations, the
fact that they had venereal disease being no excuse for their non-
participation in any battles. Upon the relief of organizations from
the front, any venereal case existing in the organization was again
returned to the venereal camp and treatment continued, while at
the same time the soldier was compelled to perform fatigue duty.
Rigid inspections at unstated times were made in all organizations
and any case whether acute or chronic was forwarded to the proper
place. Prophylactic stations were maintained at every point where
troops were quartered and rigid inspections of these stations were
made, and in cases of uncleanliness, disciplinary action taken. With
the cooperation of line officers, division chaplains, and division head-
quarters the subject received particular attention at all times in such
a manner that sexual hygiene was brought constantly- to the atten-
tion of all troops of the command.
Eegardless of what area this division occupied there were at no
time delousing plants in waiting upon the arrival of the troops.
Periods of from two to four weeks passed before the officer in charge
of delousing was able to obtain material to carry on his work. Such
plants, when obtained, were invariabh' badl}' in need of repair or the
number insufficient to meet the requirements. The matter of de-
lousing has always received particular attention and the cooperation
on the part of the line officers has been admirable. The troops have
at all times been anxious and willing to carry out all instructions
that would enable them to rid themselves of vermin. In bathing and
A. E. F. — DIVISIONS.
1637
change of clothing the same conditions were encountered. The divi-
sion has always been compelled to construct its own baths, even in
the so-called rest areas, and following the movement of troops into
these areas several weeks elapsed before delousing and bathing could
receive proper attention. When baths were constructed, rosters were
formulated and organization bathed accordingly, change of clothing
being effected at that time. .In the Lorraine sector and the 9th train-
ing area divisional laundries were established after a lapse of three
to four weeks and many of the organizations were successful in tak-
ing advantage of the opportunity. Several companies established a
so-called company laundry, while a number of troops had their cloth-
ing washed by the French. In the Yeslo sector there was little or no
attention given to the matter of delousing or heating. The division
was very active at all times, and upon being relieved immediately
took up a position in the Argonne sector. The conditions existing
between these two months did not permit any organization to be de-
loused or bathed. Following the first phase of the Argonne drive
the division was brought back in reserve and remained there for
about two weeks. At this time delousing and bathing plants were
established and before entering on the second phase of the Argonne
drive delousing and bathing of the entire division, also equipment,
in so far as clothing was concerned, had been accomplished. Follow-
ing the signing of the armistice this matter again received particular
attention, and for a few daj^s following and prior to the movement
of the division to the 9th training area approximately one-half of
the troops received baths and were deloused. In the 9th training
area, after a lapse of several weeks, which time was devoted to the
collection of equipment and establishment of baths and a laundry,
the hygiene of the troops was again placed first in all schedules and
from that period on regular schedules have been followed.
The Medical Department, from the standpoint of equipment, has
experienced little or no difHculty, when taking into consideration the
various conditions and situations which existed. The general com-
plaint throughout the entire division was lack of transportation.
While in the Lorraine sector no difficulty was experienced, as requi-
sitions were promptly filled and forwarded by rail from the depot at
Is-sur-Tille. Upon "the evacuation of that sector by this division,
three-fourths of the medical supplies were turned over to the 37th
Division. This resulted in a shortage when we arrived in the next
sector. Requisitions were forwarded from the Vesle sector August
14, 1918, and articles contained in this requisition were received
October 9, 1918. The reason for this delay is explained by the fact
that it w^as necessary to forward requisitions through so manj^ chan-
nels and have them O. K'd by the heads of various departmeiits be-
fore they reached their final' destinations. It can not be said that
most of' the articles requisitioned for were not necessary for the
proper operation of any department, and in order to properly treat
the great number of cases that were passing through the hospitals at
that time, the Red Cross was called upon to furnish supplies, which
they willingly did and upon very short notice. In this sector great
inconvenience was caused to the regimental surgeons by the fact that
the medical supplv depot was located so far to the rear. The sup-
plies were forwarded from the depot by ambulances which were
evacuationg from the front, and in many instances these supplies
1638 REPORT OF THE SURGEON GENERAL OF THE ARMY.
never were delivered to the organizations, explained by reason of
intensive shelling of all roads and by the fact that very often dress-
ing stations changed their locations between the time the ambulances
left the stations with wounded and returned with the medical sup-
plies. In the Argonne offensive the advanced medical-supply depot
was established with the triage and advanced with that unit, so that
no difficulty was experienced by any organization in obtaining sup-
plies. One' fault encountered here was the fact that the main supply
depot for the division remained stationary and did not advance with
the troops. In a very short time the distance between the advanced
supply depot and the main depot was so great that to make the round
trip required three days. The main reason for the main depot not
advancing was again lack of transportation. Full and complete equip-
ment for all purposes Avas on hand at all times, and, with the excep-
tion of absence of a few drugs, such as ammonia chloride troches and
Brown's mixture, the divisFon has not, with the exception of the
Vesle sector, suffered from the lack of essentials such as blankets,
litters, splints, front parcels, serum, and narcotics. The 308th In-
fantry stands first on the list as having received one-half of the
drugs issued bv the medical supply depot. The 305th and 306th Field
Artillery are at the foot of the list, having been issued less than any
other oro-anization. In spite of the difficulties encountered, due
chiefly to'^the lack of transportation and partially to the necessity of
forwarding requisitions through so many channels, the division has
received it's quota of supplies. The elimination of these faults even
partially would have resulted in absolute satisfaction and the expe
dition of the receipt of all supplies.
The sentiment of the line officers throughout the division, as ex-
pressed relative to the medical officer, leads one to believe that in the
majority of instances, througli his devotion to duty and the atten-
tion fy'ixen to the many details which are directly responsible for the
health of the command, that the services of the medical officer are
indispensable and highly appreciated. As before stated, cooperation
on the part of the line and various organization commanders with
the medical officer has been very commendable. The relative value
of the medical officers as to efficiency classed beginning as excel-
lent, is very variable and differs materially under conditions as
they existed— whether in battle or in rest areas. Many medical
officers who did not show any degree of efficiency in the various prob-
lems encountered in military life and as met with in cantonments,
etc., proved to be highly efficient under battle conditions. The
inverse is also true. In this division attempt was made as early
as possible to assign medical officers acrording to their ability along
professional lines, as per example: Those experienced in surgery
were placed, in so far as conditions permitted, in field hospitals,
as it was at this point the greater number of surgical cases were
received. Those particularly advanced in internal medicine and
especially proficient in diagnosis were placed with field hospitals
rereiving medical cases, and in this manner the efficiency of the
field hospitals as a whole was developed to a high degree. In the
ambulance companies very few changes were made until after the
cessation of hostilities, thus the fact that these units remained in-
tact from the time of their organization resulted in a high degree
of efficiency. Many changes were made in the medical detachments
A. E. F. — DIVISIONS. 1639
of the various Infantry organizations, some due to inefficiency, others
resulting from sickness, wounds, deaths, etc. As a result the recom-
mendations of regimental surgeons as concerned their respective
organizations did not receive the uniform attention to details as
would have been given had these organizations remained intact.
Under battle conditions the work of the entire medical department
in caring for the treatment and evacuation of wounded is to be
highh^ commended, and although not perfect can be classed as very
good. Following the armistice there was an apparent relaxation of
the interest demonstrated by all sanitary units and detachments
which resulted in the spread of disease which would otherwise have
been checked had the interest formerly demonstrated been continued.
This condition, however, was corrected, but it can not be truthfully-
said that the combined interest of the Medical Department, after
the cesation of hostilities, equalled that preceding. From a stand-
point of percentage, and assuming the grade of " excellent " to mean
perfect, the following will suffice: Very good, 80 per cent; good, 10
per cent ; f ai r, 5 per cent ; poor, 5 per cent.
TVHiile the division remained in the Lorraine sector it could hardly
be said that actual battle conditions existed. However, the strength
of the division prior to what operations took place at that point was
20,346. In the Vesle sector prior to active operations strength of
the division was 26,193, and in the Argonne sector 25,709.
In the Lorraine sector activities were chiejfly those of trench war-
fare— occasional active machine-gun fire and very much sniping,
occasional raids by both sides and abundant enemy air-craft activity.
No advances were made by either side. In the Vesle sector the divi-
sion engaged in all types of warfare and the enemy took advantage
of the ravines and other natural positions, using considerable gas.
Enemy air craft activity in this sector was also extremely hea^n^-.
Liquid fire was used on several occasions by the enemy. At all times
there was very active machine-gun and artillerv fire. An account
of the activity in the Argonne sector has already been published
to which reference can be made. Maps of the various sectors in
which this division was active accompany this communication.
Beginning with the few activities in the Lorraine sector an effort
was made to establish some definite plan that would be applicable
for the evacuation of the wounded as quickly as possible under all
conditions. Previous mention has been made of the establishment
of a triage in this sector, and although it was the first experience at
organization of a unit of this type by the medical department of this
division, it was found to be very satisfactory. It resulted in the
evacuation and classification of the sick and wounded to the various
hospitals designated for the cases, quickly and without confusion.
Upon establishing positions on the Vesle sector, the same plan was
adopted on a more elaborate scale and resulted in increased satisfac-
tion. Battalion aid posts in this sector were ofttimes just established
when it was necesbary to move, and many times the wounded were
collected at one point (collecting points'), from which ambulance
companies received them and evacuated through the advanced dress-
ing station to the triage. From the triage the cases were evacuated
to the evacuation hospitals and hospitals for nontransportable
wounded. Established in conjunction with the triage were the field
1640 REPORT OF THE SURGEON GENERAL OF THE ARMY.
hospitals receiving slightlj- wounded, sick, and gassed. No cases
were held at this point except true nontransportable wounded.
In all sectors in which the division operated, two ambulance com-
panies Avere sent forward and two kept in reserve, the reserve units
leapfrogging when an advance was made. When field hospitals oper-
ated as units, receiving selected cases, such as one receiving gas, one
medical cases, and two receiving surgical cases, it was impossible to
hold any unit of this type in reserve. Therefore, two permanent
triage units were established, using the officers and personnel of the
two field hospitals designated to receive surgical cases. The descrip-
tion of the evacuation in these units and their activities will be given
under description of "Field hospitals, mode of functioning." The
division has always been fairly well supplied with ambulances.
When casualties were heavy, ration trucks and any other available
transportation were utilized. In the Argonne Forest, German rail-
roads were used, and it was also often necessar}' to litter patients
from 1 to 4 kilometers to the nearest collecting point or battalion
aid station. The advances here were so rapid that no definite bat-
talion aid station could be established for any length of time.
Liaison between the ambulance companies and regimental sanitary
units was maintained by means of runners. Liaison, under conditions,
was good, but the difficulties encountered for evacuation were many.
Roads were congested; when not so, were being shelled heavily.
These two factors made it extremely difficult for the field hospitals
and triage to keep pace with the advances, but by the system of leap-
frogging and the establishment of the before-mentioned collecting
points, a fair degree of success was obtained in the evacuation of all
wounded.
Beginning at the time the division entered the Lorraine sector and
ending with the signing of the armistice, the division was in action
107 days, and 22,953 cases of sick, wounded, and gassed passed
through our hands in that period, the average rate of flow being
about 200 cases a day. Of the total number of evacuations, 66 per
cent were sick and 34 per cent wounded and gassed. The latter clas-
sification is subdivided as follows: Slightly wounded, 15 per cent, the
greater proportioij of which were received from shrapnel and
machine-gun bullets and hand grenades; seriously wounded, 9 per
cent, all of which were received from shrapnel and shell fragments
and hand grenades; 10 per cent were gassed, 9 per cent of which were
slight and 1 per cent severe. During the period of activity the
greater number of sick evacuated suffered from dysentery, influenza,
and bronchitis. Those three diseases represented the cause for the
greatest number of evacuations, influenza being especially prevalent
from September, 1918, to February, 1919; bronchitis from October,
1918, to February, 1919 ; and dysentery from August, 1918 to Decem-
ber, 1918.
During actual hostilities and at all times when organizations of
the division were most actively engaged, very little time lapsed be-
fore those who were killed in action were buried. At some points,
hoAvever, it was impossible to give this matter attention for a period
ranging from 12 to 24 hours, but after this time in the majorit}^ of
instances the dead were collected and buried. This task was accom-
plished by the Pioneer Infantry under the direction of the sanitary
inspector of the division. They follow^ed each advance, combing
A. E. F. DIVISIONS. 1641
the country in a methodical manner. The hygiene of the battle
fields was as good as could be expected under the circumstances,
which, in turn, was of a necessity very poor. Advances were so
rapid and destruction so complete that hygiene, from a true hj^gienic
standpoint, was next to impossible. The enemy in many instances
cared for some of their own dead, but on the other hand it was neces-
sary for our own units to bury their dead, who had oftentimes been
exposed for a period ranging from one day to a week. The roads
were littered with man}' dead horses, and it was only possible to
bury them after all the advancing units had passed. During the
period of advance dysentery was very prevalent among our troops,
who stuck to their work in spite of this handicap, but did not give
much attention to straddle trenches, etc. All these conditions were,
however, corrected as soon as possible, and within a few days after
an}^ one unit had advanced the area in which they had just left was
placed in first-class condition by the sanitary squads and Pioneer
Infantry.
Owing to the extreme congestion and violent shelling of all roads
and to terrific machine-gun fire in the front lines, it was oftentimes
impossible to remove the wounded until dark. This was true par-
ticularly on the Vesle sector and to a great extent in the Argonne.
In the latter case the roads were constantly jammed with divisions
taking their places in the line, and the divisions which were being
relieved moving back. Some effort was made to reserve certain
roads for evacuation of the wounded, but it was apparently impos-
sible. In spite of these conditions, however, the average length of
time in transporting a wounded man from the place of receiving
his wound to the field hospital consumed a period between 3 to 8
hours. The evacuation hospitals, in the case of this division, with
one exception, were so far to the rear that no average time could be
calculated for the transportation of the wounded to those points.
At the begining of the Argonne drive evacuation hospitals were
from 30 to 60 kilometers from the field hospitals.
The majority of the wounded received at battalion aid posts were
in good condition with, of course, the exception of the severely
wounded. Provisions were made to combat shock at these stations,
but not on as extensive a plan as at ambulance dressing stations or
field hospitals. A man being received at battalion aid post in a
state of shock was given some treatment for this condition there,
also at the ambulance dressing station, and upon reaching the field
hospital more extensive treatment than at any of the places before
mentioned was received. In this manner we were able to successfully
combat a great many cases of shock who would have otherwise died.
On evacuating such cases from field hospitals, which, in the case of
this division, operated as triages, the patients were surrounded with
hot water bottles, heated shell cases, and any other article capable
of maintaining heat that was possible to procure. By so doing
it was the invariable rule that our cases reached the evacuation hos-
pitals in better condition than they were an hour or so after receiv-
ing their wounds. Every effort was exerted to institute all modern
methods of treatment for shock. Special tables were constructed
from broken litters, which were collapsible and easily transported.
It will be interesting to note in the attached resume of work done
by surgical department the high percentage of evacuations of all
1642 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
classes of cases from the triage. We have no reports of any cases
djnng en route to the evacuation hospitals.
At all stations where wounded were received a goodly supply of
antitetanic serum was always on hand. Immediately upon the ar-
rival of a w^ounded man at battalion aid post the serum was admin-
istered. If, hoAvever, he was evacuated first to an ambulance dressing
station, the serum was administered there and during such times
when these stations were crowded quite a few cases were admitted
to the triage that had received no serum. Any case thus admitted
received his injection at this point, so that no man was evacuated
from this division without having received antitetanic serum. Splints
were also kept on hand at all three places, and among the many cases
received at triage requiring splints, only two or three were admitted
not having had splints applied. The records from units receiving
wounded from this division will show that this department was espe-
cially proficient in its work.
No cases receiving wounds from machine-gun bullets, shrapnel,
hand grenades or other missiles were salvaged directly for the di-
vision. Instructions were received that all cases were to be evacuated
regardless of hoAv slight the wound, and these were carried out to the
letter. There were, however, in the Vesle sector 2,700 gassed, 50 per
cent of which were returned to duty from the gas hospital. In the
Argonne sector 500 cases of gas were admitted, 75 per cent of which
were returned to dut3^
Approximately 10 per cent of the men who were tagged " gassed "
were found to be suffering from causes other than gas.
The distribution of gas cases is as follows: Baccarat sector — 250
gasses, of which 200 were dichlorethyl-sulphide and 50 phosgene; no
deaths were reported. In the Yesle-Aisne sector — 2,700 were gassed,
all of which were dichlorethyl-sulphide ; 50 per cent of these showed
evidence of external burns. In the Argonne-Meuse sector — 500 were
gassed, 50 per cent being from dichlorethyl-sulphide and 50 per cent
from chlor-arsine ; no deaths were reported from divisional hospitals.
In the Vesle sector a great number of our casualties were produced
by gas. It, however, can not be said that gas was of any great impor-
tance. The troops of this division continued fighting regardless of
what type or of how much gas was thrown amongst them.
The average time for recuperation of those cases returned to duty
from divisional hospitals varied from one to three days and, as before
stated, only gas cases were so disposed of, with the exception of a few
mild cases of bronchitis, etc.
Only two cases of so-called " shell shock " have come to the atten-
tion of the medical department of this division. These were marked
" cases of hysteria," one of which was returned to duty after a rest
in a divisional hospital for about a week and the other evacuated.
There were a number of cases that appeared at the battalion-aid posts
who claimed to have shell shock, etc., but received very little sympathy
on the part of those in attendance and were returned to their units
almost immediately. No particular means were necessary to limit
these cases. The men themselves knew that unless they were really
sick or wounded there was very little chance for evacuation for con-
ditions attributed to neuroses.
From the standpoint of comfort, the Artillery organizations pos-
sibly fared better than any other units, as it was often possible for
A. E. F. DIVISIONS. 1643
them to obtain comfortfible billets. Every effort was made to pro-
vide the same degree of comfort for the Infantry organizations and
other units of the division but the necessities of actual warfare very
often made it impossible for the greater portion of these men to
receive other than a fair degree. During inactive periods billets were
always obtained, which, of course, did not varv in any particular
from billets occupied by other divisional troops. The various depart-
ments of the division during these times exerted every effort to obtain
bedsacks, straw, etc., and to proA'ide sufficient fuel and were in many
cases successful in their accomplishments. In rest areas the greatest
drawback seemed to be lack of sufficient fuel and the scarcitv of
quarters or billets that could be called comfortable or dry. Athletics
were encouraged at all times as well as competition along these lines.
Except in wet weather troops were compelled to remain outdoors, and
divisional entertainments, dances, etc.. were provided to maintain as
high a degree of enthusiasm as possible. For hospitalized men the
various auxiliary organizations, as well as divisional entertainment
units, strained every effort to make them comfortable and cheerful.
Transportation of the diAnsion has been handled as in other divi-
sions of the American Expeditionary Forces, i. e., by pooling the cars
and distributing them by assignment. During periods of activity
each ambulance company retained its own transportation.
Experience in the Lorraine sector taught that utilization of the
triage was the most satisfactory method of hastenins: evacuation and
thorough treatment of the wounded, and immediately upon resuming
activities on the Vesle, two permanent triage units were formed. The
triage units referred to were organized by drawing on the personnel
of two field hospitals. Surgical, shock, gas. and medical teams were
formed. The enlisted personnel was carefully selected, two being
assigned to each officer, which in turn constituted a team and which
lemained permanent from the time of its organization. Other en-
listed men were chosen who were thought to be especially proficient
in such duties as administration of A. T. S., morphine, application
of bandages, and splints, etc. Permanent details were organized for
other duties such as providing nourishment, litter bearing, policing,
and salvage, records (entrance and evacuation), etc. The operating
room detail was chosen from men who had been hospital orderlies in
civil life and by so selecting and keeping permanent the various teams
in a short time the organization became very proficient. Equip-
ment was selected from that of two field hospitals, disregarding en-
tirely the tables of organization and choosing only those articles which
were thought to be useful at all times. In this manner much of the
equipment was salvaged and in its place other articles such as addi-
tional litters, blankets, A. T. S., front parcels, etc.. substituted.
The wounded received in the divisional hospitals were evacuated
immediately. In the hospitals receiving medical and gas cases only
those seriously ill were evacuated, the remainder being detained
for a period of from one to two weeks, at the end of which time they
were returned to duty. Bed capacity of the medical hospital was
normally 216, but in many instances Avas enlarged by the addition of
several ward tents so that at times they accommodated from 300 to
450 cases. The gas hospital accommodated 216 patients. The operat-
ing capacity of the hospitals receiving surgical cases which in turn
1644 REPORT OF THE SURGEON GENERAL OF THE ARMY.
functioned as triafre units, varied. No operations were performed
that were not absolutely necessary as explained in the attached report.
It was. however, possible with the arrangements made to keep two
operating teams busy.
The patients received at field hospitals were evacuated by our own
ambulance companies with the aid in several instances of corps am-
bulance companies. It was also necessary at several times to utilize
trucks obtained from whatever source possible.
Remarks. — The results obtained by the mode of functioning of the
various sanitary units of the division were so successful in hastening
evacuations that it seems applicable at this time to recommend that
the application of permanent triage units as organized and operated
by this division, with an increase in the personnel of the ambulance
companies, would be a valuable asset to the organization of the Medi-
cal Corps of the United States Army ; also, that should similar cir-
cumstances arise in the future the hospitals organized for the purpose
of receiving the nontransportable wounded be so arranged as to func-
tion with the triage. A combination of a triage and nontransportable
wounded hospital could be so organized that not only would the
wounded receive better and more detailed attention, but evacuations
would be greatly expedited as well as the unit being extremely mobile.
STJBGICAI, DEPABTMENT, 77TH DIVISION.
At these points complete operating rooms, with all facilities for per-
forming any t3"pe of operation, were established. All cases admitted
to the triages from the dressing stations were assumed to be operative
unless in a marked degree of shock or dead on arrival. Cases of
noticeable hemorrhage, even though in shock, were considered as
operative to the extent of controlling the hemorrhage. Any case
subjected to operation was such that delay would have most certainly
resulted in the death of the individual in question. Supplementing
this latter statement, during the early activities of the division along
the Vesle, operating teams were attached to field hospitals, some being
designated as particularly capable of operating on selected types of
cases, viz, chest, abdomen, etc. A number of chest cases were sub-
jected to operation which, as later experience proved, would have
progressed more satisfactorily if treated sj^mptomatically. During
this period of operative interference on practically all cases of pene-
trating shrapnel wounds of the chest 81 per cent died, whereas under
more conservative measures 96.5 per cent of all chest cases admitted
were evacuated in good condition.
The abdominal cases operated upon where of the following type :
{a) Penetrating wounds of upper abdomen, evidencing signs of
hemorrhage.
(h) Shrapnel wounds of abdomen in which torn intestines were
protruding.
(c?) Wounds of abdomen showing protrusion of abdominal con-
tents. Symptomatically these cases simulated strangulated hernia
The majorit}^ showed no perforations.
{d) Cases reacting from shock sufficiently to justify operative
means at once as their only chance for recovery. Further transporta-
tion and subsequent operation on this type was out of the question.
A. E. F. — DIVISIONS. 1645
N. SEVENTY- NINTH DIVISION.
The 79th Division was authorized by War Department orders and
formed on August 25, 1917, Maj^ Gen. commanding,
Col. — ^ chief of staff, with Lieut. Col. division surgeon,
and Maj. as division sanitary inspector, the latter officer arriv-
ing about September 20, 1917.
This division, after long months of weary waiting and arduous
training, began its movement overseas on July 8, 1918. Because
of conditions existing during a state of war the division sailed part
from New York and part from Philadelphia (Artillery brigade).
From July 18 to 25 the division was debarking at Brest and in
English ports, to be assembled later.
The Infantry brigade and other units moved into the 10th train-
ing area (Prauthoy-Champlitte area), 38 towns, to train under the
4th and 6th American Corps. The soldiers were billeted in stables,
barns, and in any available spot, all towns inhabited being as filthy
as possible, sanitation was very difficult.
The billets of the men were in many, many instances identical
with the billets of horses, cows, and chickens — foul, dark, damp
places reeking with a million unsavory odors. After much planning
and work these billets were made habitable, and men began to
settle down to training.
In the latter part of August influenza started in the division and
was at once recognized as a dangerous epidemic. Prompt measures
were taken to stamp it out, such as head to foot sleeping of the
men, abundant ventilation, careful inspections daily by medical
officers to detect sick men. Temperatures of all men coming to
sick call or found feeling " badly " were taken, and every case
showing a rise in temperature was isolated. In one organization, the
304th Engineers, the epidemic became so severe that it was quar-
antined; two hospital tents were put up, one for sick patients, the
other for convalescents, with competent medical attendance, and
in this way the epidemic was finally stopped. The division had a
total of about 600 cases with 4 per cent mortality. Owing to con-
ditions existing it was impossible and impracticable to do post-
mortems, so the number of empyemas was dubious, as fatal cases
died rather quickly, sometimes within 48 hours after the onset.
During this epidemic, which was the worst in the history of the
division, the Medical Department was constantly at work and/
achieved admirable results, and this work was but an indication
of the ability of the Medical Department to meet trying conditions
under difficult circumstances and meet them properly to win.
There were no other serious epidemics in this area and nothing
of importance, so that further discussion of health conditions is
felt to be unwarranted.
Tra'ming. — When we think of that work in connection with the
Medical Department in this division we breathe a great breath and
say : " Thank God for some of the training our men got at that
time, especially the application of Thomas splints."
Splinting was finally taught the men, all splints having to be
improvised as we were able to get only two or three Thomas splints
from any source whatever, after repeated efforts, until a few days
prior to our departure for the front. Thanks to the efforts of our
1646 EEPORT OF THE SURGEON GENER^iL OF THE ARMY,
division ortliopedist and his asistants every man in the Medical
Doi)artnient coukl put on a Thomas splint when we went into line.
The sanitary train began to put on maneuvers and function as
tliouah in combat, and after a few of these maneuvers the men felt
tliat they were really going to function as Medical Department
troops. Working early and late, cramming and rushing in all infor-
mation possible, and scouring every possible source for further in-
formation we felt that the Medical Department had done its con-
scientious duty as far as training went, and as it happened, combat
results proved us correct in our belief. Every medical officer in the
division seemed to feel his individual responsibility and worked
feverishly to instill all phases of first aid, cleshocking, splinting, etc.^
into the enlisted men under him. Eegimental detachments functioned
with their regiment in maneuvers, so that a fair idea was obtained
as to what the function of the detachment was to be.
On September 9, 1918, the division began its move toward the
front, by rail. This move was very quietly done, the division finding
itself in the Robert-Espagne-Bar-le-Duc area just back of the Ar-
gonne, widely scattered, and, as a consequence, exceedingly difficult
to administer. Spending only a few clays here, nothing important
happening, we will skip on to the move by motor bus to relieve the
15Tth French Division, in sector 301 (Montfaucon).
This move and relief was accomplished about September 18, the
distribution of units of the division as illustrated on accompanying
diagrams and maps.
Here our influenza almost entirely disappeared in the face of
greater trials and tribulations. Health conditions improved re-
markably, only a few cases of influenza having to be evacuated. Men
were living in dugouts, shelter tents, old buildings, any place that
would afford shelter.
Especial attention was given, from the beginning, to " trench
feet ■' and, although no cases occurred, every precaution was taken to
fight it if it did appear.
Chlorinated water had to be used, and, owing to the conditions
under which men were living, it became essential that responsible
officers see that men filled canteens at the beginning of the day and
that they drank water no place else.
Sanitary conditions were bad, but by a little care, the use of
straddle trench latrines (English type), and good climatic conditions
we experienced very little difficulty in keeping the men in good
condition.
When the action began in this sector on September 26, our division
triage was about 10 miles behind the lines at a point called Clair
Chenes, with ambulance dressing stations as indicated in operations
reports. Eegimental units were apportioned to battalions equally^
or as necessity indicated, two medical officers and as many enlisted
men as needed, usually.
Road conditions were terrible, the only available evacuation route
being the axial road of corps, so that what with supply trains, ammu-
nition trains, artillery, etc., ambulances had a very difficult time in
getting to and from the front.
With ambulance dressing stations in dugouts or wherever cover
was available, officers and men from their respective companies
Avorked unceasingly, with no thought apparently but to " do the job
A. E. F. DmSIONS. 1647
Avell." Often under heavy artillery and rifle fire, these parties, as
did regimental detachments, did wonderful work. Regimental de-
tachments followed lip the Infantiy, often going over with it, from
one cover to another, so that as soon as a man was wounded first aid
was administered, and this division had the enviable record of not
having a single fracture case get back without a splint. Splints
were actually adjusted under heavy fire at times, and the training
T^hich our troops had received certainly stood them in good stead
now in this trying time.
Because of congestion on this one evacuation route, motor ambu-
lances were held for 36 and 48 hours on one occasion, and here we
will speak of our animal-drawn ambulance company again. When a
message came down that a road block was holding ambulances, the
animal-drawn ambulances were rushed to the scene, and, by driving
out through mud. bushes, and shell holes, were able to relieve, to a
great extent, this holding of wounded, and we feel that although an
animal-drawn outfit may be valueless under certain conditions, that
there are times, such as this, when they unmistakably save the day.
and are instrumental in saving many lives — being able to go where
motor vehicles can not go.
Trucks and anything else going to the rear were loaded with
wounded destined for our triage hospital, which was fully equipped
to take care of gassed cases (of which, incidentally, there were very
few), and which had a capacity for about 800 patients. A little
30-centimeter railroad was also used successfully in evacuating
Abounded to this hospital.
At the triage wounded were given quick but sufficient attention by
the medical personnel, and supplied with hot drinks, cakes, ciga-
rettes, etc., by the Red Cross representative stationed there. At this
point we feel that we must remark on the activities of the Red Cross
in this division. The division representative, Capt. , jr.. was
efficient to the highest point in procuring needed supplies — svringes
for antitetanic serum administration, shell dressings, etc. The co-
operation given the division by the Red Cross was splendid, and
Capt. personally rendered invaluable service in evacuating
wounded, working night and day, under fire practically all the time.
In this ofFensiA'e the division had 3,496 casualties, of which about
T50 were classed as missing.
On the 30th of September, at midnight, the division was relieA'ed
by the 3d Division at a point about 2 kilometers north of Xantillois
}>nd withdrew to a point south of Souilly, where we gathered up
" broken ends " and prepared for our next action. The troops were
exhausted, footsore, and feeling somewhat discouraged, because of
those two factors and the grueling experience of the preceding days.
The ISIedical Department, after leaving one field hospital at Clair
Chenes to care for straggling wounded of the division for a day or
two, began operations immediately after arriving in the new area,
so that its function was uninterrupted, even though the Ford ambu-
lances were nearly all " down," for out of the original 40 ambulances
only 12 Avere able to make the journey down, the rest having to be
rejiaired before making the move.
We remained in this area about one week, then moving into the
Troyon sector, relieving the 26th Division on October 8, 1918.
1648 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Copies of operations reports of the sanitary train in all sectors are
attached, so that positions occupied will be readily seen.
In this sector the time was spent in more or less trench warfare,
the sector being comparatively quiet.
Evacuation was easy, and the casualty list was small; as a matter of
fact, the most of our evacuations Avere cases of influenza and bron-
chitis. Eegimental and battalion aid posts were splendid for their
purposes, except that the battalion posts were in a somewhat exposed
position, but practically shellproof, and no casualties occurred at any
of these posts.
This period was very beneficial to the division as a whole, as we
Avere resting and getting replacements in preparation for the next
offensive movement in which we might participate. We were under
the Second French Colonial Corps at this time and received both
courteous and efficient cooperation.
On October 26 we w^ere relieved in this sector by the 33d United
States Division, and on October 30 we relieved the 29th and part of
the 26tli United States Divisions in the Grande Montague sector (east
of the Meuse).
The Germans were bombarding roads and possible covers in this
entire area feverishly and unceasingly, and the heaviest casualties
w'ere among troops who were forced to be on roads, as supply trains,
ammunition trains, Engineers, etc.
In this sector, as in the Troyon sector, we were in a French corps,
this time in the Seventeenth French Corps, and again received the
same courteous, efficient cooperation as before.
We operated a division triage and gas hospital at an old French
hospital at Glorieux, which was shared with us by Evacuation Hos-
pital No. 15, and in being so close to this hospital we Avere Aery fortu-
nate, as serious cases could receiA-e the necessary surgical attention
immediately, Avhich meant the saving of lives and limbs in a great
many cases. Our advanced stations were well located and fairly safe,
so that Avounded were quickly given first aid and quickly evacuated.
An ambulance " pool " AA-as made at a point in close proximity to
two regimental aid posts, where cover Avas available, and by this
means prompt eA^acuation of regimental aid posts Avas effected.
In this sector we began using wheel litters, which proved very satis- .
factory indeed.
Although casualties Avere heavy, evacuation Avas prompt, and, there
being no road blocks, the Avounded were promptly gotten to our hos-
pital. The aA'erage time between the incident of a Avound and arrival
at our division hospital Avas about three hours in this sector. About
the 4th of November the division got 41 Ford ambulances of its own,
and the S. S. U. units were relieved.
Health conditions were fair, although owing to the intense artillery
fire by the enemy it was often impossible to get chlorinated water up
to the combat troops in time to prevent them drinking from shell
holes and streams, so that as a result this division had a good many
typhoid cases (this was the only focus of infection Avhich Ave found
likely to have caused the disease), as comparatively few "carriers"
Avere found.
Sanitation Avas difficult in the advanced zone because of heaA-y fire,
and, as a consequence, our sick rate suffered an appreciable rise, imtil
A. E. F. — DIVISIONS. 1649
\re were able to take measures to get men in a little more sanitary
environment.
It has been our experience, as we presume it has been with others,
that sanitation in the real sense of the Avord is practically impossible
in an open, moving warfare, but that if enough enthusiasm and
enei'gy is exercised that men can be fairly well cared for.
On November 11 the armistice ended active operations, and we
began immediateh- to police up the battle field and institute rigid
sanitary measures, in which we were very successful.
We were in this area until December 27, Avhen we moved to the
Souilly area, south of Verdun. This area was very poor, there being
inadequate housing facilities; the towns unusually filthy and the
question of sanitation was a serious one.
Typhoid cases continued to appear, and it was thought necessary
to reinoculate about 2,500 men, which was done, and this cut the
typhoid occurrence appreciably.
Venereal disease gave us considerable worry in this area, as there
was a sprinkling of prostitutes over the area, and in addition leave
trains brought back a good number of A'enereal cases. Every effort
was put forth to check the occurrence of exposure and infection, but
in most cases Avith little effect, for the division was in a bad area in
the first place, and, as a consequence, the morale of the men was not
\ery high, and they naturally had a tendency to disregard repeated
warnings, since they felt as though they were to be in France for a
long time and a case of gonorrhea didn't matter much, or at least that
was the impression we got from talks with venereals and other men.
Matters Avent along uneventfulh^, comparatively, and on March 29
the division started its move to the Ith training area, near Chaumont.
In this area we have found almost ideal conditions, sanitation being
easy, housing abundant, and chief of all, troops, except in one or
two instances, are not billeted in toAvns, but just outside in Adrian
barracks. This arrangement permits of better control of the men,
and avoidance of contact with the civilian population, which is sure
to show a decided effect upon the venereal rate, and a better general
sanitary arrangement.
Evacuations have been light and the health of the command at
this time is extremely good. In conclusion there are a few points
which we desire to bring up and which we will deal with hurriedly :
1. Billeting as it has been done in France is most unsatisfactory,
because of the poor quality of billets Ave have had to use.
2. Training of Medical Department troops has, to a big extent,
been erroneous, in our opinion, for where tent pitching, for instance,
has been used, it seems that splinting and bandaging could have
been substituted to a great advantage to all concerned.
3. ^ledical Department troops should be trained at all times in
conjunction with combat troops, so that their function is clearly
understood and in order that complete cooperation may exist;
maneuvers have been invaluable to us in the teaching of our men
to Avork Avith line troops in combat.
4. The proposition of causing a diAdsion to have to use S. S. U.
units, or anything else, over which the division surgeon has prac-
tically no control is not conducive to the efficient evacuation of
Avounded in auA^ sense. The sanitarv train Avith its four ambulance
1650 REPORT OF THE SURGEON GENERAL OF THE ARMY.
companies have been trained to function Avitji its division, and it
would be infinitely better to give these companies their own equip-
ment, or even a part of it, and allow them to function properly and
under the jurisdiction of the division surgeon.
5. Ford ambulances are unsatisfactory in some sectors while being
almost essential in other sectors over bad roads; if B. M. C. ambu-
lances were furnished to two ambulance companies of a sanitary
train, Fords to another, and animal-drawn to another it would
about even matters up, for then heavy ambulances could be used
in places where even Fords can not operate, as in the case mentioned
dui'ing the Argonne fight.
6. There should be better liaison between corps and division, as
in our case we have at times sufl'ered because of this weakness in
our organization.
7. It seems that in order to properly function and give efficient
service the regimental personnel should be increased appreciably,
especially in the matter of enlisted men, and that our ambulance
companies should be increased in personnel, and especially in the
number of ambulances.
8. A mobile laboratoj"}- equipment becomes a liability to a division
instead of an asset if no transportation is furnished for it, for in
the case of this division we have never yet had anything like our
full transportation, and innumberable hardships have been the re-
sult, and to have to cart this equipment around only adds more worry
and work, as it is never used during combat such as this division
took part in.
9. Our medical carts are far too heavy and cumbersome, as they
kill horses that are unfortunate enough to have to pull one ; it seems
that a four-wheeled vehicle with at least two animals should be
substituted.
10. Tents that are furnished our field hospitals are almost useless,
unless two of the ward tents are pitched together; a substitution of
the French type of ward tent would be extremely advantageous, al-
though slightly more expensive, as in these tents real care can be
given the wounded man and some light, ventilation, and warmth is
insured, as well as freedom of movement on the part of attendants.
It is suggested that the tables of organization carry one additional
medical officer, who shall be termed "Attending surgeon to division
headquarters," as neither the division surgeon nor his assistant has
time from his administrative duties to do this work.
The sanitary train of a division should be furnished an adjutant,
preferably a sanitary corps officer, with the rank of captain.
The sanitary train should be allowed to carry colors, as this would
be a great stimulus to morale and create a fine pride in the organiza-
tion.
O. EIGHTIETH DrV^SION.
The various units of the 80th Division left Camp Lee. Va., com-
mencing May 18, 1918, for the ports of embarkation at Hoboken,
X. J., and Newport News, Va., units leaving camp before the end of
June, 1918.
Conditions on sMphoard. — The units sailed on various ships in
difi^erent convoys from Hoboken, N. J., and Newport News, Va.
A. E. F. — DIVISIONS. 1651
Some of the ships were reported by the medical officers as being in
excellent condition and some as being insanitary. This last was true
of the Rei cVItalie and the Duca (VAhruzsi. In cooperation with the
transport surgeons, sick call was organized, sanitary inspections made,
and police details assigned. Although bathing facilities were limited
on all the transports, endeavors were made to have the men bathe as
frequently as possible and change their socks and underwear at least
twice a week. Comparatively few men were- infected with vermin of
an}' kind. The health of the men on board ship was excellent, and
few men were sent to hospital on arrival at the ports of Brest,
Bordeaux, or St. Xazaire, France.
Ports of debarkation. — Upon arrival the men were taken to rest
camps awaiting entraining orders at Bordeaux, St. Nazaire, and
Brest. Adverse comment was made by the surgeons of the scarcitj'
of water, bathing facilities either being meager or not existing.
The men were all warned of dangers of venereal disease, cards of
warning were issued and prophylaxis treatment provided by the
surgeons of each unit. Orders were received from the base com-
manders to turn in all medical equipment, and the instructions were
complied with except that the emergency supplies for the journey,
which could be carried by hand, were retained.
After a delay of from three days to one of nearly three weeks
for the field signal battalion, the four Infantry regiments. Engineers,
machine-gun battalions, military police, and field signal battalion
entrained for Calais.
Samer area. — June 5, to July 4 : The troops had their first experi-
ence with billeting, and, as much of the area had not been previously
occupied by troops, no baths were available and latrines had to be
dug. The men were billeted in barns, stables, lofts, and houses.
Man}^ of these were dirty, or littered with dirty straw or manure,
and a small number of the men became infested with chicken lice.
The men were then ordered to put up their shelter tents wherever it
was feasible. This was found to be more conducive to health and
cleanliness and, although there were many British in this area and
cases of influenza developing daily in nearly every British unit, no
cases of influenza developed while in this area. There were but few
cases of disease and but few men became infested with vermin.
Beauval. — On July 4 the division entrained at Samer and Desvres,
and by July 6 all the units were billeted in the Beauval area, from
Bocquemaison north as far as Rapembre south. This was a perma-
nent British area, where latrines, baths, and incinerators had already
been constructed. One additional bathhouse was constructed at
Beauval by the 305th Engineers according to plan furnished by
the Third British Army. Upon moving into this area many billets
were found in a very dirty condition, especially in Sus-St. Leger,
Beauval, Friifes, and Bonneville. Upon completion- of phase B of
the training the units moved forward to within 3 to G miles of the
front lines. Many of the units were in tents. Tents were found to
be cleaner and better liked by the men, and were far more healtliful.
In this area air raids were frequent, many bombs being dropped by
German aviators, but there were no casualties in the division from
this cause.
142367— 19— VOL 2 43
1652 REPOKT OF THE SURGEON GENERAL OF THE ARMY.
As training progressed and the various units went into the line,
first by phitoons, then by companies and battalions, casualties oc-
curred. The medical officers and enlisted men accompanied their
units, and the first casualty in action occurred on July 24, 1918, near
Mill, in the area occupied by the New Zealand Division.
During the period of training there were 3 officers and 54 enlisted
men killed and 6 officers and 235 enlisted men wounded. Reports of
casualties were much delayed, as the American units were attached to
four different British divisions.
The division left Beauval area August 19 ; spent two daj^s at Ber-
naville area; entrained at neighboring points during the next two
days en route for Aignay le Due area. Upon arrival at detraining
points troops marched from 15 to 30 kilometers to billets, arriving
much fatigued. Many feet in bad condition.
On September 1 the division moved to the Stainville area. From
this area the division moved to Trouville.
Nancois area.- — Here again there were lack of latrines and bad sani-
tary conditions.
From here the division moved to Osches area, w^est of Souilly;
encamped in woods without any sanitary conveniences. Thence to
Lempire and the woods to the northwest, where there was similar lack
of sanitary conveniences. These woods had been occupied for long
periods by the French, and manure was piled behind the stables and
picket lines from 4 to 8 feet high. The flies and filth in these woods
were indescribable. Water was scarce and had to be drawn from a
distance. From these woods the men went forward to attack the
enemy on the night of September 25, 1918.
Sanitar}^ conclitions in town of Fromerville, where two divisional
hospitals were established, were in a disgraceful state. The entire
area on which the division was engaged was in a very insanitary state,
due to lack of responsibility for sanitation being placed on area
squads instead of transient troops. The question of good water while
in this area became a serious question. Great difficulty was expe-
rienced in securing horses for water carts. The division at this time
did not have its full quota of Lyster bags. Practically all water had
to be carried by hancl and all chlorinated. Good chlorinated water,
therefore, was used for drinking, washing, and cooking. This short-
age of water became a serious menace to the health of the troops, as
cooks and kitchen police did not wash hands frequently; mess kits
and utensils could not be thoroughly cleaned, and the liability to
intestinal disease became paramount, with the result of 1,250 cases
of diarrhea during the month of October. Change of clothing for
men in forward areas was not available. Some difficulty also was
experienced in readil}^ obtaining change of clothing for gassed
patients.
Battalion medical detachments accompanied attacking battalions,
established aid posts, and rendered immediate service. In some in-
stances the work of the detachments was temporarily delayed, owing
to lack of transportation for transporting litters, supplies, etc., but
this was quickly overcome by the help and supplies which was given
by ambulance companies.
All detachments accompanying their units Avere severely taxed by
work, but proved themselves untiring, courageous, and efficient under
shell fire, administering first-aid treatment imder most trvinff condi-
A. E. F.— DIVISIONS. 1653
tions. The division surgeon established headquarters at the forward
post of command of the commanding general, from which place he
was able to advise and direct the sanitary train as to all military
movements in advance, so that proper preparations could be made
for ambulance companies, etc., to advance with the waves of the line
troops, carrying forward supplies, etc., for dressing stations and bat-
talion aid stations. The commanding officer, sanitary train, was lo-
cated at the forward field hospital or receiving station, from which
place the work of the various organizations of the train could be
coordinated and from which place liaison with the division surgeon,
the more forward dressing stations, and the large hospitals in the
rear areas could be more successfully accomplished.
On October 12 the division, less the 155th Artillery Brigade, and
the SOotli Aiiununition Train were relieved from the line, and moved
to the vicinity of Thiaucourt, stajdng at Foret et Hesse and Bois de
Cusy tAvo days, at which places many cases of diarrhea developed, due
to water, fatigue, and sleeping conditions. A very large portion of the
command was at this tinue lousy, but no cases of scabies were reported.
Each' soldier was able to obtain a complete new uniform, under-
clothing, etc., for which they were very much in need. Although body
lice were very prevalent, no preventative measures were taken. No
bathing or laundry facilities were available.
On October 21 the division, after having been reorganized and
equipped, was again ordered forward, and was established in the La
Chalade les Islettes area (Argonne), where it remained, awaiting
further orders, until October 30, when it was moved forward and
relieved the 82d Division (less Artillery) and on November 1 at-
tacked near Fleville, Sivry. (See history of 305th Sanitary Train for
full activities of that organization attached.) The advance was suc-
cessful from the starting hour, and the division was relieved on No-
vember 7, had reached a point along the Yoncq-Beaumont road, and
were progressing rapidly along the jNleuse. Although the advance of
all line elements had been extraordinarily rapid, the advance of all
field hospitals, and all units of the sanitary train was not less rapid,
due to the method of " leapfrogging " of these units, thus insuring
hospitalization and efficient service at the closest point possible at all
times without interruption incident to moving.
During the activities, November 1 to 10, 2,133 patients were evacu-
ated by the division sanitary personnel, (S3G of whom belonged to this
division, the remaining number belonging to flanking divisions.
On November 10 the division moved back to the La Chalade-Nefeuv
(Argonne) area.
On November 18 the division was ordered to the 15th training area
and proceeded by foot. A number of cases of diarrhea occurred dur-
ing the march, due mostly to the indiscreet use of articles of food and
drink ]:)rocured in the local shops along the route and the probable
lack of supervision by surgeons of water used for drinking. A num-
ber of cases of influenza developed during the march, due probably to
exhaustion and overcrowding.
The troops arrived in this area about December 1, and were
billeted in about 42 small towns. Billets where taken over by this
division were in a ver}' insanitary condition — damp, dirty, and with
an average of 35 square feet per man. Latrines were lacking in
most of the towns. In general the billeting situation was poor, but
1654 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
ffradiially improved by installation of stoves, bunks, building of
latrines, etc. The climate was very poor — raining and dismal.
Higher authority, however, ordered intensive drill and juaneuvers.
Tlie division surgeon advised as to the probable results of such pro-
cedure during the inclement weather, but to no avail. New clothing,
shoes, and underwear were received in very limited quantities, and
bathing facilities were inadequate.
Conceived in the AVar Department order which designated the
division composed of National Army men from western Pennsyl-
vania, West Virginia, and Virginia as the 80th Division, the 305th
Sanitary Train was born into actual existence with the arrival at
Camp Lee, Va., under the command of Capt. Elliott B. Edie, Medical
Reserve Corps, of Ambulance Company A and Field Hospital No.
22. These two Regular Army organizations had been organized at
Fort Oglethorpe, Ga., and had received their preliminary training
there. They arrived at Camp Lee on August 27, 1917. From this
nucleus has been evolved the present organization, a sanitary train
which has seen hard and arduous service, -both in training and in
action.
In May, 1918, the organization was ordered overseas with the
division, and proceeded to Newport News, Va., embarking on May
24 and 25, 1918, sailing the next day, the 26th. Train headquarters,
divisional medical supply unit, and Ambulance Company 318 sailed
on the transport Huron. Ambulance Companies 317, 319, and 320,
with headquarters ambulance section, two sanitary squads, and the
mobile laboratory, sailed on the U. S. S. Syhoney. The four field
hospitals, with the headquarters field hospital section, sailed on the
IT. S. S. Mcrciu'y. Before reaching France the convoy split up into
two sections and the Huron entered the port of Brest, the Syhoney
and the Mercury making the port of Bordeaux. The organizations
on board the Huron debarked on June 8 and proceeded to the
Pontanezen Barracks, a few miles out of the town of Brest. Those
on board the Syhoney and the Mercury debarked on June 9 and
proceeded to Camp Genicourt, about 6 miles out of Bordeaux. The
organizations at Brest proceeded after three daj's to a small town in
the Department of Haute-Saone, known as Semmadon, arriving there
on June 15. This journey was made by train. Nine days later, on
the 24th of June, they proceeded, by a march of 25 kilometers, to
the neighboring town of Ouge, Haute-Saone, in which town they
remained until the train rejoined the division. The organizations
which landed at Bordeaux left Camp Genicourt on June 15 and
proceeded by train to the town of Vitrey, Haute-Saone, arriving
there June 17, and marched 4 miles to the villages of Chauvirey-le-
Viel and Chauvirey-le-Chatel, in which villages they remained until
the train rejoined the division. Headquarters for the train was first
located at Semmadon and later at Ouge.
Upon landing in France the division proceeded to the Artois
sector, and was brigaded for training in actual combat with the
British, In July Ambulance Companies 319 and 320 were ordered
to join the division in that sector, and they left in accordance with
these orders for Beauval and Warluzel, where they were attached to
British field ambulance companies for training. This training con-
tinued until the 18th of August, when the whole division was ordered
to the vicinity of Tronville as corps reserve in the St. Mihiel offensive.
A. E. F. — DIVISIONS. 1655
P. EIGHTY-FIRST DIVISION.
The 81st Division was organized the latter part of August, 1917,
at Camp Jackson, Columbia, S. C.
Mo^■ement to port of embarkation began July 13 and continued
until July 18, 1918. The troops were camped at Camps Upton and
Mills. At these points replacement troops were assigned to the
division to bring it up to full strength, and movement overseas be-
gan from New York and Hoboken July 29 until August 8, 1918.
Some of the troops went to Liverpool, England, and others direct
to France.
The division was assembled in its training area at Tonnerre
(Yonne), France, where it completed its training. At this place
terrain exercises were carried out in conjunction with the line.
September 15, 1918, after a four weeks' training in the 16th train-
ing area, Tonnerre (Yonne), during which time the Medical De-
partment was actively engaged in training and study to meet the
conditions of modern warfare, the movement of the division began
by rail to St. Die (Vosges) sector.
Owing to the fact that in the St. Die sector the front was 37 kilo-
meters and the evacuating points were two, Bassarat and Bruyeres.
respectively, it was necessary to establish all four of our field hos-
pitals with varying functions. Field hospitals were located as fol-
lows: 321st at Bruyeres. 322d at La Salle, 323d at Eaon I'Etape, and
324th at St. Die. To the latter was attached the mobile laboratory
unit and United States Surgical Team No. 397. Ambulances were
stationed at various points on the front and were accessible at all
times for the sick and wounded. During the stay of the division in
the division in the St. Die sector, as no large offensives were under-
taken by either side, the casualties were very light, and, as a conse-
quence, no difficulties of transportation were encountered. The
wounded in action evacuated to our own hospital were 62 during
the period September 20 to October 18, 1918.
It was while in this sector that the division encountered its most
formidable foe, influenza, which at the time was raging in all the
armies in Europe. What rendered the problem harder to cope with
was the fact that the men in the trenches were crowded in dugouts
as a military necessity, and the damp, cold weather and the impos-
sibility of getting always sufficient hot food.
October 20 the division was relieved in the St. Die sector by the
French, whose sanitary units took over the nontransportable sick and
wounded. The troops were trailed by ambulances from this area to
their rest area around Eambervilliers, one motor ambulance being
assigned to each battalion. AVhile in the Eambervilliers area the
epidemic meningitis made its appearance, though at the time the
incidence of influenza was decreasing remarkably.
The division movement by rail to the front, east of Verdun, began
on the 1st day of November, the transportation of two motor .am-
bulance companies was sent overland to be assigned to the battalion
units as they detrained to evacuate the sick to hospital promptly and
accompany them on the march to the Bolrupt sector.
On the night of November 8 at 23 hours orders were received from
the Seventeenth French Corps headquarters, under whom this divi-
sion was placed for tactical purposes, to advance at 6 hours the fol-
1656 REPORT OF THE SURGEON GENERAL OF THE ARMY.
lowing: (lay. The position at Fontaine Brilliant for '^liage and hos-
pital purposes Avas most convenient, as can be seen from the accom-
panying map. It was well protected by hills, had an abundance of
water me hanically chlorinated, Adrian barracks, and shower baths,
besides ample room for the pitching of field hospital tents. Field
Hospital No. 321 Avas ordered up to Fontaine Brilliant to take over
the triage function and Field Hospital No. 322 established to receive
gas cases and render any necessary surgical treatment. The sick
were to be sent to Field Hospital No. 324, at Petit Henthairons while
Field Hospital No. 323 was to be in readiness to leapfrog the triage
in case the advance rendered the establishment of a hospital in an
advanced position advisable. A motor aml)ulance company' was at-
tached to each Infantry brigade and the commanding officer in-
structed to keep in close touch with the regimental surgeon of the
attacking element. Sufficient animal-drawn ambulances were at-
tached to each ambulance compar,}^ to work in the forward area and
bring back wounded from battalion aid stations The bravery of
these wagoners and amlnilance orderlies in evacuating the wounded
o\er the Moulainville-^roranville-Cricourt road under continuous
shell and machine-gmi fire will live in the memory of those who
witnessed their untiring labor.
Throughout the engagement the ambulance companies had their
aid stations established with the regimental aid stations and requi-
sitions for supplies and other messages from the most forward bat-
talion dressing stations were brought back to their destination by
ambulanres returning with the wounded and action Avas quickly
taken. Our liaison by means of ambulances performing their special
function of evacuation was like clockwork, and supplies were sent
out by the division medical supply officer operating at the triage to
the places where needed by the returning empty ambulances.
Immediately following the armistice searching parties from the
bearer section for the ambulance companies were sent out over the
field of battle to bring in the wounded. By 10 p. m. of the evening
of tlie 11th of November all cases had been cleared from the triage.
Ij\ the offensive of November 9 to November 11 the following are
the figures as given by the triage report of sick and wounded :
Total number admitted to triage 1,040
Wounded in action 537
Wounded accidentally 30
Gassed 242
War neurosis 38
Sick 193
The gassed cases were all due to arsene gas and were in no single
instance of sufficient gravity to require more than two clays' treat-
ment, and none required evacuation farther back than our owni field
hospitals.
On November 19 the movement back of the division to the 12th
training area was begun. Including rest, this march covered the
period of November 19 to December 3, 1918. The march was un-
eventful and only 357 men were evacuated en route. There is little
to record of the stay up to this time in the 12th training area except
that sporadic cases of meningitis, influenza, and pneumonia have
occurred.
A. B. F. DIVISIONS. 1657
Attention is invited to the small number of cases of war neurosis
in spite of the fact that the artillery fire of the enemy for the three
days was terrific. This was due, we believe, to the fact that the
medical officer of this division let it be clearly understood that such
cases would not be certified for Avound chevrons and was besides a
reflection on the man's mental ability. All cases " tagged " as gassed
were seen by the division medical gas officer, who either verified or
changed the diagnosis.
Q. EIGHTY-SECOND DIVISION.
ACTIVITIES OF THE MEDICAL DEPARTMENT.
The division came into being on September 2, 1917. The medical
department of the various organizations was made up of a nucleus
of commissioned and enlisted personnel from the training camp,
Fort Oglethorpe, Ga. To these were added from time to time
medical officers and enlisted men ; the enlisted men were chosen with
no reference to their qualifications. It was soon found that the
medical detachments were largely composed of men totally unsuited
for the work they would have to perform. This was also true of
enlisted personnel of the sanitary train. However, this fact was
brought to the attention of the various commanding officers, and they
permitted the surgeons to go through their organizations and select
men suited for the work of the medical department, transferring
from the medical detachments men who were not satisfactory. This
procedure in modified form was carried out in the sanitary train,
so eventually a fairly satisfactory enlisted personnel was obtained.
The division, minus the Artillery and sanitary train, arrived
in the Somme area during the month of May, 1918, and remained
until the latter part of June. 1918. "N^Hiile in this area, the sick were
cared for by the British medical service, the sanitary train not being
with the division. Intensive training was given medical officers and
detachments. At least one medical officer and two enlisted men from
each organization were sent to the British school for sanitation at St.
Valery-sur-Somme. The experience gained at this school in con-
structing various sanitary applicances proved very valuable.
Actu'itifs of the Toul sector. — The division arrived in this sector
the last of June, 1918, the sanitary train joining at this time. The
division relieved the 26th Division, and the medical department took
over unit for unit of the 26th Division, establishing two field hos-
pitals at Toul, which functioned largely as base hospitals; one near
Koyameix, which functioned as a triage and gas hospital, and one
at Rangeval Abbey. The Toul sector was a very quiet one, and there
was little activity in the medical department other than caring for
the ordinary sick; as the health of the division was very good, this
Avas not an arduous task. While the division was being relieved by
the 89th Division the Germans launched a gas attack, which resulted
in about 750 casualties, a vast majority of which were from the 89th
Division. The sanitary train of the 82d Division, not having been
relieved by that of the 89th, handled these casualties, practically the
entire number being given treatment at the gas hospital, near
Royameix, and evacuated to Toul in less than 30 hours. The total
1658 REPORT OF THE SURGEON GENERAL OF THE ARMY.
number of casos of all kinds passed through the field hospital acting
as a triage in this section was 2,532.
Aeiiv'dies trhHe in the Marhach sector. — The field hospital section
established three companies in a large French hospital at Millery
and one at Dienlouard, to act as a triage for the troops on the left
bank of the river. This sector was very quiet, and there was very
little work for the medical department until the St. Mihiel drive on
September 12, 1918. The principal casualties during this drive
came from the 328th Infantry, which was the part of the division
on the left side of the Moselle River. The total number of cases of
all kinds passing through the division triage in this section was
1,807. Xothing of unusual interest occurred. The evacuation of the
sick and wounded occurred without special incident; but it might be
mentioned that the triage located at Dieulouard was hit on the morn-
ing of September 17, 1918, about 2 o'clock. Fortunately there were
no patients in the hospital at this time, but of its enlisted personnel
six were killed and four wounded.
Activities irhile in the MeAise-Argonne offensive. — The division
moved from the Marbache sector to the Argonne Forest during the
latter part of September, 1918, establishing various dressing sta-
tions and triages, the details of which are given in the history of
the sanitary train, until finally the field hospital section of the
sanitary train took over a large German hospital at Appremont.
This was an excellent place for a hospital, and the buildings, sup-
plemented by tents, furnished ample accommodation for a large
number of patients. The division was held in the front line for a
continuous period of about 26 days. The number of effectives was
greatly reduced by the evacuation of the sick and wounded ; in fact,
a large number of the men in the front line were suffering with
diarrhea, colds, and exhaustion. At the direction of the command-
ing general, the field hospitals at Appremont were made ready to
care for the sick and exhausted, and where possible to return them to
the front. This proved to be an excellent plan. The men were sent
back and received medical attention, baths, and proper food and in
from two to seven days were ready for duty again, in this way re-
turning a large number of men who would have been lost to the
division under the usual procedure of evacuating the sick. The
total number of cases of all kinds handled by the division triage in
this sector was 9,964. The figures of the number of cases handled
in this and the two above sectors represent the total number of cases
handled by the division triage during its front-line activities. Some
of these cases were from other organizations and it is presumed that
other division triages handled cases from this division.
Activities in the training area after loithdraioal from the front. —
The division arrived, by various stages, at the 10th training area
about the middle of November, 1918. While in this area all troops,
including those of the medical department, pursued active training.
Especial attention was paid to sanitation and a marked degree of
excellence was maintained at all times. The health of the troops
while in this training area was exceptionally good. A number of
cases of mumps developed among the replacement troops and a few
sporadic cases of epidemic meningitis and influenza occurred.
Seventeen cases of typhoid fever occurred in Battery E of the 321st
Field Artillery. These cases occurred in three groups and were
A. E. F. DIVISIONS. 1659
traced to carriers working in the kitchen. Energetic sanitary
measures were taken and the threatened epidemic was checked. On
March 1 the division moved from the 10th training area and since
that time the sick of the division have been cared for by the area.
On September 24, orders were received to move from the Marbache
sector to a new area. This movement had been anticipated for a
few days as the advance section of a French sanitary unit has been
with us checking up property which they expected to take over
from us.
While in this phice the 325th Field Hospital operated as a triage
and hospital for the sick of the division. After three days here this
hospital was moved to just north of Waly on the Waly-Froidos road.
While at this last place several wounded from the 28th and 35th
Divisions were treated. During this time the 326th, 327th, and 328th
Field Hospitals were in reserve.
On October 6 the 327th Field Hospital moved to Clermont and on
this same day at 8 p. m., orders were given to establish a triage at
Varennes before daylight of the 7th. The 328th Field Hospital was
selected for this and had started by 10.30 p. m. Due to the con-
gested traffic, Varennes was not reached until daylight. l)ut the hos-
pital was ready for patients by 8 a. m., and they immediately started
in as our Infantry had gone over the top that morning. In the
afternoon of this same day the 326th Field Hospital was moved up
from Neuvilly to act as a gas hospital. While at this station many
gassed and wounded were treated and evacuated under very adverse
conditions; on four or five occasions the area was shelled but work
continued as usual.
While here the largest amount of work since being in the American
Expeditionary Forces was accomplished for the next three weeks.
On looking back, the work accomplished by these hospitals was of
first-class order considering the difficulties experienced. When they
left Marbache sector they had to leave behind as complete an equip-
ment as it was possible to secure for a set of field hospitals, due to
the lack of transportation. Before going into action all that they
were able to secure from this equipment was some blankets, litters,
dressings, and half a dozen of the most essential boxes, besides the
tentage. This material was secured by sending their trucks back to
Millery while we were at Passavant. Hence when they began to
function at Varennes every possible thing had to be utilized, and,
due to the lack of equipment, helmets were used for bedpans. This
was no fault of the hospitals, but a condition which it was impossible
to remedy.
By the time we had to move to Apremont the medical supply officer
had replenished our supplies to a great extent, and hence it was not
as hard to work at this place. While here, too, a truck train was
sent back to Millery and brought up all that was left of our supplies
there. Hence with what we had acquired in excess of our regular
equipment we were very fully equipped again, with the exception of
our X-ray and sterilizing outfit. All of this equipment was turned
over to the 6th Division, which relieved us.
While at Passavant, Waly, Clermont. Varennes, and until the last
10 days at Apremont, the hospitals did only triage, gas hospital, and
sick hospital work. After the worst of the fighting in which our divi-
sion took part was over, the hospitals immobilized, tents were floored,
1660 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
and ATc had a rest camp of 30 war tents, in which we took care of all
the exliaustion and diarrhea cases in the division. As the men had
been in the lines for a long time and nearly all the days were rainy,
there were many of these cases, the largest number at any time being
over 700.
Due to the lack of ambulance transportation, trucks had to be usea
to a great extent, and patients were evacuated as rapidly as possible
by any means avaihible. During all the rush everyone was w^ell fed
and cared for. The Young Men's Christian Association and Red
Cross helped out wonderfully in this work. The corps consultants
visiting the hospitals informed us that there was no criticism as to
the condition of splints and dressings and condition of the men when
they reached the hospitals farther back.
Everyone worked willingly and well. On several occasions the
area in which the hospitals were was bombed and shelled, but the
work went on just the same. On the day leaving Apremont a shell
fell as near the center of the tent group as it was possible, but hurt
no one. Due to the soft ground, it penetrated very deeply before it
burst.
On November 2 the 6th Division relieved us and we marched away
at 12 m.. feeling the need of a much-needed rest.
R. EIGHTY-EIGHTH DIVISION.
EARLY ORGANIZATION OF THE MEDICAL DEPARTMENT.
Organization of the division medical department began at Camp
Dodge, Iowa, near Des Moines, about August 27, 1917.
Organization of the medical department and assignment of medical
•officers to various units by the division surgeon was soon underway.
Few troops were in the camp at this time. Barracks had not at this
time been completed, and there were many difficulties that had to be
surmounted. But this was well underway and the work progressed
rapidly.
THE FIRST BIG DRAFT.
The first big draft of men began to arrive shortly after the middle
of September. Here the Medical Corps started its first work in the
camp in the inspection of the men for signs of contagious diseases
or any marked illness as they passed in line to the assigning office.
EPIDEMIC DISEASES.
Only one really severe epidemic occurred during the stay of the
88th Division at Camp Dodge; this was the septic pneumonia which
broke out in March, 1918, among the Negro troops from Alabama
located in the southern end of the camp, and spread throughout the
entire cantonment among the white men. Around 300 lives were lost.
During the height of the epidemic 38 men died in one week. The
mortality was very high, an average of one death occurring in every
three cases. The epidemic began to decline toward the end of April
and died out about May 1.
The Negro troops had the highest mortality, over 70 deaths occur-
ring in one of the colored organizations alone.
A. E. F. DIVISIONS. 1661
Forewarning of the epidemic was given by both Lieut. CoL Shook
and Maj. Fronk in recommendations to the commanding general that
the organization commanders should not allow troops to lie down on
the ground after long hikes or drill, that overcoats be secured for all
men, that more bed clothing be provided, and that barracks be kept
sufficiently heated. These conditions were remedied as far as pos-
sible. That the epidemic had its inception among the Xegro troops
was due to the fact that these men suffered from close housing and
exposure on trains on the Avay to the camp; that they arrived poorly
clad and underfed in a cold climate to which they were not inured,
and that they were utterlj" ignorant of the laws of sanitation. The
epidemic nature of the disease was shown by the fact that the major
portion of the cases occurred among the negroes where it had its
start and among the white troops housed in their vicinity.
Vigorous measures were taken to stamp out the epidemic. The
men of the camp were instructed in the laws of sanitation and were
compelled to observe them. All cases of colds were promptly isolated,
shelter halves were placed between bunks, gauze masks worn, cul-
tures were made of all contacts and suspects by the laboratory at the
base hospital.
The pneumonia epidemic at this time was prevalent both among
civilians at home and soldiers and civilians at other cantonments, so
that Camp Dodge was not alone in misfortune in this regard. An
epidemic of measles, with only a few deaths, occurred in January and
February. 1918. Another of mumps in the winter and spring of
1918. But the cases were not generally of a serious nature. In the
early spring of 1918 we had a mild epidemic of meningitis.
GAS INSTRUCTION.
Gas instruction was carried on under the direction of Capt.
-, Medical Corps, division gas instructor. This instruction
began in Xoveml)er. 1917. and continued throughout the course of
the camp. All officers and men were included. Lectures were given
in both defensive and offensive gas warfare, the various kinds of
gases, gas shells, etc.. were taken up, including the symptoms and
treatment of gas poisoning. Officers and men were drilled with
masks on under tear gas-bomb attacks, and finally put through a
chamber containing poisonous chlorine gas. Early in 1918 the gas
course was taken over by the Engineers, with Lieut. Frank P. Bliss
in charge.
WIND-UP OF TRAINING AT CAMP DODGE.
About the last of May, 1918, the final draft that was to fill up the
88th Division came in and the work of getting these men into shape
for overseas service began. The middle of July saw the first units
of the division on the move to Camps Upton, ]SIills. or Merritt.
Various routes were taken to Xew York by the different units. The
work of moving out of camp covered a period of about two weeks,
two trains leaving daily over different routes.
After reaching one of the eastern camps the men remained for a
few days, receiving their final equipment for overseas. They then
proceeded to an embarkation port, some to Hoboken, N. J., and others
to Montreal or Quebec, Canada, for the journey to France. Prior to
1662 REPORT OF THE SURGEON GENERAL OF THE ARMY.
their departure from Camp Dodge the men were given their final over-
seas examination for tuberculosis or any other disqualifying causes.
Daily venereal inspections that lasted for three weeks were held.
In the final examinations also held at the seaboard camps a few were
weeded out. but most of these had been eliminated out of the division
before leaving Camp Dodge.
The division arrived in its first training area in Cote d'Or on Sep-
tember 7, 1918. Division headquarters was located in the town of
Semur. centrally located in the area. The men were billeted in
houses and barns, for the most part comfortable and well ventilated.
The area had not previously been occupied by American troops, and
hence there was some difficulty at first in convincing the population
of the necessity of making sanitary improvements.
The division arrived with incomplete equipment resulting in many
discomforts. The nights were cold, and as the men had no overcoats
and but one blanket apiece and were wearing summer underwear
there was much complaining of cold. The division had no field
ranges, having been obliged to surrender them at point of debarka-
tion, and hence until improvised ranges could be constructed food
was improperly prepared.
The health of troops was excellent, and there were few evacuations.
On September 17. 1918. the movement to the advanced training
area was begun. The movement was made by rail from Les Laumes
to the vicinity of Hericourt, Haute- Saone. at which place division
headquarters was located.
Conditions in this area were of the worst. Spanish influenza was
prevalent among the civilian population. The men in nearly every
organization were crowded into the poorest kind of billets in bams
and houses. The billets were dark, damp, and practically without
ventilation. The resistance of the men was lowered by lack of
proper clothing and blankets, long hours of drilling under full pack,
most of the time in the rain. After drill they returned to the over-
crowded billets exhausted, and were forced to sleep in their wet
clothing without sufficient covering. There were practically no facil-
ities for drying clothing or shoes. Orders were issued directing
organizations to establish such rooms, but in most cases it was im-
possible on account of crowded conditions. The food was improperly
cooked because of lack of ranges and utensils, the various organiza-
tions being obliged to buy kettles from the French and to construct
improvised ranges and ovens. On September 20 an extensive epi-
demic of influenza began.
Within eight days the 351st Infantry reported 1,370 cases. The
spread to other organizations was very rapid — a total of 2,254 cases
being reported by the division during the first week.
The spread continued at about this rate until October 5, when a
gradual decline began to be noticeable. The decrease continued
throughout October, when the disease ceased to be epidemic. The
total number of cases reported was 6,845. During tlie first week of
the epidemic there were few complications, but later the number of
comi^licating pneumonias was very large. The total number of cases
of pneumonia reported was 1,041, but there is every reason to believe
that the actual number of cases was larger. Four hundred and forty-
A. E. F. — DIVISIONS. 1663
four deaths occurred. It is the concensus of opinion among the medi-
cal officers that all of the deaths were due to pneumonia. The largest
number of deaths for one day, 80, was reported October l-i. From
then on there was a steady decline until Xovember 5. when the last
death was reported.
Most of the patients were of necessity treated in billets. There
were but two ambulances on duty at the French hospital, and they had
to serve both French and American units. The best billets were used
as sick rooms, officers in many cases giving up their billets to be used
by the severe cases. Every effort was made to make the isolation
as thorough as possible and to give every possible comfort to the
sick. Ventilation was secured in so far as possible: many men were
moved into pup tents that they might have fresh air. Rigid inspec-
tions were made to insure quarantine of cases and prevent intercourse
between patients and friends. Attempts were made to secure kitchens.
Blankets and bedding were obtained. Every effort was put forth
to prevent spitting and to enforce the covering of the mouth and
nose during coughing and sneezing. The sick and the well were pro-
vided with cans to be used as sputum cups. These were sterilized fre-
quently. Proper washing of mess kits was insisted upon. The packs
were reduced and in some instances the training schedule was modi-
fied during the epidemic. Medical officers were unanimous that cases
treated in billets showed more favorable progress and a lower per-
centage of complications than did those sent to liospital.
During the period covered by the epidemic the training of the
sanitary troops had to be decreased. Every effort was made to follo\T
the schedule as closely as possible, special emphasis being placed
upon intrenching, gas defense, splinting of fractures, and treatment
of shock.
On October 7 the division moved into the Haute- Alsace sector and
until October 12 held the line in conjunction with the French. On
October 12 the division took over the sector. Division headquarters
was located at Montreux-Chateau and Xovillard, the division sur-
geon's office being in the latter town. Two regiments of Infantry
went into the line; two were billeted in the rear. The living condi-
tions in the sector were very good. The dugouts for those in the line
were well built, dry, and well ventilated. The billets, located in
houses and barns, were airy and clean. The weather was more agree-
able and the health of the troops improved rapidly. Field ranges
were issued and the food was of good quality. The men had over-
coats : sweaters and socks were issued by the Red Cross. Latrines in
the sector, including those at the front, were of the French variety ;
pit latrines covered by planks and flush with the gi'ound. Chloride
of lime was available and was used daily.
There was no activity beyond a few raids, and casualties were
slight. The sick admission rate was low and there were no extensive
epidemics. About October 18 cerebrospinal meningitis made its
appearance and for a time threatened to become epidemic. Twenty-
one cases were observed during a period of 15 days. All contacts
were isolated and treated with antiseptic gargles and sprays. One
hundred and seven contacts were cultured. Seven positive cultures
were obtained. Two cases of trench foot were reported. Prompt
preventive measures were taken and no further cases appeared.
166-1 REPORT OF THE SURGEOjST GENERAL, OF THE ARMY.
The sector was divided by the Rhine-Rhone Canal into a noitherD
segment, lield by the 175th Brigade, and the southern segment held
by the 176th Brigade. One regiment of each brigade was in the line.
In the northern segment two battalions were in the line, with head-
quarters at Hecken and Buethwiller, respectively. The northern bat-
talion operated two advanced aid posts, located in dugouts in the
woods, as indicated on map attached, and a battalion aid station at
Hecken. All of these stations were easily reached by ambulance.
The southern battalion operated one advanced aid post in the
northern end of their line and a battalion aid station at Balschwiller,
which was very close to the front line. It was necessary to carry by
litter from the upper station to Balschwiller, which was easily
reached by ambulance. These two organizations evacuated directly
to field hospital located at Bellemagny all except gas cases, which
were sent to triage at Retzwiller.
The segment south of the canal was held by three battalions of one
regiment, with headquarters at Hagenbach, Badricourt, and Fulleren,
respectivel}'. The northern battalion operated a battalion aid station
at Hagenbach and three advanced posts located in the woods behind
companies in the front lines. All of these stations were so located
that an ambulance was able to get to within a very short distance.
The middle battalion operated a battalion aid station at Badricourt
and three advanced stations located along a road behind the com-
panies in the line. All of these stations were reached by ambulance.
The southern battalion operated a battalion aid station at Fulleren
and two advanced stations behind companies in the line as indicated
on the map. These stations evacuated by aml)ulance.
• All of the organizations south of the canal evacuated patients from
the battalion aid stations by ambulance to the triage at Retzwiller.
The advanced aid posts were equipped to do first-aid dressing and
to hold a limited number of patients pending evacuation. The bat-
talion aid stations were equipped with shock tables and the means of
furnishing hot drinks to patients Avho needed them. Antitetanic
serum was administered here. The supplies and equipment were
ample for the care of the wounded received. The regimental stations
were used as supply depots, carrving reserve supplies. They cared
for only a few slightly sick men who needed care for a day or two.
A system of exchange of supplies was used so that the equipment
and supplies remained constant in each station.
On November 3 the division began to move from the sector and
established in vicinity of Belfort. Division headquarters was opened
at Valdoie. The stay in this area was very brief. Billets in barns
and houses were good. Training was continued along the same lines
as previously.
On Xovember 8 a movement by train was started. On November
10 the division was in the Toul sector, with headquarters at Lagney,
9 kilometers north of Toul. Arrangements were made to complete
equipment for more active fighting. On November 11 the armistice
put an end to preparation and there was a general relaxation.
The uncertainty as to the fate of the division, added to the living
conditions, produced a marked depression in morale. A rigid and
severe training schedule was instituted and followed. The weather
was continuously rainy and conditions became bad. The billets were
good, though somewhat crowded.
A. E. F. — DIVISIONS. 1665
SANITARY TRAIN.
On the 26th of August. 1917, 11 officers and 100 new Reguhir Army
men arrived at Camp Dodge, Iowa, from Fort Riley, Kans., to
organize the sanitary train. In addition to this, though, they did a
big share of the examining of the draft men and others who enlisted
in Dodge, and were prominent in the organizing of the camp hos-
pital.
They were followed shortly by the Red Cross Ambulance Com-
pany Xo. 30 on September 13, an organization composed of ^ledical
Enlisted Reserve Corps men from Denver, Colo., and on September
19 by Red Cross Ambulance Company No. 21 from Flint, Mich.
On October 30, 1917, the Red Cross Ambulance Company Xo. 30
became Ambulance Company Xo. 349 and the Flint organization
became the Ambulance Company Xo. 351. At this time the four
field hospitals and other two ambulance companies were also formed
with the old officers and men from Fort Riley as the foundation to
build on or around. The rest of the personnel of these organizations
was then made up of the newly drafted men.
From then until the 313th Sanitar}^ Train received orders for
overseas service the work narrowed down to the training of draft
men who were continually coming in and then being transferred out
to other units, mostly to other camps.
The trip overseas was made on the British freighter Vedic, Ameri-
can transport N^o. 697. After a ciuiet voyage of 14 days the ship
docked at Liverpool on the 31st of August, and immediately the
organization marched for the English rest c amp. Knotty Ash, where
it remained until September 3. when we boarded the train for South-
ampton. Arrived at Southampton the same day and camped at
another rest camp overnight, and on the next afternoon marched to
the docks for transportation across the English Channel. That
night, on September 4, the ship pulled out for Le Havre, France.
Arrived the next morning at Le Havre and went into camp there,
again at an English one.
Left Havre, P'rance. September 8 and arrived Semur (Cote d"Or)
September 10, 1918. Training program carried out from September
11 to 14. Departed by marching from Semur to Les Lameus morn-
ing of September 15, and entrained, arriving at Hericourt morning
of September 16, marching to Aibre (Doube). Training program
carried out until October 10, 1918, when headquarters was estab-
lished at Chevannes sur L'Etang (Haute- Alsace sector). The di-
vision medical supply unit established at Fontaine (Haute-Alsace
sector) September 22 until Xovember 9, 1918: Pagney sur Meuse
from Xovember 10 to 11, 1918; Avrionville (Murthe Moselle) Xo-
vember 11 to 29, 1918, and Gondrecourt (Meuse) Xovember 29 to
date.
S. NINETIETH DIVISION.
The 90th Division as an organization dates from August 27, 1917.
By War Department telegram, dated August 17, 1917. Col. Paul S.
Halloran, Medical Corp*^. was assigned division surgeon. The medi-
cal historv' of the division, incorporated in the medical history of
Camp Travis, covering the period of his incumbency is on file in the
Surgeon General's Office.
1666 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
The headquarters of the division arrived overseas July B. 1918,
and proceeded to the trainintj area in Cote d"Or and established
headquarters in the village of Aigne3'-le-Duc, July 11. 1918. The
division surgeon's office wa^ established in this village same date with
complete persomiel.
The ambulance section of the division sanitary train did not re-
ceive its ambulances imtil a few days before the division was ordered
forward. In the meantime, three ambulances were assigned by the
Army for duty with Field Hospital No. 42, and were used to evacu-
ate patients from infirmaries to the field hospital, and from the field
liospital to the base hospital at Chaumont. Ambulance drivei-s from
the ambulance section were assigned from time to time for duty as
r)rderlie5 with these ambulances in order to familiarize themselves
with roads and routes.
The preA^ailing disea^s during the stay in the training area were
diarrhea, due to moldy bread and badly balanced ration. A few
sporadic cases of cerebrospinal meningitis occurred on account of
which a complete meningitis survey was made of the division by
unit from central medical laboratory at Dijon. There were four
cases of typhoid fever, investigation of which showed all to have
been vaccinated, and the period of incubation would indicate that
the men were infected either at the port of embarkation or en route
overseas. There were nine new cases of venereal disease developed
in the training area, seven gonorrhea and two chancroid. Five gon-
orheas were contracted by troops en route through England.
GAS ATTACKS.
Gas discipline will be most strictly enforced and you are required
to report to your immediate commanding officer all violations ob-
served. All men who have been gassed are to be litter cases and
will be promptly evacuated to the gas hospital (Field Hospital No.
358) after receiving first-aid treatment, which will consist of irri-
gation of ej'es, nose, and mouth with 5 per cent solution of sodium
bicarbonate, an application of soft issue soap or soda solution to
body.
T. NINETY-FIRST DIVISION.
The medical personnel of the 91st Division began to assemble at
Camp Lewis, American Lake, Wash., in July, 1917, when Provisional
Field Hospital Company B, from Portland, Oreg., and Provisional
Ambulance Company B, of San Francisco, Calif., were ordered to
duty at that station during the period of construction of the camp.
These companies later became part of the 316th Sanitary Train, as
the 364th Field Hospital and 364th Ambulance Companies, respec-
tively. August 24 a detachment of officers and enlisted men arrived
from the training camp at Fort Riley, Kans., and were assigned to
various positions in the forming division. All of the regimental sur-
geons remained on duty at the mustering office during the examina-
tion of the first-draft increments and did not join their regiments
until January, 1918. In the meantime, the regimental infirmaries
and detachments were organized by the assistant surgeons.
The division was entirelj'^ organized and trained at Camp Lewis.
A. E. F. — Dmsioxs. 1667
In June, 1918, movement of the division toward the Atlantic coast
was begfun.
During this transport of troops 10 cases of anthrax were admitted
to the base hospital. Camp Merritt, from the division. Shortly prior
to departure of the division from Camp Lewis a case of anthrax had
developed in a Avagoner of the 362d Infantry Supply Company. On
investigation this was thought to be due to shaving-brush infection,
a new issue of shaving brushes having arrived at the camp for issue
to troops en route overseas.
Travel overseas was without special incident. There was some dis-
semination of the acute contagious and sputum-borne diseases, par-
ticularly mumps, following the crowding on shipboard, but as the
troojDS were divided in small detachments for billeting in the training
area these were rapidly eliminated.
The 8th training area was reported to have been occupied by troops
of the 83d Division for about three weeks before this division en-
tered. Thirty towns of the area were used for billeting by tlie 91st
Division. Billets were good. The water supplies in the area had
been incompletel}^ examined ; a few reports based on French analj'ses
were furnished by the zone major. During August, United States
Army Laboratory No. 1 completed a bacteriological survey of the
water sources in this area. Copies of these reports were turned over
to the zone major of this area for file, and water supplies in the va-
rious towns were labeled "' good " or '* bad " according to these re-
ports. Latrines were of open-trench variety; as soon as lumber
became available, flat fly-proof pit covers were constructed. Garbage
disposal in the area was by collection by the civilians. In view of
the subsequent history of the troops in regard to diarrhea it is be-
lieved that Lyster bags and a reserve supply of hypochlorite should
be carried with every organization at all times. This equipment for
divisional troops was sent overseas with the freight ancl, due to sal-
vage of all freight, Avas not received and not on hand when troops
arrived in this area. Hospital facilities were furnished by Camp
Hospital No. 8, located about 1 kilometer north of Montigny-le-Roi ;
this was a barrack hospital with a capacity of 250 beds, electric
lighted, with its own water system and excellent shower baths. Dur-
ing the month of August training was continued in the 8th area.
Medical detachments with line troops received instruction with their
organizations in open warfare. The 316th Sanitary Train was held
in St. Nazaire most of August, ostensibly awaiting assembly of motor
transportation in order to drive overland to join the division. They
arrived by railroad in the area on August 27, and took part in but
one maneuver during the training period. In addition to the in-
struction received in the units, medical officers were assembled by
truck in Montigny-le-Roi on three occasions for lectures and dis-
cussions.
Beginning September 6 the division left the training area and
moved northward to the region of Sorcy; division headquarters
being at that location during the St. Mihiel offensive. This move-
ment was accomplished by marching and on railroad. On the 13th
of September the division moved to the region of Yavincourt by
French trucks. While in the Sorcy (Gondrecourt) region, sick were
evacuated to the camp hospital in Gondrecourt. While in the region
of Yavincourt sick were sent to Evacuation Hospital No. 9 at Yau-
142367— 19— VOL 2 44
1668 REPORT OF THE SURGEON GENERAL OF THE ARMY.
becoiirt. Diirin": this movement of the division transportation of
medical supplies was again seriously hampered by lack of trans-
portation.
While the troops were in bivouac in the woods south of the trenches
for the week prior to begiiming of Meuse-Argonne offensive on Sep-
tember 2G the diarrhea largely cleared np becanse of improved sani-
tary conditions while in bivouac over those encountered during the
march north, and also the opportunity given for the men to rest
during this time.
At the beginning of the Meuse-Argonne offensive, the sanitary
train had established field hospitals in Brabant for sick, gassed, and
wounded; evacuations from here were handled by evacuation ambu-
lance companies of the Fifth Army Corps (American). The am-
bulance and field hospital companies of the train in reserve were
camouflaged and parked on the Parois-Vraincourt road, just south
of Parois. Trucks were available for transport of all the field hos-
pital equipment, including the medical supply unit. The personnel
of the sanitary train had been in bivouac in the Bois de Parois within
6 kilometers of the front line for several days prior to establishment
of the field hospitals in Brabant, which last was done on Septem-
ber 25.
On September -26 troops of the 91st Division advanced as part of
the American First Army on this date. During the day of Septem-
ber 26, advance was made on the Epinonville Ridge, about 8^- kilo-
meters to the north and slightly west of the sector occupied bv this
division. First reports of wounded were received bv division sur-
geon at 10 a. m., who immediately recommended to G-1 that ambu-
lance transport be sent forward to clear wounded. Due to com-
plexity of orders governing transportation which required that
recommendation must be submitted to representative to G-1, as traf-
fic regulating officer, before an order could be issued allowing any
specific transport on the road, it was after 2 o'clock before ambu-
lances could go forward to begin evacuation. In the administrative
order for action, an advanced dressing station had been established in
the vicinity of Rendezvous de Chasse, 2 kilometers in the rear of the
front line of trenches ; another dressing station for slightly wounded
was established on the left of the divisional sector, some distance
from the front. Personnel and material for these stations were in
position the night of September 21—25. At 12 o'clock division sur-
geon ordered two additional dressing stations established at La-
Xeuve Grange Farm, and in the vicinity of Bois de Very. At 6
o'clock the 361st. 363d, and 361th Ambulance Companies were or-
dered forward to act as litter bearers to clear the woods and assemble
the wounded at dressing stations or along roads for evacuation.
Light Ford ambulances of S. S. U. 593 and 610 were energetic and
persistent in movement and clearing of wounded.
On September 29, 1918, the division commander ordered field hos-
pital established in Very. Field Hospitals 361 and 363 were moved
from Brabant to crossroads 1 kilometer southeast of Very. At this
time Very was being shelled by the enemy; shells were also falling
in the vicinity of sanitary train trucks standing near these cross-
roads. Under protest of division surgeon that the proposed loca-
. tion was too near front line for establishment of field hospitals, the
chief of staff ordered that hospitals be not established at Very.
A. E. F. DIVISIONS. 1669
Field Hospital 361 as triage with surgical operating unit attached,
and Field Hospital 363 acting as medical and gas hospital were
established afternoon of September 29 in Bois de Cheppy near La-
Xeuve (jrange Farm on the Avocourt-Very road 3 kilometers from
Avocourt. This location was 6 kilometers from front line. During
the night of September 29-30 about 200 patients were admitted to
this hospital.
Since the first day's fighting, troops of this division had advanced
to the village of Gesnes. Troops now held a line about H kilo-
meters northwest of Epinonville (where division post of command
was located). Casualties since the first day were mainly due to
enemy artillery fire. Evacuation of wounded from vSeptember 26 to
date was seriously hampered by condition of the roads. Owing to
the congested condition of the road to the rear from Avocourt evacu-
ation of patients from field hospitals was very poor on September 30
and October 1 and 2. During the nights of September 30 and Octo-
ber 1 the field hospitals in Bois de Cheppy were taxed to their utmost
to care for the wounded on account of slowness of evacuation.
Many patients were evacuated directly from dressing stations on re-
turning ammunition trucks of this division through AAOcourt and
through the areas of adjoining divisions to e^'acuating hospitals in
Froidos and Fleurv. In addition many wounded of this division
were sent to field hospital of the 3oth Division on our left, in Cheppy.
The axial road of this division from Yen- through the Bois de
Cheppy to Avocourt was congested at all times. Traffic of three
divisions of the Fifth Corjis went through Avocourt on a one-way
road with consequent resulting delay. Amlndances were held within
200 yards of this congested section for 12 hours and longei- before
being permitted to pass through to the rear with their patients, this
over the protest of division surgeon and counnanding officer of the
sanitary train made to G-1 and M. T. O. of the division, who con-
trolled 91st division traffic over axial road. To make the trip from
field hospitals in Bois de Cheppy to evacuation hospital in Froidos
and return in some instances took 24 hours, a distance of 50 kilo-
meters for the round tri]).
On October 1 the division surgeon moved to the advanced division
post of command at Epinonville from the rear echelon at Cote 290
in the Forest de Hesse.
On relief of the division the troops were tired, but with excel-
lent morale. Practically all had diarrhea to a greater or less extent.
There were about 700 evacuated during the ofi^ensive for this cause,
of a total of 4.800 tagged by surgeons attached to line organizations
of the division. Diarrhea had l^een present to a small extent since
the time in the training area ; sanitary conditions during the move-
ment of troops toward the battle front were never excellent, and
with the poor sanitary conditions in the advance there was a marked
tendency to spread of dian-hea. Most of the admissions to hospital
while troops were returning to rest from October 5 to 12 were for
this cause.
The removal of wounded during the first four days of the advance
was as good as possible with the road conditions. It is believed in an
advance of this sort that field hospitals shoidd be established on the
enemy side of the natural line of resistance (in this case. "• Xo man's
land"), as soon as it is possible to push them over this obstruction.
1670 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
This natural lino of resistance is the site of subsequent traffic jams,
and facilities should be available here for treatment of the bulk of
the wounded. Many evacuations were accomplisliod directly from
ambulance dressing stations througli Cheppy to the evacuation hospi-
tals in Froidos and Fleury by returnina- trucks; neither time nor
men were available to put 6 inches of earth in these trucks, and
statements of wounded are unanimous tliat truck transportation is
extremely uncomfortable. Examination of the re]5orts show that
divisional hospital units handled three-fourths of the number of the
divisional casualties, many coming from adjoining divisions to our
field hospitals.
Accompanying the return of the 181st Brigade to the line with
the 1st Division on October 5, S. S. U. 593 with its ambulances and
trucks went forward to serve until that brigade was relieved on
October 11.
On October 10 the division, minus artillery, which had been at-
tached in the advance, and the 181st Brigade, which was still Avith
the 1st Division, began movement toward Eevigny by marching.
This movement cost the division several hundred men, as the troops
had not recuperated from the exhaustion of fighting, and many had
diarrhea. Arrangements had been made to accomplish the move-
ment in French camions, but owing to some disagreement this was
not done: many camions were available, but none was used. On the
12th of ()ctol)er two field hospitals Avere established in Revigny for
the sick, and approximately 1.000 men were evacuated through here,
mostly for diarrhea. Five thousand replacements were in the Re-
vigny area upon arrival of the division, being held in quarantine
on account of the prevalence of epidemic influenza. Fortunately the
isolation of the replacement troops was sufficient to prevent appear-
ance of an ejndemic among divisional troops; some of the replace-
ment companies were held in isolation until they Avere assigned to
units after the division reached Belgium. One replacement detach-
ment of 500 men en route from the coast to Revigny Avas reduced in
strength to 278 before arriAal, the remainder having been lost on
account of influenza and other respiratory diseases. These replace-
ment troops were billeted in five towns betAveen Betancourt and
Cheminon-la-Ville, separated from all other troops of the division.
Medical officers Avere provided from the sanitary train.
While at ReAigny 18 medical officers reported to the diAnsion,
which number Avas sufficient to bring tlie number of medical officers
up to full strength.
With the orders for movement of the division to Belgium came
orders detaching S. S. U. 593 from the diA^ision, and information that
41 amlndances for the ambulance section Avere available in Marseille.
An officer and the requisite number of men Avere immediately sent to
drive these OAerland; this convoy reported for duty in Belgium on
the day the offensiAe of the 91st Division began there, Avithout having
lost a machine or man en route. The trucks assigned to the sanitary
train Avere left behind Avhen the moA'e Avas made to Belgium by order
and Avere not replaced; the train after this never had more than six
trucks for its use.
On October IG the movement of the division began toward Bel-
gium. One field hospital and 10 ambulances Avere sent by first train
to provide facilities for those arriving sick.
A. E. F. — DIVISIOXS. 1671
The 3G2d Field Hospital, which went ahead, was established at
Boesinfrhe. near Ypres. and remained in this location until movements
of the division had been completed across " no man's land." Evacua-
tions from this hcsj^ital were made to British Casualty Clearing
Station Xo. 36, located 3 kilometers northwest of Ypres on Ypres-
Elverdinghe road. The officers in charge of this casualty clearing
station treated our troops with the greatest courtesy, and patients
sent there appreciated the considerations extended by the British.
With the movement eastward, hospitals were " leapfrogged " to
Roulers. one l)eing established in Oostniewkerke for a few days. In
Roulers. through the French Service de Sante. permission was
obtained to establish a hospital in an annex to the convent : this Iniild-
ing had previously been used by the Germans for hospital purposes.
Siclaiess in the division, especially diarrhea, is diminishing rapidly
at this time (October 23) and the general health of the command is
good.
During the Argonne offensive it Avas demonstrated that the iiiedical
belts of the enlisted men were inconvenient for use and did not carry
sufficient dressings. Many extemporaneous methods were arranged
for dressings transport, including ammunition musettes, hand gre-
nade carriers (which were highly praised by some detachments), dis-
carded officers' musettes, gunny sacks, etc. The thin musettes for
automatic rifle ammunition that were obtained for the Belgian offen-
sive did not serve as well as the heavy canvas musettes or pouches
made of material stout enough to maintain the shape when empty.
Another item of equipment that had received its share of criticism
Avas the medical cart : this was too heavy for one animal to draw, and
as animals Avere scarce the cart was frequently in troul)le.
From October 26 during all operations in Belgium until troops re-
turned to the A'icinity of Ypres, all evacuations were made to Evacua-
tion Hospital Xo. 5 (United States), established in Staden; at one
time five evacuation amlndances were furnished the division, but most
of the evacuations Avere done Avith divisional ambulances, at th^^^^
over a distance of 45 kilometers.
October 31 the 91st Division began an offensive action eastward
from "Waereghem (northeast of Courtrai) toward Audenarde as part
of the SeA'enth Corps (French).
The evacuation of wounded was expeditiously performed during
the entire advance. In most instances ambulances removed wounded
from battalion aid stations. The roads were more numerous, not so
congested, and in better condition than those encountered in the Meuse-
Argonne. The G. M. C. ambulances which replaced the Ford S. S """y
ambulances after the first day. gaA'e excellent service. During the
offensive, they were all operated from an ambulance head located in
the A'icinity of the division surgeon (i, e., near division post of com-
mand). Liaison between regimental detachments and ambulance
companies was excellent ; bearer detachments of ambulance companies
Avorked in front of regimental stations, collecting Avounded at regi-
mental aid station, or in ambulance dressing station. During Xovem-
ber 3 and 4 an aid station was maintained in Audenarde by an officer
and men of the 361st Ambulance Company : at this time the toAvn was
under shell fire of the enemy, who continued shelling the town for
several days after relief of this diA'ision.
1672 REPORT OF THE SURGEON GENERAL OF THE ARMY.
On November 6, a bathing and delousing plant installed by the
Germans in a cotton factory in Oostroosebeke was pnt in repair by the
316th Mobile Ordnance Repair Shop; 3"2 shower heads, 3 concrete
wall sterilizing rooms, and 5 })athtubs were in the installation. It
was operated by personnel from the sanitary train, and 1,311 men
bathed the first'day (November 7) of whom 179 were fomid to have
lice and 20 scabies.
On November 9 the division advanced to take position preparatory
to crossing the river Escaidt. One field hospital had come out of
the line on November 4; the only hospital in operation was the 361st
Field Hospital in Koulei*s.
On November 11, the day the armistice became effective, the di-
vision was in the vicinity of Audenarde. One field hospital was es-
tablished in the college 'buildings in Audenarde; one remaining in
Roulers as a relay station in the evacuation to Staden.
While in the area about Rousbrugge, troops were in billets and
barracks left bv the allied armies. There was much rain, and much
mud, but the general health of the conunand remained excellent.
Most of the admissions to sick report were for colds, and mild respira-
tory infections. Some difficulty was experienced in obtaining proper
sizes of shoes ; several thousand pairs of English shoes were obtained
for issue; but these were not satisfactory to the troops; they were
uncomfortable, did not fit well, and caused many sore feet. Diarrheal
disease was practically absent, there being but 15 admissions to
hospital from this cause during the month of December. Bathing
of the men was done in extemporaneous outfits such as heating water
in boiler and pouring through a perforated bacon tin to make a shower.
One Belgian bathing and delousing outfit in the vicinity of Crombeke
was available for a part of each day to troops of the 181st Infantry
Brigade. The 53d Field Artillery Brigade (28th Division), that had
been attached to the 91st Division at the beginning of the BelgiaP
campaign and remained with the division until the return to France,
had one steam disenfecter, which did not work satisfactorily on ac-
count of poor drving of the clothes.
During the early part of February there were many cases of
upper respiratory tract infections or 'influenza. It spread rapidly
through the division, affecting about 10 per cent of the command,
and stopped rather abruptly after about two weeks' course. There
were 21 deaths from pneumonia during February, in divisional troops,
all of whom had influenza onsets.
The 316th Sanitarv Train w^as organized at Camp Lewis, Wash.,
during the latter months of 1917, by the consolidation of the field
hospitals of the 91st Division and the ambulance companies, camp
infirmaries, and medical supply unit of the 91st Division.
Between the time of organization of this unit and its departure
for France all efforts were bent toward the thorough instruction of
its personnel in matters both military and technical through the
medium of lectures, drills, demonstrations in first aid, practical in-
struction at the base hospital at the training camp, and by practical
fieldwork, and by the time of departure for service overseas the
organization Avas' as thoroughly schooled in all branches of its de-
partment as was possible.
The organization left Camp Lewis on June 27, 1918, arrived at
Camp :Merritt. N. J., on July 3, and sailed from New York on July
A. E. F. — DIVISIONS. 1673
12, 1918. on the transport Olympie, arriving at Southampton. Eng-
land, on July 20. 1918, where a change of transport was made and
final disembarkation accomplished at Cherbourg, France, on the
morning of July 21, 1918. After remaining a few days in the Brit-
ish rest camp at Tourleville, near Cherbourg, the organization pro-
ceeded to St. Xazaire, France, where it remained in further training
until August 21, when it proceeded to Montignj'^-le-Roi and rejoined
the 91st Division.
On September 6 orders were received for the procedure of the 91st
Division to the advanced section, and by a series of night marches
we arrived by September 12 in the reserve area of the St. Mihiel
sector, where the American forces were pursuing their offensive and
where we were officially in reserve. There being no opposition to
the American arms, we proceeded by marches to a position in the
P'oret de Hesse preparatory to the Meuse-Argonne offensive, which
was launched on September 26, 1918,
On September 21 a triage, gas hospital, and a hospital for surgi-
cal and nontransportable cases was erected in the rear, and one
dressing station and one slightly wounded station were sent for-
ward. At this time the ambulance section had no ambulance equip-
ment other than seven animal-drawn ambulances, which were used
at the advanced dressing stations. The bulk of the evacuation Avork
fell to the two S. S. U. units which were attached to the train,
S. S. U. 593 and 610. As the offensive proceeded many more dress-
ing stations were located in the advanced area.
By September 29 the offensive had so proceeded as to aHow the
establishment of field hospitals in the Bois de Chepp}', at that time
from 5 to 6 kilometers behind the front line. This location so close
to the front was made necessary by the heavy congestion of traffic,
which made evacuation of the wounded to hospitals located farther
to the rear a difficult and well-nigh impossible problem. The estab-
lishment of these hospitals assured the wounded of more extensive
care than was possible in dressing stations, and manv delicate opera-
tions were successfully performed under the most adverse and trying
conditions while in this position. The severe congestion of traffic
on the roads made it necessary to utilize all kinds of transportation
for the evacuation of the wounded, and trucks were used extensively
for sitting cases and at times for litter cases. Dressing statioM^
were operating in the advanced area at all times under terrific shell
fire
On October 1 orders were received relieving the division from
front-line duty and as soon as possible hospitals and dressing stations
were evacuated and the organization proceeded to St. Pierre, near
Jouey, for rest. Later the division was ordered l)ack to the Eevigny
area, where it remained until October IT.
During this offensive the 316th Sanitarv Train handled about
3,700 cases.
Hospitals for gassed, for triage work, and for operating purposes
were established and dressing stations and stations for slightly
wounded were established in the advance. The ambulance section
was now equipped with 11 standard G. M. C. ambulances and at all
times performed with the highest efficiency and bravery the task of
evacuation of the wounded from the front to the hospitals.
1674 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Because of the fact that the nearest evacuation hospital was many
miles in the rear it was necessary that much more surgical work
be performed in these hospitals than usually fell to the lot of
a field hospital, and the sanitary train reviews with pride the sue ess
which crowned the unselfish effort of its men.
It is with a feeling of satisfaction that every man in the organi-
zation reviews the work of the sanitary train from the time of its
organization to the present. Although while in the Argonne offen-
sive it operated without proper evacuation facilities, it won for itself
the hearty praise of its superior officers for the way in which the
patients were placed in established hospitals. AVhile in Belgium they
won the praise of the commanding general for their cheerfulness
.and morale while living under the most despicable of conditions in
the dead of winter, without sufficient heat, poor water, etc.
During the two offensives before mentioned and in which the 91st
Division took an active part the sanitary train handled approxi-
mately 8,000 patients. A detailed report of the participation of the
ambulance and field hospital sections accompanies this report.
3. Chief Surgeost of Advance Section, Services of Supply.
In a general way the office of the surgeon, advance section, has
functioned in the manner described in paragraphs 817, 818, and
819, Manual, Medical Department. The provisions of these regu-
lations have, however, been dej^arted from considerably in order
to meet the special conditions which have arisen. The functions
of the commanding general, advance section, and the scope of his
control have never been specifically defined. The duties of this
office might be considered as comprising those of a department
surgeon with the addition of the control of many Medical Depart-
ment units, notably camp, mobile, evacuation, and field hospitals,
ambulance companies, medical supply depots, sanitary squads, and
laboratories.
Conditions in the advance section have been peculiar and have in
many respects differed radically from those in other sections of
the American Expeditionary Forces. The area has included the
territory just behind the fighting lines and has coincided with what
is called the French zone of the armies. Replacement and supply
have been its principal functions. In its area have been located up-
ward of 25 training areas, in which divisions have been billeted on
their way to the front and to which they have returned for rest,
replacement, and refitting.
The special activities in the section have been very numerous.
Staff and line schools of all branches of the service, sui:)ph' depots
of all kinds, air service depots, and the various activities of the
technical services have been located in the area. The number of
troops under the jurisdiction of the commanding general, advance
section, has varied considerably. At the date of this report it is
210,082.
The exemption from control of these headquarters of a number
of special areas and organizations has resulted in a lack of coor-
dination of Medical Department activities in the advance section.
I refer to school areas, regulating stations, supply depots, base
hospitals, light railways and roads, and other projects. It appears
A. E. F. DIVISIONS. 1675
to me to be altogether desirable that these areas and technical groups
should be placed under the jurisdiction of the commanding general
of the section for medical administration and sanitation. A satis-
factory solution of the matter Avould have resulted if there had been
put into effect the plan proposed in the draft of a general order
which was prepai-ed in October last.
The health of the troops has on the whole been satisfactory. The
epidemic of influenza, which prevailed during August, September,
and October, constituted the most serious outbreak of communicable
disease. Some organizations suffered very severely, and in certain
camps, notably at Valdahon, the epidemic assumed a grave aspect.
Influenza continued to constitute the principal cause of admission
to hospitals up to the date of this report. Since the epidemic of the
autunni the cases have been less severe in character and the com-
plications, especially of pneumonia, less frequent.
Typhoid fever has appeared in numy places and in a number of
combat organizations there have been well-marked outbreaks. Among
Services of Supply troops, the cases have been scattered with a single
exception, in which instance 15 cases occurred in one camp. Cases
of cerebrospinal meningitis have occurred in many organizations.
During the epidemic of influenza its incidence was high and in one
camp, ^"aldahon, it assumed epidemic proportions.
No other communicable disease merits especial discussion in this
j)lace.
Water supplies in many instances have been inadequate in quan-
tity. In quality they have generally been unsafe for drinking
purposes. Gross pollution has been by no means uncommon and
manj^ outbreaks of diarrhea have been traced to this cause.
Much difficulty has been encountered in carrying out measures
for the supervision and control of veneral conditions in the ad-
\ance section. Tlie constant movement of troops on their way to
and from the front, the lack of control of thee headquarters over
many of the organizations, and the wide distribution of Services of
Supply troops have made it hard to follow with success a compre-
hensive and centralized s^^stem. There have been very many small
detachments in isolated localities with which it has been difficult
or impossible to comnuuiicate by mail, telegraph, or telephone. The
mmiber of separate camps or stations of troops has reached over
400 in number. Changes have occurred at such a rate that these
head(juarters has never been able to maintain an accurate record in
its weekly station list.
At the present time there are 32 central reporting officers who col-
lect reports from the troops in their areas .and send in by telegraph
or telephone a weekly consolidated report. These officers also act
as local supervisory of veneral disease control in their areas.
The plan of establishing areas for American troops was formu-
lated soon after the entrance of the United States into the war.
A similar system had been in operation in the British service, al-
though in that service the training areas were in reality reserve
areas, which in tl^e event of great activity, particularly of an ad-
vance of several miles hj the enemy, such training areas might, and
occasionallv did, beconie active sectors.
Each divisional training area was leased from the French Gov-
ernment, and included a sufficient number of towns to accommo-
1676 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
date a full combat divi^^ion. The troops were billeted in houses,
barns, and outbuildings, and in barracks erected b}^ onr troops.
For administrative purposes, a zone major and three or four
assistant zone majors were assigned to each training area. These
officers represented the rents, requisitions, and claims department
of the American Expeditionary Forces, and were under the direc-
tion of the chief billeting officer of the advance section, Services of
Supply. In each town occupied by American troops a town major
was appointed by the conmianding officer of the unit, who super-
vised the distribution of troops and arranged the settlement of
chiims for damages.
The general plan of work in the areas was (1) to keep the zone
juajor constantly informed of sanitary conditions in the area; (2)
to estimate the billeting capacity of each town in order that troops
might be given the maxinuim degree of comfort and air space; (3)
to work in conjunction with the central laboratories in placarding
water sources aft^r proper analysis had been nuide; (-f) to render
assistance to incoming units in preventing the occurrence of epi-
demics; (5) to assist in the organization and operation of bathing
and delousing establishments in the area and keep these in repair;
(6) to keep a general supervision over the sanitary and disease
conditions in the civilian population in order that the troops might
not be exposed to disease.
The following is a list of hospitals Avhich have operated in the
advance section during the period covered by this report :
Camp Hospital —
No. 1, Gondrecourt (Meuse).
No. 3, Bourmont ( Haiite-Marne).
No. 4, Lafauche (Haute-Marne).
No. 6, Barisey-la-Cote (Meiu-the-et-Moselle).
No. 7, Humes (Haute-Marne).
No. 8, Montigny-le-Roi (Haute-Marne). .
No. 9, Chateauvillaiu (Haute-Marne).
No. 10, Prautlioy (Haute-Marne).
No. 12, Valdahon (Doubs).
No. 13, Ma illy (Aube).
No. 18, Liffol-le-Grand (Vosges).
No. 21, Bourbonne-les-Bains (Haute-Marne).
No. 22, Langres (Haute-Marne).
No. 23, Langres (Haute-Marne).
No. 24. Langres (Haute-Marne).
No. 38, Chatillon-sur-Seiue (Cote d'Or).
No. 41, Is-sur-Tille (Cote d'Or).
No. 42, Bar-sur-Aube (Aube).
No. 48, Racey-sur-Ource (Cote d'Or).
No. 49, Laignes (Cote d'Or).
No. 50, Tonnerre (Yonne).
No. 64, Chatillon-sur-Seine (Cote d'Or).
No. 6.5, Semur (Cote d'Or).
No. 67, Moneteau (Yonne).
No. 97, St. Dizier (Haute-Marne).
No. 100, Belfort (Belfort).
Evacuation Hospital —
No. 1, Toul (Meurthe-et-Moselle) .
No. 2, Baccarat (Meurthe-et-Moselle).
No. 10. Froides (Meuse).
No. 114, Fleury-sur-Aire (Meuse).
Mobile Hospital —
No. 10, Vitrey (Haute Saone).
No. 11, Donjeux (Haute-Marne).
A. E. F. EVACUATIOX HOSPITALS.
1677
IX. HOSPITAL REPORTS.
1. Evacuation Hospitals.
a. evacuatiox hospital no. 1.
A Regriilar Armv orofanization, the first evacuation hospital in
existence. No. 1, was begun at Fort Riley. Kans.. October 10. 191T.
In Xovember, its equipment was completed and in December it was
called into active service.
It left Fort Riley December IT. 1917; arrived at Camp Merritt,
N. J., December 20, 1917; entrained for Portland, Me., on December
23, 1917: sailed for Liverpool, England (via Halifax. Xoval Scotia),
on the British steamer Gcunada December 28, 1918. Liverpool was
reached on January 7, 1918. and the unit disembarked the next day.
The personnel consisted of 17 officers and 181 enlisted men.
The men and equipment were ordered to Toul (Meurthe-et-Mo-
selle). and occupied a group of unfinished buildings. 3 miles north of
the quaint old city proper, February 4, 1918. This permanent home.
Sebastopol Barracks, was 7 miles south of the battle line held by our
own American troops. At first the bed capacity was placed at 900.
(It may be stated here that just before the St. Mihiel drive in Sep-
tember, 1918, the bed capacity had reached its maximum. 2.800.)
Daily numher of patients.
February. 1918.
March, 1918
April, 1918
Mav, 1918
June, 1918
Julr, 1918
August, 1918. . .
Sept. 1-12
Sept. 12
Sept. 1.5
Sept. 30
Oct. 1-22, 1918..
Oct. 22-31
Nov. 4-
(After the 11th, when armistice was signed, we began taking sick as well
as wounded.)
Nov. 17-30. combined cases varied from 410 to
December, 1918
January, 1919 ,
Februa'n,'. 1919
Minimum. Maximum
20
55
70
100
160
80
90
100
300
300
420
40
120
360
240
250
260
260
120
460
430
570
180
500
640
530
670
390
620
About the middle of January. 1919, venereal cases were sent here.
Operaticms. — While the number of operations of which careful
record is kept is stated to be 3.915, it is believed that in the rush of
work, particularly after the St. Mihiel drive of September, many
records Avere necessarily slighted. In addition, many patients had
multiple injuries. The above figures. 3.915. may be divided for con-
venience into the cases coming before the armistice Xovember 11,
1918, which comprised 3.410. and those coming after it. 505. The
largest number of tables in use was 28, which functioned in 8 sepa-
rate operatii^.g rooms supplied by 2 sterlizing rooms.
Evacuation Hospital Xo. 1 not only acted for itself as a hospital
but was responsible for the training of dozens of surgical teams,
nurses, adjutants, quartermasters, and even commanding officers of
1678 REPORT OF THE SURGEON GENERAL OF THE ARMY.
later organizations of similar type who arrived in the American Ex-
IDeditionarv Forces later than No. 1. Nearh' all of the above-men-
tioned people were ordered to Evacuation Hospital Xo. 1 for a period
of instruction and observation. The only serious defect in the organi-
zation of this model evacuation hospital that has been ol)served is
the fact that the loading platform was 2 miles away, necessitating
the permanent attachment and use of an evacuation ambulance com-
pany. A standard-gauge railroad should come directly into a hospital
plant, and no evacuation hospital should be established except at a
rail head or with its having a spur into the hosi)ital grounds. The
(juestion of mobility of an evacuation hospital still seems to be mis-
understood by manj^ It is not the plant that is mobile, but the
patients, in that they are evacuated continuously. A modern evacua-
tion hospital, with any kind of equipment sufficient to do good surgery,
can not be mobile, but it can be movable with sufficient truck trans-
portation. Thus it can be changed from one place to another and
function in a fe^x days again, provided that it has a proper military
organization and discipline. It must, therefore, have a very large bed
capacit}' in order that it may carry a surplus of capacity for non-
transportable cases, and it must have a very large personnel.
B. EVACUATION HOSPITAL NO. 3.
On July 12, 1917, at Camp Greenleaf, the 1st Provisional Evacua-
tion Hospital of the United States Armv was organized (S. O. 47,
Hq. M. O. T. C, Fort Oglethorpe. Ga., July 12, 1917). Twelve officers
from the medical officers' training camp and 200 enlisted men from
the recruit camp were assigned for duty with the new organization.
The camp was situated to the east of the medical officers' training
camp on what was known as the " Hill," together with the 1st Ten-
nessee Field Hospital. In September the field hospital left, and the
camp was newly laid out in the form of a rectangle. Pyramidal and
wall tents were used by enlisted men and officers, respectively.
On September 26 the organization was designated " Evacuation
Hospital Xo. 3" (S. O. 57, Hq. M. O. T. C, Fort Ogelthorpe, Ga.,
July 23, 1917).
About December 1 it was rumored that the unit would become a
permanent one. At that time the organization and function of an
evacuation hospital was not clearly understood by anyone.
On Christmas eve movement orders arrived. Most of the property
had already been packed, and about 4 o'clock Christmas morning the
organization left Lytle en route to Camp Merritt, X. J.
()n the morning of the 28th. after four tedious days of travel, the
company arrived at the embarkation camp. Camp Merritt, X. J.
On January 11 the company entrained for Hoboken and went
aboard the U. S. S. Madawaska, formerly the German liner Koening
WiJhelmll.
On the evening of January 12, the ship sailed. The vessel carried
about 1,800 troops, including our own, 306th, 307th, and 308th Sup-
ply Trains and more than 100 casual officers. The next day we
joined our convo}^, the Mount Vernon^ the Agamemmon., and the
battleship Montana. Storms were encountered continually and at
times the serving of food was rendered impossible. On January 23
the convo}^ was met by destroyers and the Montana left us. The
A. E. F. EVACUATION HOSPITALS. 1679
submarine zone was passed uneventfully and on the 25th the Mada-
v^anha ancliored in a fog at the mouth of the Loire. The next day
the weather cleared and the ship proceeded up the river to St. Na-
zaire. On January 27, after 16 days aboard ship, the company dis-
embarked and marched 3 miles to Camp Xo. 1, Base Section Xo. 1.
The organization was now divided into two detachments of fairly
even strength and professional distribution, and on February 1 en-
trained for Tours and Blois.
The following day one detachment, consisting of 8 officers and
75 men. arrived in Tours, while the second detachment, consisting of
10 officers and 100 enlisted men, proceeded to Blois. At this point
Evacuation Hospital Xo. 3 temporarilv ceased to exist; the entire
personnel of each detachment being assigned respectively to Camp
Hospital Xo. 27 at Tours and Camp Hospital Xo. 25 at Blois.
The first hospital in Tours was opened February 2, at Camp Hos-
pital Xo. 27, a large building on Rue des Urselines.
Uj) to this time all American sick had been cared for in French
hospitals, as there was only a small infirmary at Beaumont Barracks.
The woik progressed satisfactorily, and at the end of one week prep-
aration had been made for the reception of patients.
On February 9 they arrived and the first operation was performed,
the case being one of rib resection for empyema. The hospital had
a capacity of about 350 beds, but during our stay was never full.
(The total admissions was 275.) All but contagious diseases were
treated, the later being sent to the French contagious hospital. The
health of the organization remained good with but few exceptions.
Unit K, from Council Bluffs, Iowa, took over the hospital, and
on ]\Iarch 15 the original detachment left for Blois.
The main function of the detachment at Tours had been to over-
haul, clean up, and adequately equip a moderate sized camp hospital
until such time as it should be relieved by a permanent unit.
After February 2 the camp at that city was known as Medical
Casual Depot Xo. 6, lines of conununication, and was stationed at
the Caserne Maurice de Saxe.
Camp Hospital Xo. 25 had already been started. The " infirmary "
at the Caserne and Hospital Xo. 13, a converted school building in
town, had been opened and were being run by a small detachment
of officers, nurses, and men from Base Hospital Xo. 31.
The " infirmary " was a small three-story modern hospital build-
ing which acconnnodated about 30 patients.
On the arrival of Evacuation Hospital Xo. 3 detachment, four ad-
ditional buildings were opened. Annex Xo. 2, a convent connected
with the Church of St. Xicholas, was cleaned and put in order for
supply rooms and quarters for the enlisted men. Hospital Xo. 29, a
converted school building, which was caring for 180 French and 6
American patients, was taken over from the French. The French
patients were transferred to the French authorities ; the building was
cleaned out. thoroughly overhauled, reequipped. and ran as a general
hos])ital with 290 beds. Annex Xo. 1. a smaller building near by,
was used first as a contagious hospital of about 50 beds, but later as
a nurses' home.
All these buildings were old, dirty, fitted with inadequate and out-
of-date sanitar}' appliances.
1680 EEPOKT OF THE SURGEON GENERAL OF THE ARMY.
On ]Mareli 15 the detachiuent from Tours arrived and was assigned
to Canij) Hospital No. 25. The hospital was then caring for more
patients than it could handle, and two additional buildings were at
once opened by the new arrivals.
Hospital No. 1, a well-built, modern, up-to-date girls' school, but
with inadequate sanitary conveniences, was taken over and equipped
as the surgical hospital of the group. Bathrooms and toilers were
installed and the operating room was thoroughly overhauled. Three
barracks were built in the court at the rear, which brought the total
bed capacity up to 300. Heretofore, surgery had been done at both
Hospital No. 29 and Hospital No. 13, but the presence of the only
X-ray apparatus in town in Hospital No. 1 made it advisable to have
all the surgery done in this building.
Hospital No. 115, adjoining the Cathedral, originally the bishop's
palace and later a museum, was converted with considerable diffi-
culty, owing to the almost total absence of plumbing, into a 175-bed
hospital with an expansion to 250. The nature of this building was
such that only convalescents or mildly sick cases could with any
degree of satisfaction be cared for at this place. Two well-con-
structed barracks were erected in the gardens of the palace and used
as quarters for the enlisted men on duty with this hospital.
Of the professional work little need be said. Until June, when the
first wounded became to come, the work had consisted of treating the
usual line of civil ailments. One short epidemic of influenza, giving
cerebral symptoms, was of interest, and the spring epidemic of ordi-
nary influenza filled the hospital group to its capacity. Battle casu-
alties began to arrive toward the very end of our work at Blois, and
up to the time we left no unusual lines of treatment had been insti-
tuted.
In the latter part of June full equipment for an evacuation hospi-
tal was requisitioned for. This property was stored on arrival until
the organization went into the field. On the 3d of July, Camp Hos-
pital No. 25 was relieved by Base Hospital No. 43, and all records
pertaining to the hospital were turned over to them.
Evacuation Hospital No. 3 once more came into existence when we
received orders to go into the field.
It is utterly impossible to adequately describe the scope of work
undertaken b}^ the organization during its five months' service at
Blois as Camp Hospital No. 25.
On July 8, Evacuation Hospital No. 3 (17 officers, 6 nurses, and
179 enlisted men) entrained for the advanced sector. After a tedi-
ous three-day trip, passing en route through Eomorantin, Nourges,
Nevers, Dijon, Langres, and Chaumont, they finally arrived at
Eimaucourt (Haute-Marne) .
The hospital center at Rimaucourt (Haute-Marne) Avas then in the
course of construction, but several units had been practically com-
pleted. The organization made itself comfortable in the buildings of
one of the units and settled down to await further orders. In the
meantime additional equipment arrived.
On July 28, Evacuation Hospital No. 3 entrained for service at
the front (per telegraphic instructions, Headquarters American Ex-
peditionary Forces, July 25, 1918). Proceeding over night through
Chaumont, Troves, vSens. Melun, to Noisy le Sec, then continued
A, E. F. EVACUATION HOSPITALS. 1681
toward the Soissons front, and during the course of the day the orders
of final destination were changed three times.
About 11 p. ni., on the 29th, the end of the raih-oad at La Ferte-
Milon was reached and there the liospital detrained. It was but four
days since the enemy had been driven from the outskirts of the town.
Not a building in or about the town had ben spared by the bombard-
ment. A stone farmhouse not far from the station was picked as a
hospital site. Sheds, outbuildings, and the farmhouse itself had been
severely damaged, and before the hospital could be set iip it was nec-
essary to clear away much of the wreck.
On August 1, Mobile Operating Unit No. 2 joined. Six operating
teams also arrived, 18 nurses from Evacuation Hospital No. 5, and
one officer returned after closing the property account at Blois. The
mobile unit set up their hospital in the orchard adjoining our own.
A Bessoneau tent and several small " tortoise tents " had been ac-
quired and the former was erected as an operating tent under the
tutelage of officers and men of the mobile unit, whose equipment con-
tained this type of tent.
A limited supply of pure water was obtained from a well in the
garden and also from another source some distance from the camp,
but at all times economy had to be practiced.. Work continued day
and night until we were ready to receive patients. At night no
lights could be used on account of the danger from the enemy air-
planes and on one occasion bombs fell not far from the hospital.
It took about four days to make this camp ready in all its details for
the reception of wounded.
On August 1 camp was broken and the organization left for the
Chateau-Thierry front in thirty-odd American trucks and ambu-
lances.
That night, after the main part of the organization had left,
Avounded began to arrive. Such as needed emergency treatment were
cared for, using supplies from the men's medical belts, and great dif-
ficulty was experienced in locating any hospital in the vicinity to
which the patients could be sent. Twenty-eight, Avho had actually
been unloaded from the ambulances, were taken along on the trucks
the next day. They were made as comfortable as possible on mat-
tresses, placed on top of equipment on lightly loaded trucks and were
dropped at the first hospital encountered en route to Crezancy.
At 2 o'clock in the morning of August 5, the hospital arrived at
Crezanc}'. Orders stated that the hospital should be set up some-
where in the vicinity of this town.
It was pitch black when the con^oj' reached Crezancy, and nobody
s<}emed to know whether we were on the main road to Hunland or
Hoboken.
There was a considerable slope to the ground at this place and the
terrain was full of shell holes and umnarked graves of German dead.
The town had been retaken five days previously; ammunition dumps
were in the immediate vicinity ; " duds," hand gi'enades, and unusued
ammunition lay everywhere. Everything of a dangerous nature was
collected and piled in a safe place and the work of laying out and
erecting a hospital was immediately started. By evening the work
was well under way and the rest of the equipment had arrived from
La Ferte-]\Iilon. What had formerly been a French field hospital
1682 REPORT OF THE SURGEON GENERAL OF THE ARMY.
furnished all the hiniber necessary and a lar<re stone farm building
adjoining the camp site retained enough of its roof and walls to
furnish storerooms for our medical and quartermaster supplies.
Work Avas rushed throughout the night and by noon on August G the
lirst wounded started coming in.
By 9 o'clock that night the operating room was in full swing,
'i here AAere but two regular oj[)erating tables and the rest of the work
was done on stretchers which rested on wooden horses that had been
constructed for that purpose at La Ferte-Milon. The tent was
lighted by acetylene gas.
The day following our arrival Mobile Unit No. 2, which had ac-
companied us from La Ferte-Milon, left for a point nearer the front.
For five days this camp was developed and operated under consid-
erable stress. In the neighborhood of GT5 cases were treated at this
site.
A complete reorganization of the camp was started. In 36 hours a
new camp was planned and erected to the east of the road. A
crushed-stone road was built for the entrance and exit of ambulances.
The damaged French barracks were repaired and reroofed, and the
receiving office, dental otKce, pharmacy. X-ray and dark room, steril-
izing and operating room supplies and shock ward were installed in
four of them. The fifth remained quarters for some of the officers.
Latrines were sunk when necessary. Water was very difficult to get
and had to l)e brought to the camp in water carts. Its impurities
necessitated the use of Lyster bags and chlorination.
A recently f ought-over battle ground, the presence of open latrines
and abundance of nuinure. rubbish and filth of every kind, rendered
sanitary conditions almost unremediable. The stream of wounded,
vrhidi commenced 36 hours after the hospital anived, made it im-
possible to do any great amount of policing. Flies and yellow
jackets were an unspeakable scourge. Material could not be ob-
tained to adequately screen the kitchen and mess hall. Efforts were
made to protect uncooked food with gauze, but this was so scarce
that even all the wounded could not be protected from the flies. It
A\as but a short time, conseiiuently, before a serious epidemic of dysen-
tery occurred among the personnel. Offi;'ers. nurses, and enlisted
]nen were affected with hardly an exception. The work of adminis-
tering the hospital and caring for the wounded was seriously handi-
capped. Had the organization remained at this place it is safe to
say that it would have been necessary to evacuate a large percentage
of the personnel.
The arrival of several additional teams and 10 nurses consider-
ably lessened the strain under which the organization had been
working. The first week at Crezancy saw the heaviest part of the
work finished and from then on until the 19th of August, when the
few remaining patients were evacuated, the work gradually lessened.
Air raids were frequent occurrences and the exposed position made
the place a dangerous one. It was difficult to completely camouflage
the necessary night lights. The new operating tent had been lighted
by electricity, supplied by a separate power plant, and the effer-
vescent glow from this tent at night was very marked. This was
imsatisfactorily diminished, l)y spreading rolls of tar paper over the
roof. No distinctive hospital mark was attempted at this camp, but
apparently the enemy made no serious effort to bomb the hospital.
A. E. F. EYACUATIOX HOSPITALS. 1683
althor.frh explosions on more than one occasion were heard in the
near neighborliood. During the operations at Crezanc}'- 1.803 patients
were treated. 298 operations were performed, and 20 deaths occurred.
On the afternoon of August 20, the organization left Mezv, near
Crezancy, by train for Toul. The trip was made in two sections,
one containing the greater part of the personnel and some provi-
sions. Passing through Epernay, Chalons-sur-Marne, Vitry-le-
Francois, Revigny. Bar-le-duc, Gondrecourt, and Sorcy, the train
eventually arrived on the evening of the 21st at Toul.
The second section, with the baggage, had already arrived and
the small detachment had made considerable progress in unloading
the cars. The whole organization went by ambulance to Sebastopol
and became the guests for the time being of Evacuation Hospital
No. 1. The property was brought up by truck during the night and
the following day. No arrangements had been made for storing it.
and it was consequently piled in the open in a disorderly and hap-
hazard fashion. In sorting over the baggage, one of the officers
found two hand gi'enades loosely packed with gauze in a T-o-milli-
meter shell case, which some nurse had attached to her baggage for
souvenirs. They were quickly and quietly disposed of and the gauze
replaced in the shell case with a couple of stones.
The organization remained at Sebastopol until August 24. when
it was moved to buildings about 2 kilometers west of Toul which be-
came, eventually, a part of the Justice Hospital group.
These were, by far, the best buildings in which the hospital ever
functioned, and it was a comparativelv easy matter to prepare the
plant as a 1.000-bed hospital in a very few days.
Base Hosi:)ital No. 4.5 was located in a large caserne to the east and
was scheduled to care for gas cases during the coming offensive.
Evacuation Hospital No. 3 was to handle the seriouslv wounded onlv.
and Evacuation Hospital No. 14. just to the west of us. the slightly
w^ounded.
Within a week after arrival. 12 operatine: tables had been pre-
(>ared. 1.000 beds were in readiness, several additional teams had
arrived, and the organization settled down, pending the commence-
ment of the drive.
On September 11. the St. Mihiel offensive started. The buildings
shook and the windows rattled with the intensity of the barrage.
The organization prepared for the coming rush. The following
morning wounded poured in. Preparations had been so carefully
made that the hospital functioned like clockwork in spite of the
heavy demands put upon it. In the following four days and nights
l.lll American wounded had been received, and G93 operations were
performed ; 42 deaths occurred, of which 18 were post-operative.
Besides these there were 76 seriously wounded prisoners of war
cared for.
Evacuations occurred daily or twice daily, so that at no time was
there a lack of bed space. Every effort was made to send cases to
the rear at the earliest possible moment and there were but few that
were kept post operatively more than 72 hours. The majority of
cases reached the hospital in a remarkably short time after being
wounded and it was merely a question of waiting their turn in the
operating room. The type of wounded coming to the hospital neces-
142367— 19— VOL 2 4.5
1684 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
sitated a larger number of priniarv operations than Avas usually the
case, consequently it was not unusual for a case to wait 24 hours
before reaching the surgeon's hands. Those which possibly could
were evacuated as preoperative cases. The staff worked under almost
ideal conditions and although they were rushed at all times, there
was a noticeable absence of confusion.
Air raids were a constant annoyance and falling shrapnel was a
menace to ever^'one. The former occupants of the building had
installed efficient window shades, so that at no time was it absolutely
necessary to discontinue work during the night.
On the 18th of September, the few remaining patients were trans-
ferred to Base Hospital No. 45, and such of the equipment as had been
used was packed for transportation. Nurses Avere sent to Base Hos-
pital No. 45 to wait there until Evacuation Hospital No. 3 Avas read}'
to function at the next camp.
The following day all was in readiness, and on September 20 the
organization in 120 French camions and American amlDulances moved
for some unknown destination. Tremendous secrecy was employed:
the officers were locked up in ambulances, the enlisted personnel was
camouflaged among the equipment in the French camions, and the
whole convoy moved out in broad daylight. Toward evening before
reaching Bar-le-duc, the convoy became very much broken up in a
traffic jam with French artillery and other troops on their way to the
Verdun front. Considerable delay was experienced there until sev-
eral miles farther on the convoy left the main road and arrived about
midnight at Fleury.
Quarters for all were found in the barracks of a large French evac-
uation hospital that was situated at the edge of the railroad yard.
Orders stated that no equipment of Evacuation Hospital No. 3
should be installed, as plans had been made for the organization to
move farther forward as soon as the offensiA^e in the Argonne should
start.
About the 25th of September the nurses came on from Toul by
ambulance. A number of evacuation hospitals had arriA-ed in the
neighborhood, and as some of them were short of teams several of
those attached to Evacuation Hospital No. 3 Avere ordered aAvaj' on
teuiporary duty, also 20 nurses.
Evacuation Hospital No. 114 was theoretically running the group,
but the personnel of Evacuation Hospital No. 3 functioned in the
most important capacities.
The drive started on September 27 and the hospital Avas hard
pushed to handle the great numbers of Avounded that poured in. In
the course of one seAen-hour period alone over 7,000 Avounded were
received, and in one day 1,400 patients were accounted for. Many
preoperative trains were dispatched to the rear and only those oper-
ated upon who needed immediate surgical attention. Tlie Avounded
Avere received as a Avhole in poor condition and a large percentage of
the wounds Avere from 30 to 72 hours old. jSIany had been wounded
4 days previous to reaching the hospital. There, as at other camps,
shifts were made every 12 hours, but even by working some of the
teams 18 hours a day for several days it was impossible to catch up
with this work. For 4 days the rush continued, but Avith diminishing
intensity, and on October 1 Evacuation Hospital No. 3 entrained for
the Champagne front.
A. E. F. EVACUATION HOSPITALS. 1685
The train pulled out about 8 o'clock in the evening and, passing
through Clermont, Ste. Menehould, and Vitiy-le-Francois, arrived
at the outskirts of Chalons-sur-Marne about 2 o'clock on the morning
of October 2. As the city was approached an air raid Avas in progress.
The night was intensely cold and those who had been able to get to
sleep were awakened by the reports of the '"Aichies " and the explo-
sion of a bomb which fell on the track a few hundred feet ahead.
For an hour or more the train was held up until repairs could be
made, when it proceeded on to Cuperly, and in the early morning the
company detrained at ^lont Frenet Hospital, a kilometer beyond the
town.
Field Hospital Xo. 10, which had been shelled out of its position
nearer the front, had partially set up its equipment in a vacant field
across the road from the French hospital in order to handle the
situation until we arrived. The same site was chosen for Evacuation
Hospital Xo. 3 and work was immediately started to erect it. The
ground was a level stretch, considerably lower than the road, and was
crossed by a narrow-gauge railroad and a deep ditch, which affordetl
some natural drainage. A rectangular roadway had already been
constructed which served as an entrance and exit for ambulances.
By the evening of the 2d the more important part of the hospital
had been set up. The attack started the morning of the 3d and by
noon wounded were coming in.
For the first 10 days wounded arrived in large numbers, but were
easilv handled. Other units functioning in the vicinity were Evacua-
tion Hospital No. 5, Field Hospital X"o. 16, and Mobile Operating
Unit Xo. 7. Evacuations on French hospital trains occurred almost
daily during the rush. During the third week only a small number
of patients arrived — these mostly sick — and during the last two Aveeks
of our stay there was practically no professional Avork done. FiA^e
thousand eight hundred and two admissions wore received, 718 opera-
tions performed, and 133 deatlis occurred.
On October 26. 1 officer, 2 cooks, 10 carpenters, 5 guards, and the 56
prisoners of Avar were sent ahead to Ste. Etienne to prepare another
■camp site. The enemy had been driven back so far that the hospital
Avas too far in the rear. But turn of cA^ents made it unnecessarv for
the hospital to move forAvard. and the detachment Avas called back
flfter having built a stone road, buried the dead who lay around and
repaired scA^ral damaged shacks for kitchen and storerooms, and
disposed of three 5-gallon kegs of vin rouge.
When the camp was first made the front Avas about 6 miles away
and the French neighbors Avere greatly alarmed at what they consid-
ered an unnecessary and careless display of lights at nio-ht.
On November 9 the hospital entrained for the Verdun front. The
small convoy arrived about midnight at Fontaine Ronton, neai
Souhesmes la Grand, about 12 kilometers south of Verdun.
A French barrack hospital group, to Avhich Evacuation Hospital
X^o. 3 had been assigned. Avas found, and preparations were started to
prepare breakfast for the organization.
On December 2 a detachment of 16 officers. 25 nurses, 4 sergeants
2 cooks, and 24 enlisted men proceeded 100 miles by ambulance'
through Verdun, LongAvy, Luxemburg, into Germany to the historic
citv of Trier.
1686 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
The advanced guard of the army of occupation had only just
passed throuixli the city. The day i)revious. Field Hospital Xo. 303
had arrived and had temporarily taken over the military prison
hospital at the Horn Kasern, the former home of the ^Oth German
Infantry. The small detachment took over the hospital from them
and commenced caring for the one hundred and sixty-odd allied sick
and wounded. Russian. Polish. British, Canadian, French, and,
American prisoners of war were found, some of whom had been in
eneni}' hands for four years.
On December 4 a hospital train Avas procured and practically all
the allied prisoners were evacuated to France, but the increasing
number of patients from the advancing Army. Avhich amounted to
800 in the first week, kept the beds of the hospital full.
On December 8 the rest of the organization arrived by train. The
compan}^ left Souhesmes 36 hours after the first detachment, but
continual delays and yard blocks around Verdun prevented it reach-
ing its destination more quicklv.
The work of cleaning up, establishing and expanding the hospital
at Treves is a difficult one to describe. From the very start the pro-
fessional demands made upon the hospital were very heavy. De-
tachments from Field Hospitals No. 150 and No. 155 were attached to
the organization during part of January and February, lessening the
burden of the work, and civilian help was employed.
The hospital was rapidlj' expanding to meet the increasing de-
mands made upon it by the Third Army. The winter epidemic of
influenza and pneumonia sorely tried the professional ability of the
staff. Assistance had to be sought and officers from the Seventh
Corps, Evacuation Hospital No. 7, and a few casuals from the
Services of Supply were from time to time temporarily assigned.
Hundreds of patients were received from Coblenz and frequent evac-
uations were necessary to keep the number of sick within the bed
capacity.
On February 16 Evacuation Hospital No, 3 was relieved by Evacu-
ation Hospital No. 19, and ended its career of active service.
Such then is a brief general history of an organization that was
formed at random, came overseas with the first 140,000. started and
ran seven camp hospital buildings in the Services of Supply, partici-
pated in six credited Army engagements on six different fronts,
opened the first hospital in Germany with the army of occupation,
and that covered more than 1,200 miles in the course of its wanderings
over France and into Germany.
Medical services. — All the infectious and contagious diseases were
segregated at the " Mixte Hospital."
About 30 lobar pneumonias, in the course of five months' work at
Blois,^ all made complete recoveries, one post-operatively after rib
resection for complicating empyema.
In May, 1918, 110 cases from a company of the 20th Engineers,
stationed near Blois, of epidemic influenza, of cerebral type, were
treated at the " Mixte Hospital." About 40 lumbar punctures were
made on the most serious of these cases. The spinal fluid was found
to be under increased pressure but was negative bateriologically.
Following lumbar puncture immediate relief to the patient was
obtained.
A. E. F. EVACUATIOX HOSPITALS. 1687
Numerous small epidemics of influenza \Yhicli showed no unusual
symptoms were treated.
Crezaney : At this place six ward tents were set aside for medical
and gas cases. Many cases of gas poisoning, practically all due to
mustard gas, were received. The first-degree burns were all treated
with bicarbonate of soda. More extensive burns were treated with
vaseline gauze after excising the blister. A solution of sodium bicar-
bonate and sodium chloride was used as an eye wash and sprayecL
in the nasal passages wdienever indicated.
A moderate number of gas patients developed broncho-pneumonia,"
find the mortality in these cases was about 90 per cent. All showed
acute dilatation of the heart at the post-mortem examination.
Mont Frenet: Tlie milder cases of influenza without lung com-
plication were evacuated immediately, the more severe type being
held for treatment and examination. A very high percentage of
these cases developed l)roncho-pneumonia, with about 50 per cent
mortality. These cases in every instance were admitted in an ex-
hausted condition.
Six cases of general emphysema without any history of previous
injury to the chest were observed. All these cases were suffering
with influenza or severe bronchial affection and all presented symp^
ioiiis of strenuous paroxysms of coughing. Death occurred in every
case. Autopsy revealed in one case broken-down pleuretic adhesions
through which air \ii\d esca|)ed into the mediastinum and thence
into iae cellular tissues of the cervical region. In every case the
emphysematious c^nditon was first observed in the tissues around
the neck.
Treves: Starting out with about 900 beds in building B, tu^
service expanded until building C had been taken over and part of
.building A, totaling finally in the neighborhood of 1.000 beds.
The work was extremely exacting during the months of December
and January. There was a great influx of patients with the epidemic
of influenza that followed on the heels of the army of occupation,
exhausted and worn out after forced marches.
Many developed or were admitted with pneumonia. Among the
first hundred cases the mortality was very high. While for the
Avhole service it averaged about 3.5 per cent, there were times when
it reached as high as 12 per cent. Broncho-pneumonia somewhat
exceeded the lobar type. About 10 were complicated by empyema
both of the pneumococcus and streptococcus hemolyticas type. Un-
fortunately no statistics were kept on this series of cases. There
were many who died within 12 to 24 hours after being admitted,
and the conclusion was that these cases should never have left the
field hospital under the existing conditions, weather, and trans-
portation.
Lahoratory. — There had been supplied no forms for the wound
reports, so there were printed 1,000 forms of a much simplified de-
sign. These showed name, date, rank, ward, building, interval from
wound to o]Deration, operator, operation diagnosis, whether taken
before or after operation, and space for laboratory number and
report in w-riting. These cards were made out by the scribe in each
operating room under the direction of the operating surgeon and
sent with the swab to the laboratory. The original card was re-
turned to the patient and the result noted in a current book. Kecord
J688 REPORT OF THE SUROKOX (iEXKRAI. OF THE ARMY.
keepino- was soveioly haiulicai)])iHl by the siiiallness of the laboratory
forcp. Durinji" Iho "(laytinic ono officer spent most of his time in the
operating room, selectino- from the 12 tables those cases which it
was thoiisht offeretl the most interestin<j tnltiiral possibilities.
Nearly half of the material came from one single operator who had
had wide experience with the British, and Avho followed^ his cases
to the ward and laboratory in spite of the rush. Great difficulty Avas
experienced in getting even the simplified cards filled out correctly,
and constant sn])ervision was necessary until the system was under-
stood by all ( oncerned. There seemed to be a lack of enthusiasm
among- the surgeons for laboratory diagnosis until cases began to
come in showing tlie infection already developed. Our surgical
director, a man of wide experience and excellent judgment, was of
the opinion that in such a rush the laboratory should attempt to han-
dle only knees, chests, and abdomens. My experience at Toul and
later has led me to believe that unless unusual facilities and per-
sonnel are provided, and unless there is offered full cooperation of the
surgical and administrative staifs in the matter of taking well
chosen cultures and in getting the cards completely filled out, his
opinion is justified. Especially is this true when no primary closures
are allowed and when no delayed primary closures are attempted.
It is, furthermore, only natural that both surgeon and laboratory
officer should take little" interest in doing work for a patient Xvho im-
mediately passes out of sight unless he can bee that it is of bcrient
to the clinical welfare of the patient.
Medical sicpply dc'pa.i'frrxnt — La Fei'te-MUon. — As soon as the
tentage of the hocpital was raised tho chiefs of the services and the sur-
o-eon« <^iiew the necessar\^ property to equip their departments. This
was the first occaaion on which it was possible to ascertain exactly
what was contained in the various cases, and owing to the haste in
equipping the wards and operating room little or no opportunity was
given to make a check. Part of the equipment consisted of 500
white enamel beds, but by this time it was decided that they were
impracticable for use in the field, so that about 400 of them and a
universal steam sterilizer were packed in a car and shipped back
to the depot.
Nurses^ history — Ci^ezancy. — About 2 o'clock Monday morning the
journey's end was reached. No place to lie down. All la}' down
with suits, coats, and raincoats on, with gas masks and helmets near
at hand, and in spite of the soft drizzle of rain all slept, forgetting
the war, until 8 a. m. That day several nurses appropriated a tiny
house by the side of the road; the others got a cot in barracks or
little tents. Later marquise tents were provided for all of the nurses.
The drive was on, the wounded poured in, the nurses forgot them-
selves in a combined efl'ort to do their share to check the crimson tide
which was so terrible at this place. The nurses with operating
teams as well as those attached to the hos])ital worked, not caring
how hard nor how long the hours. The object of all was to save.
The dead about Crezancy w^ere still unburied, and the fiies and
yellow jackets were too terrible for description. Many of the
nurses were ill. Sanitary conditions here were most pitiful.
The weather was extremely hot — especially were the tents ex-
tremely hot — the blazing sun beat down on the tents at day, and at
night the windows and doors were kej^t tightly closed to keep light
A. E. F. EVACUATION HOSPIT.kLti. 1689
from shinino' through. The combined smell of ether, blood, stale
p.ir, and heavv atmosphere from the steam sterilizers is one to be
not easiiy forgotten after 15 or 18 hours of work.
The nurses always carried f^ns masks and helmets to and from
work. None of the hospital personnel went to dugouts during air
raids, though many used helmets as the shrapnel from the anti-
aircraft guns tinkled around. The French could be heard pattering
by Avith their wooden shoes at all times, going to or coming from
dugouts.
The rats, mice, and lizards were unpleasant and constant visitors
in the nurses' tents, but aside from the characteristic feminine
squeal the nurses \mk\ them little attention.
Fleury : At 10 p. m. the last ambulance of nurses arrived at Fleur3%
where Evacuation Hospital Xo. 3 was located with Red Cross
Hospital No. 114. This hospital had never functioned, and the
wounded came before preparations could be made for the tremendous
task it was called upon to do. Therefore the nurses from Evacua-
tion Hospital No. 3, with their previous experience, were of great
value, as they took complete charge. The firing at this place was
very disturbing, and although accustomed to the noise and jar of
guns this was so near the front lines that it was hard to sleep at all.
The wounded lay many hours uncared for, and the whole force
worked most unselfishly.
It was a tired crowd that assembled on the afternoon of October 1.
The 20 nurses were hastily brought from Evacuation Hospital No.
11 in time to take the train with Evacuation Hospital No. 3, and the
journey to the Champagne front connnenced. This was a never-
to-be-forgotten journey. Having been accustomed to French trains,
everyone was enthusiastic and glad to be together again after the
}>a>t two terrible weeks. The nurses were quite crowded in compart-
ments, but "' C'est la guerre," so no one fussed. As night came on,
and the train cautiously felt its way through the dai'kness, each
nurse sought comfort as best she could. Two on the floor of each
apartment, and two in one apartment climbed up into the racks
above the seats, thus giving more room for those curled up on the
seats. The train running in silence and darkness stopped fre-
quently. The firing was near, and to lend novelty to the ride,
near Chalons-sur-Marne a bomb fell on the track about 100
yards ahead of the engine. The tinkle of shrapnel from antiair-
craft guns was distinct on the roof of the cars. " ^A^iere is my
gas mask?" one nurse asked. " Keep still; I am using it for a pil-
low," came from a corner.
Mont Frenet : The ground was white with frost when on October
2 stitf-kneed nurses tumbled to the ground from the high French
cars. That day was aimlessly spent by the nurses as equipment
was being unloaded. Everyone tried to rest, but there was no place
to sit except on the ground. A French hospital was there and
beds were obtained in barracks for the first night, officers occupying
half of the barracks (blankets put up between).
The crowd was so tired it soon forgot all discomforts and awak-
ened about 3 a. m. by the whistle and shriek of shells. Fritz had
taken the picture of our arrival, and in his Hunnish way was bid-
ding welcome. Some of the shells came very near. Most of the
nurses were awakened and lay listening, speculating whether or not
1690 REPORT OF THE SURGEOX GEjnEP.AL OF THE ARMY.
the next one would be a *•• ciUd," ^-he dull thud of which announced
its arrival or the explosion telling a real one h?d fallen near.
Toward daybreak things became quieter, and that day all prepared
for the splendid work Avhich was accomplished at this place.
Toward the last of the drive it became very cold. The mud would
be frozen under the cots each morning. The clothing in trunks and
suit cases became mildewed in spite of airing.
On the evening of November 9 the nurses once more boarded the
train and the nurses Avere just beginning to get settled when they
were aroused and told that 24 were to go by ambulance to Evacuation
Hospital No. 6 at Souilly to stay there for the night. So out they
went. It was cold, dark, and raining.
Fontain Ronton : At this place the nurses were billeted in bar-
racks. The 24 nurses who Avere Avith Evacuation Hospital Xo. 6 for
the latter part of the night came in by ambulance the next ds\j, and
the family was together again.
The next clay, November 11. the nurses, as Avell as entire personnel,
were awed by the great silence Avhich came at 11 a. m. It could hardly
be real ; yet when each nurse listened, the sound was gone; silence, and
they Avere just becoming accustomed to the roar of the guns.
Recommendations. — So far as our OAvn organization Avas concerned,
the personnel Avas from start to finish entirely too small.
Tentage: The Army Avard tent seemed impractical, no matter what
use it Avas put to. It Avas too narrow to admit an aisle through the
center unless the poles were set criss-cross at angles: there were no
accommodations for stovepipes, and the doors Avere extremely awk-
Avard.
The Bessoneau tent, of Avhich we had fiA^e, Avas a remarkably fine
structure in every Avay, provided the organization made few moves,
but the countless number of parts and delicate framework made it a
bulky and difficult piece of equipment to transport. Four of them
Avould serA'e excellently as operating rooms and shock Avards. The
British " Marquise " tent, in our opinion, was a Aery poor hospital
adjunct; it covered too much ground in proportion to the inside area;
there Avas too much wasted effort in putting it up. The possibility to
join them either sideways or lengtliAvays was a point in their faA-or.
For the operating tents some sort of black lining should be supplied.
Beds and bedding: About 50 high, but narrow, iron beds with high
back should be carried for use only in the shock or A^ery seriously
wounded tents. All Avalking Avounded should be giA^en lutters. of
Avhich the number should lie increased. The mattresses we used in
the field and carted from place to place Avere unnecessarily thick and
bulky.
Well-constructed Avard boxes to contain such supplies, fixtures, and
common medicines as are always necessary Avould aid materially in
the speedy ec^uipping of the wards. These could be standardized and
the contents enumerated.
Folding stretcher racks that could be used in the receiving tent,
dressing tent. X-ray, and cA^en the operating room should be sup-
plied. On more than one occasion frame horses Avere made for this
purpose and found indispensible.
Our observations on cases received from field hospitals and mobile
operating units have brought us to the conclusion that the former
should limit itself to the operation of '' triaging " and feeding and
A. E. F, EVACUATION HOSPITALS. 1691
that the hitter shoukl be done away with. The mobile unit demands
a considerable personnel, does not seem to possess anj' remarkable
amount of mobility or speed, and, once filled to its limited capacity,
can not expand, and the rest of the wounded come on back to the
evacuation hospital. But on one occasion were we placed sufficiently
near the front, and it was then but a few days until the front had
vanished into the distance. If ihe evacuation hospital were divided
into two sections, with parallel equipment, all of which would not
be too much for the whole ho-pital, one section could advance with
half the equipment, start a new camp, tind carry on until the sec-
ond section had disposed of its patients, when it would join the
first section. By leapfroggin"; in this way the evacuation hospital
would be kept in close touch with the front and painfidly long hauls
would be avoided.
C. EVACUATION HOSPITAL NO. 4.
Evacuation Hospital Xo. 4 was organized at Camp Greenleaf,
Fort Oglethorpe, Ga., on Xovember 20, 1917.
February 1.5 : Removed from quarters in Camp Greenleaf. M. O.
T. C, Fort Oglethorpe, to Camp Forrest, M. O. T. C, Fort Ogle-
thorpe, Ga. The quarters into which the company moved were
those recently vacated by the 81st Field Artillery, electrically lighted
and with bathing facilities not previously enjoyed.
March 2 : Marched to Lytle, Ga., and entrained about 9 p. m.
March 3 : Stopped at Bristol. Va., and took a hike. March 4 :
Stopped at Philadelphia. Pa., and took a hike.
April 6: Marched to railroad station and entrained for Mineola,
Long Island, X. Y., arriving at Xassau-Queens County fair grounds
about 4 p. m.
May 8 : The company left fair grounds, Mineola. Long Island,
X. Y.. at 3 a. m.. and entrained at Camp ]\lills, X. Y., at 6.15 a. m.
Detrained at Long Island City at 7.45 a. m.. embarking on ferry
at 8 a. m. Embarked on the Italian S. S. Caserta at Hoboken, X. J.,
between 9 a. in. and 10.30 a. m. May 10 : At 5 p. m. call to quarters
was blown and every man went below deck, and, with at least three
faces to every porthole, we dropped down the river at 5.30 a. m.
May 24: Debarked at pier at Brest at 3 p. m. and marched to
Pontanenzen Barracks, a distance of 3 miles. Were given an egg
and an apple as travel rations. Arriving at camp through long
lines of strange-looking children, old men, and 'u^omen, we found
our old friend, the pyramidal tents, waiting to receive us. Of course,
the ground was hard, but it might have been muddy.
June 3 : Detrained at L'Angres, Haute-Marne, and marched to
Humes along the path by the Marne Canal, a distance of 2 miles,
arriving in the peaceful village at 12.15 p. m. The company was
here quartered in new United States barracks erected as a camp
hospital.
July 2: Departed from Humes. Haute-Marne, by truck train for
Camp de Mailly. the largest Artillery camp in France, some distance
south of Chalons, Arrived at Camp de Mailly at 9 p. m., covered
with the white dust of French roads. On the way we had our first
view of Indo-Chinese camion drivers. July 6 : We were rejoined
by the second platoon and balance of equipment and proceeded by
1692 REPORT OF THE SURGEON GENERAL OF THE ARMY.
truck train to EcuiT-sur-Coole. Marne. Jul}' 7 : Began erection
of tentage in a wheat field adjoinino; a French evacuation hospital
in anticipation of the subsequent ISIarne-Champagne defensive. July
15 : Just following inidnight began the Marne-Champagne defensive,
with heavy cannonading. Mobile Hospital No. 2 and two field
hospitals at Busse le Chateau were shelled oiit early in the morning,
as was also the Red Cross hospital at Ciialon sur JSIarne. necessitat-
ing the admission of their patients bj' cur hospital, in addition to
those received from the front. The first patients arrived at 4 a. m.
from cur neighboring di-tressed hospitals. Our capacity was 750
beds, and they were all filled in 12 hours. The medical cases and
slightly wounded were evacuated to Camp Hospital No. 14, at Camp
de Mailly. The surgical teams began work at noon, all water being
brought by hand from the French H. O. E. Lights were furnished
by utilizing the X-ray generator. All our patients were from the
42d Division (Rainbow).
July 17: We received 1,200 patients in the last 48 hours and still
coming, though more slowly. Operating room running day and
night.
July 18 : By noon this date we have caught up with the operations
for the first time since the drive began. Evacuated to the American
hospital train to-day, 325 patients remaining. At 11.30 p. m. an
enemy plane flying about 150 feet over the camp dropped a bomb
which struck in the wheat field about 50 yards from camp. No one
was injured. A detail was required to search for and return to the
hospital the patients who took cover away from camp. The last one
was found at 4 a. m. the following day. One patient was found
nearly a half a mile away. He had lost the splint off his broken leg,
but goino- strong. Others were found under grain shocks, in bushes,
in trenches, and some Avere fislied out of the river.
July 21 : Broke camp, packed, and moved bv truck train. It re-
quired 100 French trucks to haul equipment. The train left in three
sections. As the last section was being loaded an enemy plane flying
at a height of about 400 feet dropped a bomb some distance from the
camp site. Then flying low over the camp the aviator swept the
camp with machine guns. There were no injuries. Five bombs were
unloaded a short distance away.
The work at Ecury-sur-Coole was done under considerable diffi-
culty. During the first inrush of patients practically the entire per-
sonnel had no sleep for 72 hours, many dropping from exhaustion
while at work. "One thousand four hundred and fifty-eight patients
were received, with 38 deaths. No record of operations was kept; in
fact, it was only by the hardest kind of work that the dead were
buried.
July 22 : The first section of the truck train arrived at Chateau
Pereuse, near Le Ferte sotis Jouarre, Seine et Marne, at 8 a. m., the
second arriving shortly afterwards. Tents were erected surrounding
the chateau, which was loaned to the American Expeditionary Forces
by the owner and Of^cupant. We received our first patients at 5 p. m.
and began operating at 9 p. m.
August 3 : Our work at Chateau Pereuse was almost concurrent
with the Aisne-Marne offensive (July 18-August 6), from which
action our patients came. The total number of patients received for
14 days was 1,427. Total number of operations, 642; total deaths, 20.
A. E. F. EVACUATION HOSPITALS. 1693
All evacuations Avere bv ambulance. The patients came from the 4tli,
26th, 28th, 32d, and 42d Divisions.
Auf^iist 6 : Left Chateau Pereuse by truck train at 1 p. m. Passed
throuo;h Vaux and Chateau-Thierry and arrived at Coincy, Aisne, at
8 p. m. August 9 patients began to arrive. About midnight of
August 24 a large bombing phme came roaring along low and as if on
business bent. It dipped low over the moonlit camp, made a detour,
and repeated its operations, looking like a monster bird seeking a
place to light. On its third trip over camp a streak of sparks left the
observer's seat, reaching the ground in the middle of the men's rows
of pup tents. The expected detonation and slaughter did not occur.
While recovering from this unexpected " dud," the nocturnal prowler
returned and, flying low over the heart of the camp, dropped another
streak of sparks. Expecting a terrific report sure this time, evcr3^one
hugged the ground, crawled behind blades of gra^s, etc. — but again
nothing happened ; this weird specter continued to circle the camp
for a good half hour while every trench and shell iiole and even tents
furnished shelter for the helpless intended victims. At last a full
breath cciild be taken, for the mysterious visitor roared intermit-
tently away in the direction from which he had come. Xo casualties.
September 14: Arrived at Souilly, Meuse, at 11 a. m. Continued
on to Vadlencourt, iSIeuse, and detrained beginning at 3 p. m.
Thence we went b}^ French camion train to some temporary struc-
tures on the site of a previous hospital at a location known as
Fontain-Routon; no village. The equipment was unloaded by
10 p. m.
September 25 : To this date no tentage had been erected, so that
enemy observation planes might not anticipate the ensuing Meuse-
Argonne offensive (Sept. 26-Xov. 11). However, orders were re-
ceived at G ]). m. this date, and practically all tentage and a large
part of the ward equipment was in readiness in the record time of
four hours.
September 26 : Meuse- Argonne offensive commenced at 11 p. m.
with terrific artillery fire. The horizon was a blaze of light and
sleep was impossible. Our boys went over the top at 5 a. m.. and
patients began arriving a few hours later. We were the farthest
advanced evacuation hospital at the time and expected heavy work.
September 27 : Patients were arriving in ever increasing numbers.
The first ])atients having wounds from 24 to 72 hours old because
of the traffic congestion and poor roads up front. One major was
in the ambulance for 36 hours to come a distance of about 15 miles.
Others were not found in the bad weather and wooded country until
several hours later, so that, with poor roads, they arrived as much as
three days after being wounded.
October 9: A fleet of 150 allied airplanes flew over our camp to-
day in the direction of the Argonne Forest. Rumored that it was
a monster daylight bombing expedition against the German posi-
tions.
October 13 : We received orders to-dav to increase our bed capac-
ity to 900.
October 29 : First detachment of hospital left Fontain Ronton at
9 a. m. for Fromereville, Meuse, a deserted village, 3 miles west of
Verdun. Almost as this detachment arrived at moon, two planes
were shot down, an hour later two aviator patients were received.
1694 REPORT OF THE SURGEON GEXERAI. OF THE ARMY.
October 30: Practically all equipment arrived at Fromereville.
where Engineers were busy building roads to our site in the open
field, on a liillside facing the north.
October 31 : Began receiving patients. Word received that an-
other thrust was imminent in the general Meuse-Argonne offensive.
Xovember 2 : At 11 a. m. this date, our hospital was shelled by 8-inch
guns. In all, 12 shells lit within the camp site, one being a " dud."
The first struck a building in which the men on night duty were
sleeping, causing several casualties. Later shells struck the head-
quarters building, and along the newly-built road to the hospital,
falling at intervals of from three to five minutes. All patients Avere
carried to the top of the hill away from the tents, and later evacuated
to Souilly.
December 7: At 4 p. m. entrained at Souilly station; personnel
occui)3'ing third-class cars with six men to a compartment. At 10.45
left Souilly for "Somewhere in Gerinany."
December 9 : Arrived at Verdun at 8.30 a. m., after standing most
of the night. Crossed the Meuse. At 1.20 p. m. arrived at Conflams.
Here the first German hat was bciio-ht, a bright red railroad cap.
At about 1.20 p. m. passed through iron-smeitir.g region of Larraine,
with iron heaps, tall chimneys, ore cars, and all the signs of wartime
industry. At 1.40 arrived at Diedenhofen (Thionville). All the
freight handling here seemed to be done by women, whose trousers
caused great comment. Train was given a rousing reception at
Sierck am Mosel at 3.15 p. m. At 6.30 arrived at Treves (Trier),
where coffee was served. This was the first important town readied
in German}' proper. On December 16, train left Traben-Trarbach at
10 p. m. for Coblenz Lutzel, a suburb of Coblenz, and on the opposite
side of the Moselle, at 1 a. m.
December 24: Began receiving patients this date.
Februar}' 18 : The entire personnel of Evacuation Hospital No. 4
relieved from duty at Oberwerth Lazarett at 7 p. m. this date by
Evacuation Hospital No. 22.
D. EVACUATION HOSPITAL NO. 6.
Evacuation Hospital No. 6 was organized at Fort Oglethorpe, Ga.,
under orders from the War Department on November 20. 1917. One
officer of Medical Corps and 16 officers from the Reserve Corps were
assigned to duty with the organization by War Department orders,
the enlisted personnel being assigned by the commanding officer,
Camp Greenleaf, from recruits stationed at the camp.
On March 29. 1918. the order to leave for overseas' service was re-
ceived. The organization prepared to leave and on March 30, 1918,
entrained at Lytle. Ga., following an inspection by Brig. Gen. .
We arrived at Camp Merritt at 11 p. m. April 1, 1918. and
encamped in barracks. At 6.40 a. m. on April 8 we entrained at
Camp Merritt and proceeded to Hoboken, N. J., where we arrived
at 8.45. embarking at once on the U. S. naval transport Covington.
The ship lay in dock until the evening of April 9, when we pulled
out into the stream and in the evening of April 10 sailed under the
escort of the U. S. cruiser Huntington. On April 20 the cruiser left
us and soon after!, at about 3 p. m.. a fleet of destroyers joined our
convoy and accompanied us to Brest, where we arrived at 6 p. m.
A. E. F. — EVACUATION HOSPITALS. 1695
on April 22. On landing the troops ^vere marched to Fontanezan
Barracks, where they were quartered. A detail was left at the bag-
gage yard to care for the property. At 2.30 p. m. on April 26 the
company marched to the station and entrained for Bazoilles. We
arrived at Bazoilles at noon of April 29 and detrained at once. At
this place the command was quartered in French Adrian barracks
established here for the base hospital group which was formed
later. Tlie base hospitals there at that time were Xos. 18, 116, and 46.
On July 18 orders were received to proceed to Meaux and at 10.30
of that night all of the equipment was packed on 54 motor trucks
and the outfit moved. We arrived at Meaux at 10 p. m. of July 20
and established a 350-bed hospital in and around a chateau in that
city. Fatients were first admitted that evening, some 200 coming in
during the first hour of opening. In all 365 cases were admitted,
l^ractically all being battle casualties. Just before the arrival of our
first patients 30 nurses joined for duty. On July 28 all patients were
evacuated and the hospital was packed in preparation of moving
forward, for at this time we were some 40 miles from the rapidly
advancing front. July 29 the hospital was moved to Chiery, a small
town 2 kilometers east of Chateau-Thierry. At this point we estab-
lished in connection with Mobile Hospital Xo. 1.
There were admitted to the hospital 3,927 cases, divided as follows:
Surgical cases, 3,847; medical cases. 180. The total number of opera-
tions performed totaled 1,709. For two days after our arrival at
Chierj' we had the experience of hearing the shells of the Germans as
they passed us on their way to Chateau-Thierry. The pontoon bridge
over the Marne just below the hospital was also the target for some
large caliber shells. Our advance soon put a stop to this and our
only excitement was the nightly visit of the hostile airplanes.
Chateau-Thierry and La Ferte were frequently bombed while we
were here, but only one direct attack was made upon tlie hospital.
This occurred on the night of August 5, when at about 10 p. m. a
single machine came over and dropped about eight small bombs in
the immediate vicinity of the hospital. Our only casualty was found
to be a horse tied to a wire fence. On August 18 orders Avere re-
ceived to evacuate all patients and to prepare to move. On the
evening of August 19 Evacuation Hospital Xo. 6 was loaded on
trucks and carried to La Ferte sur Jouarre, where it entrained for
Xeufchateau. Mobile Hospital Xo. 1 was detached and entrained
at Chateau-Thierry. The field hospital reported to American Red
Cross Hospital Xo. 114 in Chateau-Thierry and two ambulance com-
panies proceeded overland to the vicinity of Xeufchateau.
At 2 p. m. August 20 the organization arrived at Chatenois, a small
town to the east of Xeufchateau. After three days" rest the hospital
was packed on trucks and on August 25 moved to Souilly, a few
miles south of Verdun. At Souilly American troops had secured
possession of a 1.000-bed French hospital constructed in 1915, before
the first Verdun drive. The hospital was occupied at the time of our
arrival by the French H. O. E. 4. Practically all equipment, with
the exception of instruments, was left in our hands, but the hospital
was far from being well equipped, as the French moved much of
their property farther to the rear. In addition to the French prop-
erty, there was considerable equipment which had been installed by
1696 KEPOKT OF THE SURGEON GENERAL OF THE ARMY.
the patroness of this hospital and of several other hospitals in the
Verdun area.
The hospital was read}^ for operation on August 27 and the pa-
tients were received on that day. No large number of patient?
arrived till September 12, Avhen the St. Mihiel offensive took place.
At this time Evacuation Hospital No. 6 and No. 7 cared for prac-
tically all the battle casualties on our side of the attack.
During the lull between the St. Mihiel and the Argonne-Meuse
offensives most of our cases were medical, but the hospital was never
crowded at this time. The influenza epidemic was responsible for
most of these casualties. Several deaths occurred from this cause.
On September 26 the Argonne-Meuse offensive commenced. Most
of our cases in this attack were drawn from the Third Corps. We
did, however, receive many cases from the other corps of the First
Army, particularly from the Seventeenth French Corps, to which
American troops had been attached. The work of the hospital was
directed to the care of all classes of wounds and to the medical cases.
It was planned to have nothing but slightly wounded cases sent to
this hospital, but it was found impracticable to restrict the ambulance
service in this way. At the commencement of our service at Souilly
600 beds were set up on our side of the hospital. As the need for
beds became greater, tents were erected and the capacity Avas in-
creased to 1,200. Evacuation Hospital No. 7, with their larger tent
capacity, was able to increase their capacity to an even greater
number. In addition there was established an evacuation area.
This area consisted of a capacity for some 600 cases collected from
other hospitals and awaitino: space on evacuating trains.
Cases admitted to this area, although cared for by Evacuation
Hospital No. 6, were never admitted to the hospital, nor taken up on
the liospital records. This evacuating area was made necessai-^^ by
the fact the other hospitals in the area had not facilities for evacuat-
ing, thev not being on the railroad. The area served Evacuation
Hospitals 4, 8, and 5, and Mobile Hospitals 1 and 5. The gas hos-
pital at Rambluzen and the neurological and contagious hospitals
at Benoite Vaux also sent their cases here for evacuation.
One of the greatest difficulties experienced by the hospital at this
point was caused by the lack of facilities for caring for slightly
wounded and sick. Cases which should have been ready for duty
within a very few days had to be evacuated as no camp was ever
established which could properly care for these cases. In fact, there
were crowded into the hospitals and the evacuating area at one time
over 3.800 patients. About November 3 we took over the entire
hospital and No, 7 prepared to move. After their departure the
capacit}^ of the hospital was set at 1,800 beds, and these were nearly
all in use. With the additional bed capacity we found ourselves
mainly handicapped by inadequate messing facilities. With the
signing of, the armistice, the battle casualties rapidly fell off, our
last real war work gave us 1,400 admissions on the day that the hos-
tilities ceased. The work now became almost entirely medical, and
continued until December 8, on which date the hospital closed and
packed, ready for moving forward into Germany. December 14 the
hospital entrained at Souilly and was ready to move at 10 a. m.
Owing to a serious wreck north of Verdun the train did not move
until the 16th, arriving in Coblenz on the afternoon of December 18.
A. E. F. — EVACUATION HOSPITALS. 1697
In Coblenz the (xarnison Lazarett, known as the Festungs Lazarett,
was requisitioned for our use. The German property left in the
hospital was almost sufficient for our needs. The hospital had been
constructed for 260 surgical cases. By utilizing all available space we
managed to increase its capacity to 450, the personnel being housed
in the small barrack buildings on the grounds. Shortly after open-
ing the city pesthouse was taken over and an additional 75 beds were
secured. Twentj-five more beds were established in one of the
German storerooms.
The work at Coblenz was entirely surgical with the exception of
one building devoted to the care of sick officers and nurses. Among
the special features of the hospital was its fracture ward, where, in
addition to the mam^ orthopedic cases, we had over 90 fractures
under treatment at one time. On February 23 the organization was
relieved by Evacuation Hospital No. 27 preparatory to our depar-
ture for the United States. The organization entrained at Coblenz
on March 13 and arrived at Vertou (Loire Inf.), France, near Nantes
on March 17. Here the command is billeted in the small town of
Le Chene, awaiting transportation to the United States.
The first surgical work done by the hospital was at Meaux from
July 22 to 27, 1918, during which time 97 cases were operated upon
by the teams made up from the personnel of the organization. The
conditions under which the work was done were unsatisfactor}', due
to the lack of proper sterilizing, lighting, and laundry equipment.
While located at Chiery we worked in conjunction with Mobile
Hospital No. 1 and furnished four operating teams from our original
personnel, besides several casual teams that were assigned for duty,
the surgical work being under the direction of Mobile Hospital No. 1.
The hospital was entirely under tents, except for the small operating
room of the Mobile Hospital equipment, and the greater part of the
operating was done in the Bessoneau tents, which were very satis-
factory for this purpose. One tent was used for serious cases and
those in shock ; special shock teams being assigned to care for them.
During the period between August 6-15 our operations totaled 1,709,
a good many of the cases being seriously wounded or cases with gas
infection.
Patients, after having been received, were triaged .into seriously
wounded, slightly wounded, and medical, and sent to separate parts of
the hospital, the medical cases being isolated as far as possible. AVe
had two operating rooms for seriously wounded and one for slightly
wounded, each of the former having tlnee tables at which two operat-
ing teams worked. In caring for tho slightly wounded, we assigned
two of our best and most skillful teams, with increased personnel, to
this work, allowing them four tables. Kapid anesthesia with ether,
by the Raus, h uiethod or in combination with chloroform and ethyl
chloride, was used by the two anesthetists. In this way it was possible
to care for a great many cases in a day, and in times of stress the
average number of cases cared for was about 175.
Splint teams which applied splints in all cases of fracture were
especialh' helpful and did much to increase the output of our operat-
ing rooms.
A shock team Avas on duty at all times and many lives were saved
by their work. The schedule for the operating teams was: 7 a. m.
1698 EEPORT OF THE SUEGEON GENERAL OF THE ARMY.
to 12 noon; 12.30 to 6.30 p. m; 7 p. m. to 6.30 a. m., the teams alternat-
ing. This schedule helped to keep up the strength of the teams, as it
allowed a full night's sleep every other night and did not interfere
with the hours for meals.
In the first few weeks of our work cliloroform was used for induc-
tion anesthesia, but tins was discontinued after two deaths occurred,
which were directly due to chloroform poisoning, and then we used
only ether.
From September 1 to December 8, 1918, we did 7,124 operations, of
which number 6.951 were done between Sejjtember 12 and Xovember
12. This was exclusive of dressings, which were not counted. The
number of surgical deaths from vSeptember 1 to December 8 was 211.
P'rom December 23. 1918. to February 23, 1919, Ave were established
in the Garnison Lazarett Hospital at Coblenz, Germany, which is a
modern, fully equipped hospital, where surgery could be done undei
the most satisfactory conditions. Except for sick officers and nurses,
all of the hospital was devoted to surgery, and while in this place we
did 521 operations with 17 deaths.
The total number of operations done by Evacuation Hospital No. 6
betAveen July 22, 1918, and February 23! 1919, was 9,915.
An evacuation hospital is designed as a " combat " organization and
owes its usefulness to the fact that a large number of injured can be
treated in a short space of time. This function depends absolutely on
the speed Avith Avhich patients are evacuated to the rear. Therefore,
although a considerable number of medical cases were admitted, no
carefid study could be made of them. At the earliest opportunity
these cases Avere sent farther to the rear, often remaining in this
hospital not longer than a few hours. In fact, 59.6 per cent of all
cases admitted Avere other than surgical.
Aisne-Marne offensive {Meaux), July 22-27. — Only 25 per cent ol
the cases admitted during this period Avere medical cases. Among
the more common conditions encountered AAcre "gas-inhalation" ex-
haustion, psychoneurosis, diarrhea, bronchitis, gastritis, and influ-
enza. These medical cases were evacuated almost immediately, and
the treatment was, therefore, in the majority of cases, entirely symp-
tomatic.
Chateau-Thien^y., July 31-Angust 15. — The conditions here were
identical with those which obtained at Meaux. There was a slight
increase in the number of cases of diarrhea, but from the clinical
course and laboratory findings the condition could not be pronounced
as of bacillary origin. A mobile laboratory sent to investigate the
cause of this epidemic discovered a fcAv cases of bacillary origin dysen-
tei\y, but my impression is that these were the exception. About this
time a number of officers and men of this organization were attacked.
The onset was sudden, with sharp pains in the lower abdomen, fre-
quent fluid stools With marked tenesmus, feeling of general malaise,
and marked weakness Avith occasional slight temperature. The dura-
tion of the attack Avas from two to five days and occasionally longer.
Blood in the stools was noted in only a few rare instances. The treat-
ment Avas free purging with castor oil, followed some hours later, if
necessary, by comp, et op. pil.
After reaching Chateau-Thierry the number of influenza cases
began gradually to increase.
A. E. F. — EVACUATION HOSPITALS. 1699
^SmdUy,Septemher 12-Decemler 8, J 918. — During this period 68
per cent of all cases admitted were medical. Our capacity was much
larger than at any time heretofore, so that certain wards were set
aside for nontransportable cases, such as the all-too-frequent broncho-
pneumonia. About this time a general order was received ordering
that no medical cases with temperature were to be evacuated. Con-
tagious cases were transferred to a hospital set aside for contagious
cases. By far the most prevalent disease was influenza, which in
itself was no cause for alarm, but the frequent broncho-pneumonia
complication was one of the most distressing conditions with which
we had to deal. For several months this hospital capacity was 130
beds, and mo-t of the time there were very few beds available. xJur-
ing this period the death rate of pneumonia was about 42 per cent.
The majority of these pneumonia patients came in with the diagnosis
of influenza. All patients admitted to the receiving ward and who
were feverish or had increased respiratory rate were sent immediately
to the pneumonia ward without the usual bath. It was an easy matter
to transfer these patients to another ward if the diagnosis was not
concurred in. The treatment is almost entirely symptomatic. "We
have no drug which seems to alter the course of the disease. Tine,
digitalis in large doses (xxx min. q. 4h ad dosses xxx) was given as
routine treatment, but so far as I was able to observe without bene-
ficial results. The one drug of apparent value was morphine. This
must be used in sufficiently large doses to get the pharmacological
action of the drug. Its use lies in its ability to arrest cough, allay
the distressing pain of pleuritis, and thus afford an opportunity for
sleep. " Stimulation," such as strychnine, cl. camph., etc., in the
severe cases seems worse than useless.
CoNciiz, Gei-mamj. Decemher 23, 1918-Felriiary 23, 1919.— Xt this
station sick officers and nurses were the only medical cases received.
The predominating disease was influenza with its complication,
brorcho-pneumonia. This was the same disease encountered at
Souilly and described above.
Pneumococcus type determinations were done on most of these
cases, and the infecting organism was usually found to be type 2.
Post-mortem shows the same pathological condition as described
above. On a few suitable cases the type 1 serum was used, but no
appreciable change in the course of the disease was noted.
The venereal question has caused extremely little trouble. Since
our arrival in France but one case of venereal disease developed, and
this was a chronic case which had been contracted prior to enlistment.
E. EVACUATION HOSPITAL NO. 8.
Evacuation Hospital No. 8 was organized at Fort Oglethorpe, Ga.,
on January 1, 1918, and began its active service on that date. Its
officers were obtained largely from the medical officers' training
camp, and the enlisted men were made up for the greater part of
those who voluntarily enlisted prior to the operation of the draft.
May 1 the organization left Oglethorpe en route to Camp Merritt.
On May 10, 1918, we sailed from Hoboken and arrived at Brest,
May 23, after an uneventful voyage. The following day the per-
sonnel disembarked and marched to Pontanezen Barracks, a short
distance from Brest, where a week was spent in resting while await-
142367— 19— VOL 2—46
1700 REPORT OF THE SURGEON GENERAL OF THE ARMY.
ins assignnient to duty. Orders were received May 30 directing;
Evacuation Hospital Xo. 8 to proceed to Montingny-le-Koi for the
purpose of assembling its equipment and awaiting orders for a
definite assignment behind the battle front. On the following day
the organization left Brest by train en route to its new station. We
detrained at Bazoilles-sur-Meuse June o, and the following day •
receivetl orders to proceed at once to Juilly, Seine et Marne, and take
station behind the 2d Division, then holding an important defensive
position near Chateau-Thierry and the Belleau Woods. Our per-
sonal propertv was quickly reloaded on the train, Avhich had re-
mained on the siding, but owing to the inability of the French rail-
way- service to provide an immediate train schedule Ave did not leave
Bazoille until the evening of June 6. Numerous delays were en-
countered Avhile en route to Juilly, which was not reached until the
morning of June 8. The property pertaining to Evacuation Hos-
pital Xo. 8 had been ordered by general headquarters to be turned
over to Evacuation Hospital Xo. 7, when it was decided to order
Xo. 8 to Juilly. This was due to the fact that we were to occupy
a group of buildings belonging to the College of Juilly and which
had been maintained as a French hospital during the war. and had
a liberal outfit of medical, surgical, and hospital supplies and equip-
ment. Upon arrival at the railroad station at Juilly we cjuickly
proceeded to the hospital, where we were to carry out our first work
of real service, and found a small personnel who had been occupied
night and day for three daj'S overwhelmed w^ith work. Wounded
men Avere lying about the courtyard on litters awaiting their turn
to be carried to the operating rooms. The morgue had several bodies
aAvaiting burial, owing to the inability to secure gra^e diggers. Every-
body Avho could be spared had been pressed into the service of
carrying litters and caring for the hundreds of wounded who had
been brought into this peaceful community on short notice. To
meet the unusual situation a feAv surgical teams had been sent from
the Service of Supply, and these teams arrived one or tAvo days
ahead of Evacuation Hospital Xo. 8. As there was immediate work
to be done, no time Avas lost in attempting to perfect the details of
to best organization to meet the crisis. Chief of the surgical service
quickly assigned surgical teams to work so as to relicA^e the tired
operators who had stood the strain for so many hours. Our opera-
tors A^•ere all handicapped in that they had nev^er seen any Avar sur-
gery, and found themselves suddenly ]>rought face to face Avith the
reality which called for immediate action. Day and night teams
were rapidly organized for the removal of patients' clothing, the col-
lection of A'aluables, and the making of records. GraA'e diggers
were at once sent to the cemetery to dig graves. A department deal- i
ing with the effects of deceased soldiers Avas immediately put into |
operation in accordance with American Expeditionary Forces orders.
Telegraphic request for motor transportation had been made seA'eral
days before our arrival, and three trucks were soon received after
we began to function. These Avere immediately put into service haul-
ing supplies of all kinds from the American Red Cross storehouse
in Paris and the Army commissary. We worked under considerable
strain, Avith intervals of comparatiA'e quiet during the latter part
of June and into July until the second battle of the Marne in mid-
July, when we Avere once more overwhelmed with w'ounded men sent
A. E. F. — EVACUATION HOSPITALS. 1701
back from the front. We remained at Juilly until August 19,
when orders were carried out which directed the organization to pro-
ceed to the First Army area. The trip was made by train to Xeuf-
chateau and billets were assigned the organization in the town of
Sionne. One week was spent at tliis place and then the entire per-
■ sonnel and equipment which had been furnished us from the medical-
supply depot and the Red Cross warehouse before leaving Juilly was
transported by trucks to Petit Maujouy, which is located about 2^
kilometers east of Senoncourt on the Senoncourt-Ancemont roacT.
Petit Maujouy was reached August 26. One thousand beds were
set up. The hospital remained in this location during the St. Mihiel
operations and the Argonne-Meuse campaign, receiving for the most
part only the most seriously wounded men. Soon after the termina-
tion of hostilities orders were received to evacuate all patients and
prepare to move forward with the army of occupation into Ger-
many. The organization entrained at Lemmes, and on December
17 left France for Mayen, Ehineland. Germany, arriving December
20. A German hospital of 175 beds was quickly taken over and three
schoolhouses were put into readiness to receive patients. The total
bed capacity of hospital and schoolhouses amounted to 631. The
hospital operated as a general hospital, admitting all classes of medi-
cal and surgical cases, and served the needs of the 3d and 1th Di-
visions. Tlie "personnel of Evacuation Hospital No. 8 carried out
this work from the time of its arrival until March 1. At that time
its work was taken over by Evacuation Hospital No. 30, which had
been ordered into Germany to relieve No. 8 and permit its transfer
to the United States. On March 13 Evacuation Hospital No. 8 left
Mayen en route to St. Nazaire to await embarkation to the United
States.
The evacuation hospital is the first large sanitary formation main-
tained along the line of march from front to rear, where adequate
surgical treatment can be given wounded men. It varies in size,
according to the demands made upon it, but ordinarily from ten to
twelve hundred beds is considered to be the most satisfactory. It
should be mobile, and at the same time enough equipment should be
on hand to properlv care for the various classes of wounded men
which are brought to it for treatment. Ordinarily it is placed from
8 to 12 miles behind the lines on roads which make it easily ac-
cessible to the front, and preferablv away from towns. Tlie French
incurred some serious losses of sanitary material during the German
offensive in 1918, and as a result did not for a time allow their evacu-
ation hospitals to become established in certain sectors closer than
18 to 20 miles from the front.
Only certain tyjies of wounded men should be received at evacua-
tion hospitals, and in order that this mav be properly carried out a
carefully arranged triage (sorting) should be ]:)rovided in each divi-
sion by utilizing one of the divisional field hospitals for this purpose.
At this sorting station all gassed and sick patients should be directed
to one or more of the other field hospitals of the division. All
wounded men who are severely shocked or who are suffering from
sucking wounds of the chest or from penetrating wounds of the
abdomen should be sent to another designated field hospital, which
should be located close to the front, so as to involve the least possible
amount of transportation. Some type of a mobile surgical unit
1702 REPORT 0¥ THE SURGEON GENERAD OF THE ARMY.
shoiikl be assijrnod to duty with this field hos))ital to do the operat-
ing, and the hospital should provide the bed capacity and do the
administrative "vvork. What to do with these patients undergoing
treatment close to the front in case the line gives way in the face of a
hostile offensive is a serious problem and one which is associated with
the fortunes of Avar, but it is clearly illogical to attempt to transport
them over almost impassable roads to a distance of 8 or 10 miles, only
to find them unfit for operation upon their arrival. These cases are
invariably admitted to the shock ward at the evacuation hospitals,
and in our experience 42 per cent of them died without ever getting
to the operating room. Indeed, many were taken out of the ambu-
lances dead upon their arrival from the front.
During a period of seven weeks in the Argonne-Meuse campaign,
while the combat divisions in front of us were engaged in a contin-
uous offensive, there were 230 patients admitted to the preoperative
shock ward. Of this number 58 per cent were operated on and 43
per cent died without operation. During this period 280 cases were
admitted to the postoperative shock ward, and of this number 28 per
cent died in the ward and 72 per cent recovered sufficiently under
treatment to enable them to be moved to other wards of the hospital
for further treatment. The total number of deaths during this
period in the postoperative and preoperative shock wards was 175.
All of the patients who were admitted to the preoperative shock
ward were suffering from shock of different degrees of severit}^, and
had they been more carefully sorted at the front it is probable that
the death rate among the more severely wounded would have been
less.
AVe found that in times of rush economy had to be practiced in the
assignment of nurses. We learned that two adjoining teams could
be served perfectly by one clean and one nonsterile nurse, thus free-
ing the second nurse of each surgical team to act as an anesthetist.
In many cases we were able to train enlisted men of the Medical
Department to give anesthetics, thus relieving the nurses from this
duty. The nurses so relieved then became available for duty in the
wards. This latter duty became very arduous on many occasions,
owing to the large number of severely wounded men received from
the front and the necessity of retaining them for many days under
treatment subsequent to their operation. At one time we had more
than 700 such patients, suffering from severe multi]3le wounds of
every description, who were unable to stand the journey to the base.
The patients required constant attention both day and night, and the
number of permanent nurses available for this duty was small.
A surgical team is ordinarily composed of two or three medical
officers, with one acting as head of the team, two nurses, and two
orderlies. Such a team would be assigned to work on two (or three)
adjoining operating tables. The advantage of having tliree tables
is that time is saved, as two patients may be operated on by members
of the team at the same time, while on the third table another patient
may be anesthetized. The third table can also be used to advantage
by the orthopedic team, after the operating is finished, to apply splints
in cases of fracture.
In addition to the surgical teams made up from among the perma-
nent personnel of an evacuation hospital, it will be necessary in times
of considerable activitv to have a variable number of additional
A. E. F. — EVACUATION HOSPITALS. 1703
teams sent from the base hospitals. The number of such teams de-
pends upon the extent of the action at the front. In the Marne
offensive we had six and in the Argonne-Meiise offensive seven visit-
ing teams, in addition to one visiting orthopedic and one visiting:
shock team. The orthopedic team was made up of an orthopedic
surgeon and two enlisted assistants, while the shock teams were com-
posed of one medical officer, two enlisted men, and two nurses. The
orthopedic and shock teams are essential in an organization, as their
work must be carried on continuously throughout the 24 hours.
After the organization arrived on German territory, the surgical
service became less prominent and took on the aspect of a small gen-
eral hospital in time of peace. The usual array of operative cases
were admitted, which amounted to about 40 per week. There was a
considerable amount of fracture work owing to the frequency of auto-
mobile accidents ; the service was all centered in a small German hos-
pital of about 175 beds, which was well equipped with all modern
conveniences for carr3dng out proper surgical technique. The medi-
cal service assumed much activity immediately following our arrival
and continued active until the organization departed from this sta-
tion en route to the port of embarkation. During the first three weeks
more than 600 medical cases were admitted from the 3d and 4th Divi-
sions, a large percentage being influenza and pneumonia. Mortality
from these two diseases was high and accounted for the majority of
the deaths occurring in the service. Nephritis contributed largely to
the sick report. There were also a few mild cases of typhoid fever
admitted for treatment. The different classes of diseases were iso-
lated, as far as possible, and treated in separate wards. Effort was
made to prevent the spread of the respiratory diseases by draping
sheets in cubicle fashion around the beds. The contagious diseases
were treated in the isolation wing of the German hospital. It had
its own kitchen department, nurses, and orderlies and was maintained
as a separate institution.
F. EVACUATION HOSPITAL NO. 9.
Evacuation Hospital Xo. 9 came into being at the medical officers'
training camp. Fort Riley, Kans., January 7, 1918. Travel orders
wore awaited with keen interest until the morning of June 1, 1918.
which saw Evacuation Hospital No. 9, with 17 officers, 4 sergeants
(first class), 12 sergeants, 8 cooks, 30 privates (first class), and 124
privates, totaling 195, entrained at Fort Riley, Kans., on a special
train for passage east, going by way of Kansas City, Chicago, and
thence to New York City, where we were ordered to proceed to Cres-
kill, N. J., at which place we were detrained the afternoon of June 3v
1918, and marched to Camp Merritt, N. J. ShortW after our arrival
at Camp Merritt the unit was enlarged to 34 officers and 234 enlisted
personnel. Our stay at Camp ^lerritt totaled nine weeks. After sev-
eral starts during the first da3^s of August, we finally left on the
morning of August 7, marching to Alpine Landing and then by ferry
to Pier 61, New York City, arriving about noon. We remained on
the pier that afternoon and night and until 4.30 p. m. the following
day, when we boarded the U. S. steamer Louisville at Pier 62 and
sailed for Europe in convoy about 5.30 p. m. August 8, 1918
1704 KKPORT OF THK SURGEON GEXERAL OF THE ARMY.
The sight of the green hills of Ireland and the English destroyers
steaming to meet the convoy was on the morning of August 19, 11
days out of New York. Liverpool was reached that night. Next
morning. August 20, at 9 a. m., Evacuation Hospital No. 9 disem-
barked, and after a short delay at the dock marched through the city
to the railroad station, led by an enormous and very proud sergeant
of the English Army on a fine-looking horse. At Southampton,
about dusk, an American sergeant met the train and led the troops
to the rest camp, 2 miles out. Here the hospital remained for nearly
24 hours, leaving the next afternoon and marching back to the docks
at Southampton. The men went aboard the fast channel steamer
Caesarca^ and late in the evening steamed out for France. Cher-
bourg was reached about 2 a. m. The steamer docked shortly after
sunrise. The hospital marched to a compound near by and was kept
there all day under strict guard. The order to entrain was received
shortly after dark, the officers being crowded into second-class cars
and tile men into the "40 lionimes-8 cheveaux" box cars of the
immortal French railroads. The train left Cherbourg about 10 p. m.
For a time it bounced and bumped and rattled along at a terrific
speed, but this was only a spasmodic spurt. It was 5 o'clock the
next afternoon before Noisy-le-Sec, on the outskirts of Paris, was
reached. August 24, 16 days since the start from New York, the
hospital reached its destination, Souilly, Department of the Meuse,
within sound of the guns around Verdun.
The medical service of the hospital was organized in the begin-
ning on a very small scale. Apparently very little was known in the
States about the character of work an evacuation hospital might
expect. The commanding officer told the chief of medical service,
when he reported for duty, that he did not know why he had been
assigned, as there would be no medical cases treated in an evacua-
tion hospital. The chief of the surgical service said he was glad tf»
have an internist along as a consultant, but that there would be no
other w^ork for him. So when the hospital reached Vaubecourt and
began to prepare for operations the medical service was given onlj'
three wards, totaling 162 beds.
The contagious ward was organized on the edge of the hospital
grounds. Here were used nine hospital tents, wuth a capacity of
8 patients each, and one ward tent with a capacity of 30, the latter
for mumps, of which more cases were admitted than of any other
contagious disease. In addition, this ward took care of measles,
scarlet fever, epidemic cerebrospinal meningitis, diphtheria, erysipe-
las, and Vincent's angina.
One object to be attained in operating an evacuation hospital is
to keep it as nearly empty as possible, to evacuate all patients well
enough to be moved as quickly as circumstances will permit. In this
hospital, however, all patients were given rest and food, made dry
and warm, and given such treatment as seemed to be required. Con-
tagious cases and those recognized as being seriousl}' ill were hos-
pitalized at once and kept in hospital as long as necessary. The two
largest classes of patients were respiratory diseases and diarrheal
diseases, these two groups comprising practically two-thirds of all
the medical cases admitted while at Vaubecourt.
Twelve ward tents, with a capacity of 360 beds, were set up in
one section of the grounds and known as ward 40. Thev were in-
A. E. F. EVACUATIO]Sr HOSPITALS. 1705
tended oidy for the slightly ill influenza and respiratory cases.
During one period of 24 hours 824 patients were admitted to and
evacuated from this ^Yard, and there were still a number of patients
left. In spite of this large number of beds allotted to the medical
side, over 1,300 in all, divided roughly into five section: (1) Pneu-
monia; (2) other respiratory diseases, including influenza ; (3) diar-
rheal diseases, including noncontagious medical cases; (4) con-
tagious; and (5) "gassed" patients, there were times when every
available bed was occupied and patients were resting on stretchers
on the ground beside the beds or under the beds or along the narrow
center passage between the two rows of beds in the tent. The tents
had stoves and were fairly warm and dry, and all these men had an
abundance of blankets and were therefore reasonably comfortable.
Occasionally one would see three men placing two beds together and
all getting into one bed thus made.
Pneumonia was the most serious problem the medical ser\dce had
to contend with. The disease was especially virulent, the men
attacked were often physically exhausted by long marches and un-
avoidable exposure : very many patients reached the hospital desper-
ately ill. The greatest number of pneumonia patients on hand at one
time was 139, on October 14. The total number of pneumonia
patients treated was 547; the majority were broncho-pneumonia.
Many were admitted moribund. Fifty-four died before they had
been in the hospital 24 hours. The total mortality was 40.1 per cent.
During the St. Mihiel offensive there were 13 cases admitted to the
surgical service, none of which were battle casualties.
During the Verdun offensive. September 26 to November 11, there
were 9.809 patients admitted to the surgical service. During the
period and including September 24 and 25, at which time the enemy
was shelling our back areas, there were performed 3,453 operations
for battle casualties and 23 operations for other emergencies, making
a total of 3,476 operations. Three hundred and eighteen of these
were performed under local anesthetics. Of the total operations,
3,119 were done from September 25 to October 19, inclusive.
The total number of surgical admissions to the hospital was 13,765.
The total number of operations performed by the surgical service
was 3,515. The surgical cases not operated were treated in the
dressing room; the vast majority of this class were evacuated Avithin
from 3 to 72 hours; amongst them were all perforating wounds made
by machine-gun ])ul]ets. All surgical cases were cases of injuries,
except 66.
The heaviest work was during February, when the influenza epi-
demic among the troops of the Third Army reached its height. Dur-
ing January and February, however, it was the rule for every bed in
the hospital to be occupied, and several times beds were set up in some
of the halls for the overflow. Often, acute cases had to be put in the
convalescent and duty wards, where there were very poor facilities
for handling acute cases, but as long as patients came they were taken
in and everything possible done for them.
BEPOKT OF SURGICAL DEPARTMENT IN COBLENZ, GERMANY.
In December practically no work was done. We were moved to
Coblenz, Germany, and located in barracks of the 68th German In-
1706 REPORT OF THE SURGEON GENERAL OF THE ARMY.
fantry. An operating room and three wards were assigned to the
surgical side. Later two of these wards were given over to the med-
ical side. As this hospital functioned more as a base, and was
designated for general medical cases only, surgical activity practically
ceased.
LABORATOKY, COBLENZ, GERMANY.
The laboratory' was in order and ready to work before any patients
had been received. The prescribed forms being unobtainable, sub-
stitutes, similar in shape, size, and verbiage, were made from blank
paper.
REPORT OF MEDICAL DEPARTMENT IN COBLENZ, GERMANY.
At Coblenz, hospitalization of the sick and wounded of the Third
Army was carried out by five evacuation hospitals, operating tem-
porarily as advanced base hospitals. All patients who would become
ready for duty as class A soldiers in two months were to be kept
until well and returned to duty, all others were to be evacuated to
the Services of Supply.
The total capacity of the 22 medical wards was 1,100 patients.
Later, when the rush was on, this was increased by the addition of
an annex in the city with a capacity of 250 patients, and by 5 large
tents in the hospital yard, accommodating 200 convalescent patients,
giving the medical service of the hospital a total capacity of 1,550
patients.
Influenza, or acute respiratory, and pneumonia comprised the
greater number of patients received, so that a large part of the hos-
pital was set aside for such patients.
G. EVACUATION HOSPITAL NO. 10.
The official existence of Evacuation Hospital No. 10 began with
the morning report of March 22, 1918. On that day there were on
duty 18 officers and 171 enlisted men. Most of the enlisted men were
assigned to duty from the casual detachment of the medical officers'
training camp at Fort Kiley, Ivans. About 11 a. m., June 1, 1918,
the organization entrained, ivith Evacuation Hospital Xo. 12, for
Camp Dix, X. J., arriving at 11 p. m.. June 3, 1918. The trip was
uneventful. The training schedule which was instituted at Fort
Riley was carried out at Camp Dix. While at Camp Dix the strength
of the command was increased to 31 officers and 237 enlisted men.
The enlisted personnel was most carefully selected from a large num-
ber of available casuals. After numerous false alarms, the command
entrained on the morning of August 15, at 8 o'clock, and reached
Pier Xo. 56, Xew York, nlDOut 11 a. m., immediately passing on board
the steamship Saceoyi, of the Union-Castle Line. The ship left the
])ier late that afternoon, and lay outside the harbor until 1 p. m.,
August 16, when the trip across the Atlantic was begun. After an
uneventful crossing, the convoy landed at Liverpool, England, on
the morning of August 28. The command was marched through the
city, and entrained at noon for Cowshott Camp Xo. 2, Brookwood,
England, near Aldershott, where they remained until 1 p. m., Sep-
tember 1, when they left for France via Southampton, debarking at
Cherbourg Harbor at 7 a. m., September 2. Two days were spent at
A. E. F. EVACUATION HOSPITALS. 1707
Englisli Rest Camp Xo. 1, Cherbourg-, after which the organization
left for Rimaiicourt, Haiite-Marne. They arrived there at 5 p. m.,
September 5.
On September 20 the command left for Froidos (Meuse), arriving
there at 8 p. m., September 21. Here the French hospital, which was
to be its permanent location, was taken over. It was situated on the
top of a hill, overlooking the villages of Rarecourt and Froidos. The
first patient was admitted about 8 p. m., September 26, and from
then on until the cessation of hostilities there was never a moment
"U'hen the operating rooms were not busy.
Until the cessation of hostilities there was a continuous stream of
wounded passing through the operating rooms.
This hospital cared for the casualties resulting from the drive of
the Argonne Forest. Because of its location near the front, there
was a very high proportion of seriously wounded. Because of the
difficult terrain of the battle area and the crowding of the line of
communication, there was great delay in the arrival of wounded at
this hospital. For that reason there was a large number of cases
with gas infection, and, for the same reason, a large mortality in the
abdominal wounds.
The following is a resume of the cases operated during the hos-
tilities :
Report of snrgic^il loork done at Evacuation Hospital No. 10 from Sept. 27 to
Not. 15, inclusive.
Total number of surgical cases admitted 5,419
Total cases operated on 3, 343
Total cases evacuated -without operation 2, 056
Total cases dead on arrival 10
Total cases died after operation 112
Total cases died without operation 109
SUMMAEY.
Number of cases passing through operating room :
Single wounds 2, 478
Multiple wounds 865
Total 3,343
Number of surgical cases evacuated 3,132
Surgical deaths 211
Mortality per cent 6. 3
Postoperative deaths 112
Deaths without operation 109
Arrived dead 10
Postoperative surgical mortality per cent 3. 4
The contagious section of Evacuation Hospital No. 10 occupies
the buildings previously used by the French as a contagious hospital,
located in the southern extremity of the village of Froidos-sur-
Meuse,
The grounds, covering an area of about 10 acres, are inclosed by a
wall of stone, and are laid out with gardens and an abundance of
trees, shade and fruit.
The buildings, 24 in number, consist of three permanent structures
of stone; the chateau, used as quarters for officers and nurses; the
lodge, used as office and receiving room, and another used as kitchen
1708 REPORT OF THE SURGEON GENERAL OF THE ARMY.
and storeroom. The reniaininc; buiklin<rs are of barrack ('oiistruc-
tion, 13 of ■svliich have been used a^ wards, the bahince as hiboratory,
dispensary, niorgne and chapel, linen room, patients' clothing room,
men's quarters and mess hall. The main wards, 10 in number, are
situated on either side of the central avenue, leading through the
grounds. Three other w-ards were used as necessity demanded,
making a total of 13 wards, W'ith a bed capacity of 256. The hospital
was opened for the receipt of patients September 26, 1918, with an
officer in charge, 4 nurses and 20 corps men. Admissions this da}'
numbered 6, 5 influenza and 1 acute bronchitis. The admissions
from September 26, 1918, to December 31. 1918. numbered 947. The
highest number of patients in the hospital at one time was October
29, 1918, when the morning report showed 218 patients.
From January 1, 1919. until April 10, 1919, when Evacuation Hos-
pital No. 10 ceased to receive patients, it functioned as a local hospi-
tal, hospitalizing patients from all troops located in the old First
Army battle area. Due to the enormous extent of this territory, and
to the fact that the medical personnel of these troops were almost
without transportation, it became necessary to establish a regular
ambulance service from this hospital to outlying points, at which
ambulance stations and central infirmaries were established. A well-
equipped infirmary was first installed at Romagne-sous-Montfaucon
(Meuse) in January, and to it were detailed personnel from this hos-
pital, together with three ambulances. A telephone was installed,
so that these ambulances could be called for at any time, and they
were used by troops as far north as Stenay and Beaumont (Meuse).
The patients were collected at the central infirmary at Romagne,
then sent on to Evacuation Hospital No. 10, at Froidos. A second
and similar arrangement was effected, using Grandpre as the location
for ambulance station and infirmary.- Troops in this area have been
unable to obtain adequate billets, due to the devastated nature of the
country; so that the question of proper sanitation has been a difficult
one. To remedy this, the commanding officer of this hospital was
appointed district surgeon, with supervision of the sanitation of the
district. From the commissioned personnel of this hospital two
assistants to the district surgeon were assigned who were on the road
constantly. The fact that troops in this area at the })resent time are
free from epidemic disease is due largely to the fact that these offi-
cers, working under the direction of the district surgeon, liave con-
stantly endeavored to see tliat all drinking water is properly treated;
that latrines are adequate, clean, and flyproof; that men are not
overcrowded in billets ; that kitchens are kept clean and food is well
cooked: and that commanding officers are made interested in the wel-
fare of the men.
In order to better combat venereal disease, prophylactic stations,
under the charge of experienced enlisted men. Medical Department,
from this hospital, have been established at Romagne, (xrandpre.
Halles, Beaumont, and Chalons-sur-Marne. The venereal rate per
annum per thousand has been kept down to a small figure— for the
week ending April 3, 1919. for instance, the rate was 10.40.
II. KVACIATION HOSPITAL NO. 11.
Evacuation Hospital No. 11 was of casual source, and was organ-
ized at Fort Rilev, Kans., during the month of Januarv. 1918. and
A. E. F. EVACUATION HOSPITALS. 1709
•called into active service diirinji- the month of March, 1918. The or-
ganization was ordered to Allentown. Pa., arriving there May 22,
1918. At that station careful instruction of officers and men was
lilvewise carried out, and about 50 of the medical department per-
sonnel were sent to hospitals in Xew York and Philadelphia for
training in nursing and anesthesia. The organization was assigned
to duty at Brizeaux-Forestierre, Department of Meuse, per para-
graph 1, Special Order Xo. 215. headquarters First Army, dated
September 18, 1918. It arrived there on September 21, 1918, and
received its first patients on the afternoon of the 25th. The hospital
was located on the edge of the Argonne Forest, about a mile north
of the village of Brizeaux, and about 8 miles southwest of Souilly;
it was Avell located for the Argonne drive, as far as proximity to tlie
fighting was concerned, but had the great disadvantage of not being
on a railroad. All patients were evacuated either to Evacuation
Hospital Xo. 10, at P^-oidos (11 kilometers): IJed Cross Hospital
No. 114, at P^leury ( 11^ kilometers) ; Red Cross Hospital Xo. 110, at
Villers-Doucourt (15 kilometers) ; or Evacuation Hospital Xo. 9, at
Vaubecourt (15 kilometers). Active work was started on September
25, and on the 26th, 73 seriously wounded patients were received. In
brief, there were 668 seriously wounded patients treated from Sep-
tember 25 to 30.
The hospital consisted of 10 wards and adjunctive buildings, and
had previously been used by the French particularly as a hospital
for the treatment of gas cases. It consisted of 160 beds only, thus
being small for the purposes of an evacuation hospital. The build-
ings on the whole were in good condition, but inadequate in number.
The operating building was entirely too small. It required quite a
little changing and was never satisfactory. The water supph' was
deficient, practically one-half of the water used having to be hauled
in water carts by the French from wells 1 mile distant.
The organization sailed on H. M. S. Oxfordshire from Xew York
on August 15, 1918, per paragraph 1, Special Order 272, head-
quarters Eastern Department, dated August 11, 1918, and reached
Liverpool on August 28. After a three-day stop in England it left
Southampton, reaching Cherbourg, France, September 2. It was
then sent to a neighboring rest camp for three days. From there,
per telegraphic instructions, commanding general Services of Sup-
ply, August 28, 1918, and paragraph 1, Special Order 70, Base Sec-
tion Xo. 5, September 2. 1918, to the hospital center at Rimaucourt,
Haute-Marne, where the unit remained for a period of one week.
From Rimacourt it was sent, per telegraphic instructions, general
headquarters, American Expeditionary Forces. September 10, 1918,
and paragraph 1. Special Order 17, hospital center, Rimaucourt,
September 11, 1918, to the region of Aulnoissous-Vertuzey, to reen-
force Mobile Hospital Xo. 39 and Field Hospital Xo. 41, during the
St. Mihiel drive. After remaining with these hospitals for about 10
days, it was ordered to Brizeaux-Forestierre, Department of Meuse.
per paragraph 1. Special Order 245. headquarters First Army,
September 18, 1918, w^here it arrived on September 21, 1918. as
above stated. The hospital was ordered closed December 2, 1918.
It was relieved from duty with the First and Third Armies, per
paragraph 1. Special Order 713, headquarters First Army, Decem-
ber 19. 1918. and ordered to Le Mans.
1710 REPORT OF THE SURGEON GENERAL OF THE ARMY.
At Brizeaiix-Forestier this organization was ordered to receive
only the serioiisl}^ wounded. This held true until the fighting in the
Argonne drive was so far in advance of the hospital that only the
sliglitly or ambulant wounded could properly be sent to it. The
slightly wounded, however, did not begin to come in until just prior
to the signing of the armistice, and it is estimated that out of a total
of 3,292 surgical cases received, that approximately 2,792 were seri-
ously wouncled. the remaining 500 slightly wounded. The largest
operating day was 195 seriously wounded. There were 216 deaths
among the surgical cases from all causes, a death rate of 6.653 per
cent.
It was not until November 15 that the main hospital began taking
in general medical cases other than those from the command. Prior
to this date, however, two annexes had been established as follows:
October 5, Camp Eaton, three-fourths mile distant, 200 beds (wooden
buildings), for influenza and pneumonia, and later for measles,
mumps, diphtheria, and scarlet fever; and (2) October 27, Bri-
zeaux-Village, 1 mile distant, 200 beds (wooden buildings), for
mumps.
These two annexes, in addition to the main hospital, treated in all
2,273 medical cases, which, with the 3,292 surgical cases, made a total
of 5,565 cases in all treated by this hospital and its two annexes
between September 25 and December 2, 1918, at which latter date
the hospital ceased to receive patients.
With the view of increasing the surgical output of the hospital,
5 surgical teams, excluding the surgical chief, were made up from
the permanent cadre. This was a mistake: it would have been much
better to have used only the three officially designated teams, or their
equivalent from the permanent stail'. This desire to increase the
surgical work of the hospital affected the administrative side and re-
duced the number of available ward surgeons. It should be added
that 13 was the largest number of visiting teams on duty at any one
time. These, with the above number, made 18 teams, or 9 on a shift
during the height of the work.
Nurses. — When the hospital reached Brizeaux-Forestierre, Sep-
tember 21, there were but 2 Eed Cross nurses present. This number
was increased to 5 on the 26th, 25 on the 27th, and 35 on October 1.
From this time on the number averaged 38. This average number of
nurses, while all that could be obtained, was reall}" too small to prop-
erly meet the demands. Fifty-five, including a chief nurse, would
have been the proper number. To this quota for the main hospital
there should be added 20 nurses for Camp Eaton, which, as previ-
ously stated, was an annex of 200 beds for influenza and pneumonia
and later for the usual contagious diseases.
There was never a deficiency of medical supplies. Sufficient sup-
plies were always on hand and were always easily obtainable.
All patients were admitted through the triage. This building was
much too small and frequently it was necessary to unload ambulances
and trucks into adjoining wards in order to provide immediate cover
for the injured. This necessitated the litterage of patients from ad-
joining wards to the triage before they could be admitted and prop-
erly prepared for treatment. Immediately upon the unloading of
ambulances or trucks patients were grouped according to the degree
of injury, so that those suffering from shock, hemorrhage, abdominal,
A. E. F. EVACUATIOX HOSPITALS. 1711
sucking chest wounds, or those still carrying tournequets would re-
ceive immediate treatment in advance of the less seriously wounded.
In order to expedite the treatment of these patients an " urgency
tag" was used, typewritten as follows: Xame. Urgency 1, 2, 3.
Preop. ward. X-ray. Evacuation wards. Shock ward. The triage
officer filled out this card and circled the number — 1, 2, or 3 — accord-
ing to the degree of urgency, No. 1 cases considered as " rush " cases.
All patients entering the triage first had their records made, cloth-
ing removed, searched, and property listed. The only exceptions to
this rule were in the most serious or " rush " cases, in which only the
necessary data was taken in the triage, the other details being at-
tended to in the shock ward or operating room.
The highest admissions during any one day was 224 seriously
wounded. To carry on this work in the triage in an expeditious
manner required the constant presence of 3 medical officers and 29
enlisted men, working in two shifts of 12 hours each, or a total of 6
officers and 58 enlisted men.
At first the operating shifts were of 8 hours each, i. e., 8 hours on, 8
hours off. These hours were found to be trying and by general re-
quest on the part of the visiting surgeons the shifts were divided up
into 12 hours each. This division was the more satisfactory as it did
not require surgeons rising in the middle of the night, as in the 8-
hour shift. The teams were required to dress their own cases. This,
however, was not satisfactory, as operators failed to dress their cases
as frequently as they should have. To overcome this the ward sur-
geon was required to notify the operators who had delayed their
dressings, and if the dressings were not then made within a reasonable
time the surgical director was so informed, or else the dressings were
made by the ward surgeon himself. It would have been better had
the operators been required to tag the cases which they desired to
dress, stating the time such dressings would be made, the ward sur-
geons making the dressings in all other cases, and in those tagged if
there was any delay.
With reference to the medical cases, as previously stated, it was
not until November 1.5 that any but members of the command were
treated in the main hospital at Brizeaux-Forestierre.
After November 15 the main hospital began to care for general
medical cases. Cubicles were installed at once in all wards and
cases segregated by opening special wards for pneumonia, bronchitis,
influenza, intestinal, and general medical cases. The number of cases
treated were as follows: Brizeaux-Forestierre. 1.211 cases: total
number of deaths. 8 (including 3 in command) : death rate. 0.661 per
cent. Four deaths were due to broncho-pneumonia, result of in-
fluenza, and 4 to lol)ar pneumonia. Camp Raton : Total treated. 559
cases ; number of deaths, 31 : death rate. 5.54 per cent. Of the deaths,
20 were due to lobar pneumonia. 3.57 per cent, and 11 to broncho-
pneumonia. 1.97 per cent. Brizeaux village : Five hundred and three
cases mimips: no deaths.
It is thought that a brief note should ]}e made in connection with
the work of the shock ward. There was constantly on duty a team
consisting of 1 medical officer, 1 or 2 nurses (according to the require-
ments), and 2 members of the Medical Department personnel, each
team working on a basis of 12-hour shifts. There were a total of
240 patients treated in the shock ward, with a total of 54 deaths.
1712 REPORT OF THE SURGEON GENERAL OF THE AEMY.
'Skni aiii\ iiiii' at the hospital showing the shock syndrome wei'L' im-
mediately transferred to the shock ward. Patients were never
removed from the stretchers on which they were received, and the
clothing in serious cases not removed unless wet or so soiled that it
was necessary to do so. The stretchers were placed on frames spe-
cially constructed or else on horses draped with blankets in such
a way that the heat applied from underneath was well conserved.
Heat was found to be an effective agent in lessening shock in practi-
cally all caries arriving from the front. The shock ward was kept
warm but well ventilated. The condition of patient, degree of shock,
and factors causing same were carefully noted. All patients were
kept quiet and at rest, morphia being used as indicated to secure this
end. Fluids were given freely b}' mouth where not contraindicated.
In those cases unable to retain fluids by mouth the ^Nliu'phy drip of
tap water was used and special treatment to combat nausea and
vomiting and acidosis, usually present in such cases. The above
procedures constituted the main treatment in most cases during the
first hour's stay in the shock ward. If at the end of this time the
body temperature having been restored, there was little reaction of
increase in the systollis blood pressure, infusion of gum-salt solution,
normal saline solution, or bicarbonate of soda solution was given.
Gum-salt solution was used in 28 cases during the first 10 days in
the shock ward and then discontinued, 15 of 28 patients having died.
The stimulants used in order of frequency were : Camphorated oil,
caffeine, adrenalin, digetalin. strj'chnine, and whisky — whisk}'^ per
rectum.
There is nothing of epidemological interest to record, except that
during the months of September and October there was a total of
60 cases of influenza arising in the command, 3 of whom died from
broncho-pneumonia. With the exception of the above disease there
were no outbreaks of any kind affecting the command. There was
one case of venereal disease in the command during the period of this
history.
This hospital left Brizeaux-Forestierre on January 4. 1919, by
train, arriving at Le Mans January 7. It was originally intended
that this unit should operate under canvas. Eecommendation for
the construction of a type A hospital was made to the chief surgeon.
American Expeditionary Forces, and a])proved. Inasmuch as the
construction of this hospital would require some time this unit, on
January 26, 1919, took over Camp Hospital Xo. 101, with the expec-
tation of operating it until the construction of the hospital at the
forwardins: camp was completed. •
Camp Hos]ntal No. 101 consisted of 10 wooden barracks and
adjunctive buildings, in addition to which there were 29 ward tents,
a portion of which were floored, with a total capacity of 850 beds.
On or about February 15 it was decided to remove all tentage and to
replace it by wooden wards. This construction was begun practically
at once and has progressed very rapidly. With the construction also
17 additional barrack buildings had been taken over, so that when
completed the hospital will have a bed capacity of 1,100 beds. Camp
Hospital No. 101 is located at the Belgium camp which is approxi-
mately S miles from Le Mans. The date of starting actual work was
Januarv 26.
A. E. F. EVACUATION HOSPITALS. 1713
I. EVACUATION HOSPITAL NO. 12.
Evacuation Hospital Xo. 12 was organized at Fort Riley, Kans.,
January 3, 1918, with 1 officer and 181 enlisted men. These were all
volunteer men of the Regular Army.
On June 1 the organization left for Camp Dix, X. J., a concentra-
tion camp for troops designated for overseas service, and intensive
training for the new men was immediately renewed in classroom and
hospital. Shortly thereafter the authorized strength of evacuation
hospitals was increased to 31 officers and 237 enlisted men. and a
request was made for the additional personnel required. On June
15, 150 men, a surplus of nearly 90, of all stages of training, joined
the embarkation camp at Hoboken, X. J. ^Yith this surplus the
training of the men eventually selected as permanent members of
the hospital was somewhat' hampered. The organization was again
reported ready for overseas service about July 10, 1918.
On August 11. after the transfer of surplus men had been efFecterl*
Evacuation Hospital Xo. 12 entrained for the port of embarkation
with 31 officers and 235 enlisted men, 20 of the authorized strength
being left behind. The unit embarked at Philadelphia, and after
remaining in the harbor at Xew York for a day while a convoy was
assembling, sailed on August 16. The convoy arrived at Liverpool
on August 28, and the ship on which Evacuation Hospital Xo. 12
sailed was towed up the Manchester ship canal to ]Manchester. The
organization entrained August 29 for a rest camp at Southampton
and reembarked for France the next day, arriving at Cherbourg on
the morning of August 31. After three days and two nights on the
train the organization reached Pagny-sur-Meuse on the morning of
September 3, where 10 Adrian barracks and a large Bessoneau tent
were found ready for occupancy. Field Hospital Xo. 117 and Evacu-
ation Ambulance Company Xo. 4 were already located and a few
patients were on hand.
Only 10 days were spent at Pagny. During that time the organi-
zation handled only a few cases, mostly slightly wounded.
The ground was ill-suited for a hospital. It was lowlying and
swampy. Latrine after latrine was dug and many tents were put in
position and fully equipped. The air was filled with flies.
The hospital was then ordered to ]oroceed to Royaumeix. The
move was started on the evening of September 13, and after three
days of steady work was accomplished. The new location was an
old French hospital, consisting of four groups and each group con-
sisting of long rows of Adrian barracks.
At Royaumeix the first j^rofessional service was performed. It
was tlie period of the St. Mihiel oft'ensive. and the liospital was so
placed that it i-eceived the surgery fresh from tlie front lines, 15
miles distant.
The main profe.ssional work shouhl have ended with the signing
of the armistice, but the fact remains that on account of the activity
(^n Xovember 11 at the front the night work of that date was unus-
ually heavy, and it continued to a less degree on the 12th and 13th.
Manv cases in the last few days Avere the result of carelessness in
handling explosives on the part of inexperienced visitors at the
front. Altogether, while at Royaumeix. the organization treated
1714 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
2,700 patients, over a thousand being seriously wounded. The num-
ber of medical cases was negligible. After the armistice about 200
repatriated allied patients were received.
Notice was received on December 1 that the organization would
move to Echternach, and on December 2, 1919, the advance party,
using all the ambulances furnished by the Second Army, and num-
bering 16 officers, 20 nurses, and 33 enlisted men, started to join the
newly formed Third Army. Fortunately some of the party reported
its presence to the chief surgeon in passing through Luxemburg,
and it was then found that Evacuation Hospital No. 12 was to take
over buildings in West Trier or Treves; but in spite of their attempt
to spread the news, a few ambulances that day and some trucks later
reached Echternach before going to Treves.
Treves was reached late in the day. This city had been taken over
by the Americans the preceding day. A field hospital and ambulance
company had arrived December 1 in the morning, and a few patients
had been received.
All the buildings were of cement construction, with basements and
attics, and with tiled corridors.
The capacity of the entire hospital was placed at 1,500 beds. The
condition of the buildings was indescribably filthy. The sewerage
system was obsolete and generally blocked, and the overflow reached
tile basement of the hospital buildings. The plumbing was worn
out and leaky. German beds and bedding were on hand, into which
patients — and 230 arrived December 3, 1918 — could be placed.
These buildings. Avhich at times would contain a population of
close to 2.000 people — patients and personnel — were situated between
the base of the steep Markus Berg and the Moselle River. The area
between buildings was considerable, and the arrangement required
considerable extra police, and therefore more personnel than or-
dinarily needed for the number of patients.
Up to the present time (April 20, 1919) 6.795 patients have passed
through the organization while located at Treves. In rush seasons
as many as 331 incoming and 223 outgoing patients have been re-
ceived and evacuated at the same time. Over 450 were evacuated on
one day.
Numerous cases of shock following wounds were treated in the
hospital from September 14, 1918. to December 1, 1918. To the left
of the receiving ward and behind the operating pavilion was a long
wooden hut, where, after admission, all patients were brought to
be prepared for operation. One half of this structure, known as
the "preoperative ward," was utilized for good surgical risks; the
other half, called the " shock ward," was used for poor surgical
risks or shock cases.
The ward consisted of about 40 beds and was equipped with means
of giving warmth and comforts to the patients, having 6 special
shock beds, several intravenous sets, and sterile solutions for in-
travenous use. The floor and thin walls were covered with thick
tarred paper, and, together with two large stoves (using logs of wood
for fuel, as coal was scarce), the temperature of the room kept com-
fortably warm.
Our special Evacuation Hospital No. 13 shock bed consisted of a
wooden bed containing a galvanized zinc outfit, from which hot air,
generated by a burning alcohol lamp, was evenly distributed in the
A. E. F. EVACUATION HOSPITALS. 1715
bed, thus producing heat which plays such an essential part in the
treatment of these cases.
The specific equipment consisted of a supply of sterile hypodermo-
clysis sets and transfusion sets. The solution used comprised Bayliss
gum solution, 5 per cent bicarbonate of soda, normal saline, and
citrated blood. In response to our call for donors, about 40 men of
our enlisted personnel volunteered and had their blood typed at our
laboratory for possible future use. One list of these types was kept
in the laboratory' and one was placed in the shock ward, and having
ascertained the blood type of the recipient it became an easy matter
to call upon corresponding typed donors.
Upon his arrival into the sliock ward the patient was immediately
placed on our artificially heated bed, wrapped up in blankets, and
given hot drinks, when possible. The ward surgeon and chaplain
were immediately notified.
The results of treatment were often discouraging, owing to the
severity of these cases, but we feel that every possible chance was
given to those unfortunate individuals, and the recoveries that we
had full}' compensated for the tremendous amount of detailed ob-
servation and treatment administered and for the sacrifices made for
these patients. In cases directly due to acute hemorrhage or true
shock, and in a large proportion of nonsucking chest wounds, the
results were generally good. For patients admitted with tourniquet,
suffering with severe wounds of extremity, complicated by fracture
compound comminuted, where amputataion was deemed advisable,
the tourniquet was left on during the operation. In abdominal vis-
ceral injuries, severe head wounds, and in cases when toxemia of an
acute spreading gas gangrene was the principal factor, treatment was
of little avail and patients generally died.
In our cases of gas gangrene, complete records were kept consist-
ing of (1) location and number of wounds; (2) character and sec-
tional area: (3) initial and subsequent wound cultures; (4) nature
of F. B. and whether removed at operation; (5) condition of patient
on admission as to shock, hemorrhage, tourniquet, sensorium, etc.;
(6) interval from injury to operation; (7) probable incubation period
for gas infection : (8) time gas was detected or suspected ; (9) method
of spreading; (10) treatment; (11) results; (12) reports. The fol-
lowing interesting data were thus obtained: Gas infection occurred
very often in deep wounds involving fleshy parts, often associated
with fracture compound comminuted, and caused almost entirely by
shrapnel. Because of condition of patient and time consumed in
bringing wounded to hospital, the average wound to operation in-
terval was 16 hours. The estimate average incubation period for
gas was 22 hours. Considering condition of these patients, high
rapid amputation gave most favorable results, both in regard to life
and prevention of reinfection of stump.
CHANGING A GEEIIAN CASERNE INTO AN AMERICAN HOSPITAL.
To transform a large number of deserted and dilapidated German
buildings into a hospital was the most difficult task which confronted
Evacuation Hospital No. 12. As described in the narrative, the caserne
was a large one, containing 19 buildings.
142367— 1&— VOL 2 i7
1716 EEPORT or THE SUEGEOF GENERALi OF THE AEMY.
The presence of numerous German laborers engaged in the manu-
facture and storing of food supplies in various buildings in the post
added to the general confusion of troops, which, for the first week,
used the grounds as a camping place. Endless amounts of sauerkraut
in barrels and other vegetation in various stages of decay, stored in
attics or basements, added variation to the odor of fecal matter from,
latrines and grounds. While the Germans were willing to do what
they could to remedy conditions, labor was scarce.
Company A, of the 37th Engineers, renewed the plumbing through-
out the institution, and under their direction the German authorities
connected the drains from the buildings with the canal emptying
directly into the Moselle River. The outside latrines still operate as
cesspools, which periodically require emptying. Numerous addi-
tional toilets and baths were placed throughout the hospital.
The presence of vermin in all the ward buildings was general.
Floor after floor was emptied, beds scoured with disinfectant, bedding
disinfected by steam or dry heat, and interiors scrubbed and kal-
somined. There are no bedbugs in the hospital and there have been
none for months. Later all German beds were replaced by American
equipment. The steam boilers alread}^ in the kitchen were in good
condition and served the immediate needs. Army ranges for baking
were rapidly introduced, so that in all kitchens there is plenty of
baking facilities.
Beneath one mess hall a complete bathing plant with boiler was
discovered. This was moved to the basement of buildmg No. 6, the
genito-urinary department. The two exercise halls were trans-
formed— the one into a Red Cross hut, the other into a large mess hall.
The laboratory was located in a suite of one large end room and two
adjoining wardrooms. The wardrooms throughout being small and
containing 10 to 12 beds, ventilation was generally poor until it was
discovered that if the two upper panels were hinged, air could be
made to circulate easily and as desired. The improvement was
worked throughout the hospital as soon as this single procedure was
put generally into effect.
PROFESSIOXAL SERVICE OF EVACUATION HOSPITAL NO. 12.
The diseases handled at Treves differed little from those found in
the hospitals in the States in nature or in severity. The most inter-
esting line of cases were the pneumonias. As the field cards of pa-
tients have been forwarded, statistics are not available from December
2, 1918, to April 20, 1919. Four hundred and eight^'-two cases of
pneumonia were received, with 89 deaths. Some of these cases of
pneumonia were convalescent, while many cases were admitted mori-
bund. Of these cases of pneumonia the greatest number were broncho-
pneumonia.
Among the cases of pneumonia and broncho-pneumonia in the
wards there were two cases with streptococcus positive in blood cul-
tures, both of which recovered ; two type I cases, one of which showed
positive blood cultures of both types I and III, both responding well
to serum treatment ; one type I with type I meningitis, succumbing,
although serum was used intraspinally as well as intravenously.
The most frequent complication was the usual suppurative otitis
media, but it was a general comment that mastoiditis very rarely de-
A. E. F. EVACUATI02T HOSPITALS. 1717
veloped, not a single case going to operation. Other complications
were septicemia and meningitis, and almost all cases showed ne-
jDhritis.
It was also noted that empyema was exceptional, and only occa-
sionally was there pleural effusion, in the latter cases generally
sterile." A number of cases of trench feet and fever were evacuated
from Coblenz to Evacuation Hospital No. 12. The characteristics
of the disease, nystagmus, palpable spleen, rose spots, slight fever,
and tender shins, were generally observed.
The cases of nephritis observed in the wards were numerous, es-
pecially in January and following the advance into Germany. The
cause was undoubtedly prolonged exposure. Many presented alarm-
ing symptoms, but progi'ess was generally satisfactory. The cases
were generally evacuated to the base.
The service in the contagious wards was very active, all the con-
tagious diseases of the area being sent to Evacuation Hospital No.
12. The service cared for mumps, measles, scarlet fever, diphtheria,
meningitis, chickenpox. erysipelas, typhoid, and dysentery. The
diphtheria service consisted of over 120 cases. The types were all
pharyngeal, except for one case of laryngeal diphtheria. Extremel}^
severe cases were present, but all responded to treatment so that no
deaths occurred. The average amount of antitoxin given was 30,000
units, but one case required 200.000 before cure was effected.
In the meningitis ward 23 cases of meningitis were treated. Of
these 10 died and 6 are in hospital, the remaining number having been
evacuated to the base. The majority ran a chronic course of three
to five weeks. Four of the cases showed a positive blood culture.
Serum was given both intravenously and intraspinally, the total
quantity given in each case varying from 200 c. c. to 1 liter.
The number of cases of pulmonary tuberculosis and suspects was
at all times under 25. They were kept in three wards, those showing
bacilli in sputum in the first; those clinically tuberculous, but no
bacilli found, in the second ; and the suspects in the third. The beds
were all screened, the patients were not allowed to walk about the
ward, and nurses who were specially trained for this work were in
charge. Particular attention was given to diet and most of the food
was prepared in a kitchen in the ward. Since the variety was limited,
a special effort was made to make the meals as attractive and dainty
as possible, and surprisingly good results were obtained.
NEtJEO-PSYCHIATRIC SERVICE.
The neuro-psychiatric service was opened on the third floor of
building V December 21:, 1918. On January 22 the service was
moved to building III, where special preparations had been made
for the reception of nervous and mental cases. The first floor was
used for neurological cases and the milder mental disorders. Quar-
ters for the more serious psychoses were on the second floor. There
were 57 beds and the construction of the building was such that the
proper classification of cases was an easy matter.
The service received all neurological and mental cases originating
in the military area around Treves, and early in April, 1919, began
receiving from the troops farther south in the Luxemburg district,
which formerly had evacuated to hospitals in France. Cases were also
1718 REPOET OF THE SURGEON GENERAL OF THE ARMY.
received by transfer from the more congested service in Evacuation
Hospital No. 14 (later Evacuation Hospital No. 16).
During the period between December 24, 1918, and April 22, 1919,
249 cases were admitted. Of this number 198 were mental or for
mental observation and 51 neurological. One hundred and eighty-
three cases, or 77 per cent, were evacuated to base hospitals in France ;
37, or IG per cent, were returned to duty. There were two deaths.
Reconstruction work for neuropsychiatric cases was begun early in
jSIarch.
The mental cases received included a comparatively small number
of i^sychoses. The greater number offered less serious mental dis-
turbances. The majority were in the group of psychoneuroses, and
there were also a considerable number of mental defectives who had
managed to carry on fairly well during the periods before the armi-
stice but wlio were unable to meet the more exacting demands of drill
and inspection in the army of occupation.
In the first two groups of cases, the psychoses and psychoneuroses,
the case histories usually showed a lack of adaptability on the part
of the individual extending over a varying length of time, for years
in some instances. Under the stress and strain of war activities
before the armistice or on account of the monotony and routine of a
less active period plus homesickness this defect became more marked
and the breakdown occurred.
GEXITO-ITRINAEY DEPAETMENT OF EVACUATION HOSPITAL NO. 12, AT TREVES.
The orders of the chief surgeon of the army of occupation required
that no cases of acute gonorrhea should be admitted to this hospital,
except (hose occurring in the troops in the Treves district. Practi-
cally all the cases of gonorrhea treated were those having complica-
tion of this disease.
All cases of acute sj'^philis were hospatilized for a period of 42
daj's, which i-epresented the first course of treatment. They were
then returned to their organization for duty, further observations
and treatment being made in these cases in the divisional genito-
urinary field hospitals.
In connection with both syphilis and chancroid cases a " follow-up "
system of letters was used. When a patient was returned to duty a
letter was sent to his commanding officer advising that the patient
was no longer infectious and also advising him of the time of the
beginning of the second course of treatment in the divisional field
hospital.
Up to April 20, 1919, the clinic treated altogether 485 patients.
Of this number about 88 per cent were venereal. The greatest num-
ber of these, or about 65 per cent, were cases of gonorrhea and
the remainder were about equally divided between syphilis and
chancroids.
SERVICE OF EYE, EAR, NOSE, AND THROAT AT EVACUATION HOSPITAL NO. 12.
Approximately 160 cases of acute otitis media were treated during
the period of four months, with but one case of acute mastoiditis
developing. Six cases gave evidence of beginning mastoid infection,
A. E. F. EVACUATION HOSPITALS. 1719
but the symptoms disappeared rapidly following paracentesis of the
drmnhead. A number of patients, especially in the pneumonia wards,
develoi^ed a profuse spontaneous purulent aural discharge, without
other symptoms than slight loss of hearing and with no reddening
or bulging of the drum membrane. These latter cases cleared up,
as a rule, in from three to four weeks, giving at no time symptoms
otlier than the discharge and partial loss of hearing.
Acute frontal sinus infection was very common, being present to
a greater or lesser degree in practically every case of so-called in-
fluenza. Many of these cases suffered with very severe headaches and
were actually tender over the floor of the sinus, but they invariably
cleared up quite rapidly under conservative treatment. During the
four-month period no case of acute frontal sinus infection came to op-
eration, their only treatment being rest in bed. salicylates and the
application of cocaine and adrenalin to the middle turbinates.
In contrast to the prevalence of frontal sinusitis was the low per-
centage or involvement of the antrum of Higmore. True cases of
antral infection were very rare, though this type naturally came to
oi:)eration in a much greater proportion than the frontal cases.
The treatment of throat cases revealed one interesting feature, the
high percentage of Vincent's angina. Certainly in our experience
these cases have not been as prevalent in civil liife as we have found
them here. The greater percentage of the patients were seen in the
wards for infectious diseases, where they had been sent as diphtheria
suspects.
J. EVACUATIOX HOSPITAL XO. 13.
Evacuation Hospital Xo. 1-3 officially became an organization on
February 13. 1918. at Camp Greenleaf, Fort Oglethorpe, Ga. On
April 17, 1918. the organization was transferred to Camp Forrest,
Chickamauga Park, Ga. On June 7, 1918. this unit moved to Camp
Gordon, Ga. The physical and military training of the men was con-
tinued and War Department orders transferred the company to New-
port News, Va.. on August 2, 1918.
Evacuation Hospital Xo. 13 left Commercy. France, on the morn-
ing of January 9, 1919, and proceeded by train to Walferdange,
Luxemburg, our present station, arriving at our destination at about
8 a. m. January 11. 1919. At about 11 a. m. on the same day we took
over all patients from Field Hospital No. 25 and began actual treat-
ment of easels.
Ejridemiology. — Evacuation Hospital No. 13 has been fortunate in
regard to the epidemic diseases. A few sporadic cases of epidemic
meningitis, diphtheria, scarlet fever, and measles have been admitted
to this hospital, but never has the proportions of an epidemic been
reached. Prompt measures of isolation of all suspicious and j^roved
cases, as well as contact, brought this good result. The influenza
epidemic, however, and a mumps epidemic paid this hospital a visit
as seen by report of medical cases.
K. EVACUATION HOSPITAL NO. 14.
Evacuation Hospital No. 14, organized Februarv 14, 1918, per
V. O. C. O. Hq. Bn. No. 14. at Camp Greenleaf. Chickamauga Park.
Ga., medical officers' training camp of Fort Oglethorpe. At the time
1720 REPORT OF THE SURGEON GENER.M. OF THE AEMY.
the organization was formed it consisted of 3 commissioned officers,
1 sergeant. 5 corporals. 10 privates, first class, and 34 privates, a total
of 3 officers and 50 enlisted men.
April 19, 1918, the entire organization was transferred to Camp
Forrest. June 1, 1918, the hospital, consisting of 7 officers and 174
enlisted men, proceeded to Camp Jackson, S. C., and arrived at that
place Jnne 7. The unit left Camp Jackson July 20 for Camp Hill,
Newport News, Va., port of embarkation. This station was reached
on July 26. With the exception of 6 officers and 10 enlisted men on
detached service to operate the dispensary on another transport, the
Ducca cW Osta^ Evacuation Hospital No. 14 embarked on the Susque-
hanna^ an interned German transport, for oversea service with 31
officers and 237 enlisted men.
On the afternoon of August 6 the convoy arrived in the harbor of
Brest. France. The night was spent on board the ships, and on the
morning of the 7th the entire unit disembarked for Juilly (Depart-
ment of Seine-Marne) August 11, At Le-Bourget orders were re-
voked and Is-sur-Tille was made the new point of destination. From
this point the entire outfit proceeded on August 16, under verbal or-
ders, to Toul, where it was assigned as a First Army unit. On arrival
at Toul August 16 the organization was temporarily stationed in the
La March group of military barracks. Six days later the Perrin-
Brichanbault group of military barracks was assigned to the use of
this hospital for the St. Mihiel offensive.
As this hospital was designated as a hospital for slightly and
seriously wounded cases, special attention was given to the arrange-
ment of the receiving ward, triage, and operating rooms.
Eleven operating tables were available for use at all times, and as
far as practicable all cases were X-rayed prior to operation.
The transportation furnished this hospital during its stay in these
quarters was entirely inadequate for the prompt and efficient trans-
portation of the necessary supplies and food for the use of patients
and personnel.
Argonne-Meuse offensive. — Evacuation Hospital No. 14 moved from
Toul, Mourthe-Moselle. to Villers-Daucourt, Meuse, arriving at that
place September 21. This hospital was ready to open and function
as a unit when further instructions were received to remove all equip-
ment from the hospital, where it had been placed in readiness for op-
eration, and store the same by the roadside pending a further forward
movement of this unit.
L. EVACUATION HOSPITAL NO. 1 5
Was organized at Fort Eiley, Kans., March 21, 1918, with 4 officers
and 169 enlisted men. June 13 we left Fort Riley for Camp Lee, Va.,
arriving there June 16, 1918. On the trip the men ate travel rations
and extra food bought with money from the company fund. At
Camp Lee, Va., the organization occupied two-story wooden build-
ings, which were to be the convalescent barracks of the base hospital.
June 20 the men were placed in the base hospital for instruction in the
various departments.
Orders were received to embark for overseas, arriving at Brest,
France, September 3, 1918. Left Brest September 10, 1918, en route
for Rimaucourt, with orders to report to the chief surgeon. First
A. E. F. — EVACUATION HOSPITALS. 1721
Army, American Expeditionary Forces, for duty. Left Rimaucourt
September 20, 1918, en route for Revigny. Arrived Revigny Sep-
tember 21, 1918; replaced French hospital. Shortly after arrival
at Revigny were joined by Base Hospital No. 83. Left Revigny
October 12, 1918, en route to Glorieux, Meuse, section of Verdun;
replaced French hospital.
October 18, 1918, 20 nurses joined for duty. This hospital acted
in conjunction with the field hospitals of the 33d and T9th Divisions.
The field hospitals taking care of transportable cases and evacuating
the nontransportable cases to the Evacuation Hospital No. 15. When
the field hospitals left, this hospital took care of all cases of patients.
Frem September 21, 1918, to November, 1918, this hospital took care
of 2,639 surgical cases, of which number 1,235 were operated upon.
From November 17, 1918, to January 1, 1919, there were 1,575
surgical cases admitted to Evacuation Hospital No. 15, of which 151
were operated upon. There were five deaths following operations, one
due to gunshot wound of abdomen, one due to gunshot wound of
skull, and one due to multiple injuries caused by gunshot wound, one
due to amputation of thigh, and one due to multiple contusions
of body.
M. EVACUATIOX HOSPITAL NO. 16.
Evacuation Hospital No. 16 was organized at Fort Rile}^, Kans.,
March 21, 1918, from casuals. United States at large, with one officer.
On May 31 orders were received directing that the organization
proceed to Admiral Md., and report to the commanding general,
Camp Meade, for duty in the base hospital at that place, and on
June 13 the hospital personnel, consisting of 7 officers and 235 en-
listed men, departed from Fort Riley, Kans.. and arrived at Camp
Meade June 16, 1918.
On August 28, 1918, the organization, consisting of 33 officers and
236 enlisted men, left Camp Meade, Md., at 7.30 p. m., arriving at
Hoboken. N. J., 9 a. m.. and boarded the U. S. S. Leviathan. The
ship left the harbor for Brest, France, at 1.45 p. m., August 31, 1918.
September 7, 1918, the unit arrived at Brest, France, and was sent
to a rest camp, known as Pontanezen Barracks, where it remained
until September 18.
On October 12 the first section of the organization entrained for
Revigny-Meuse, the balance following the first and second days
afterwards. At Revigny-Meuse we were received by the personnel
of Base Hospital No. 83, left at that station, and on the day after
our arrival the hospital was taken over by this organization.
The hospital, which was built to accommodate 800 patients, was
within a short time housing approximately 1,450, every building
being pressed into service for this jxirpose. Our first influx of pa-
tients was from the 91st Division a day or so after our arrival, who
were then in rest area adjacent to the hospital. This commenced our
busy career of actual work of receiving the sick and wounded coming
for surgical and medical attention. It was here that a system was
instituted for serving every patient who entered the hospital with
an abundant supply of hot cream soup, which was a preparation by
our " chef," who had in previous days prepared this same excellent
soup for one of the big New York hotels. This had a great deal to
do with the quick return to duty of the slight influenza cases, a
1722 REPOET OF THE SURGEON GENERAL OF THE ARMY.
high percentage being able to return direct to their unit within a
few clays. This system was a great relief to the men, who had been
without hot food for days, and was highly appreciated by them.
N. EVACUATION HOSPITAL NO. 18.
Evacuation Hospital No. 18 came into existence pursuant to Spe-
cial Order 138, War Department, AVashington, dated June 13. 1918.
This order detached eight officers from duty with the Camp Zachary
Taylor base hispital, and made them the nucleus of the new unit,
which was immediatel}^ on active service. The remainder of June,
July, and until August 22 were spent at Camp Taylor, traini)ig the
enlisted personnel, most of whom were National Army troops from
Fort Riley, Kans. Instruction in gas defense, various hospital
duties, together with sanitary drill, made up this training. On
August 22 the unit arrived at Camp Upton, where the overseas per-
sonal equipment of the men was drawn and three officers added to
the organization. The unit went on board the U. S. S. Kroonland
on August 29 and sailed on August 30 at 4.30 p. m.
Stationed at St. Mihiel November 3-21, 1918. On November 24,
1918, the unit was ordered by the chief surgeon. Second Army, to
Briey, France, from St. Mihiel. Eighty-five motor trucks and fifteen
ambulances were used in transferring the personnel and equipment.
At Briey many of the assigned to the surgical staff were transferred
to medicine on account of the much greater influx of medical patients.
At this place, the center of the coal and iron mining section of
France, it occupied a French civilian hospital, taking over possession
from Field Hospital No. 29. Evacuation Hospital No. 18 was then
transferred to the Third Army, A German medical lieutenant and
eight enlisted men were still at the hospital, awaiting a pass through
the allied lines. The hospital was indescribably filthy, no effort
having been made, apparently, by the Germans to clean up for some
time before they left. The plumbing was in very bad condition
and the building quite foul from unflushed sewerage. Tlie field
hospital complement was much too small to do any more than barely
look after the patients.
Within 48 hours after we had taken over the hospital more than
1,200 patients were admitted, the divisional sanitary units just ahead'
sending all their patients back so that they could move on with their
divisions. This gave a total of over 1,300 patients in the hospital
and the surrounding tents and barracks which had been thrown up
to take care of the overflow. Cots were placed two deep in the cor-
ridors, and the recreation parlor and every other available floor space
was utilized. The men were all fed and had a sleeping place, either
bed, cot, or stretcher, but they had very little room to move around.
This overcrowding was relieved the third day by a hospital train,
which was brought up to within 15 minutes' ambulance run of the
hospital. The second great handicap was lack of water. The build-
ing is supplied by an electric pumping station with a high tank.
But the source of this water is a reservoir which is filled from the
river by an electric pumping station of very limited capacity, located
at some distance from the hospital. The source of power for this
station was at this time electricity, sent a long distance from Strass-
bourg, in German Lorraine. One or the other of these links in the
A. E. F. EVACUATIOlsr HOSPITALS. 1723
chain of supply was broken each clay, so that water coiikl be obtained
but rarely. When this is taken into consideration with the tremen-
dous overcrowding, the filthy condition of building and grounds,
and the defective plumbing, it can be readily seen that a very un-
comfortable state of affairs existed. In addition, the Boche had
plugged the chimney from the main cooking range with bricks, so
that it was entirely out of commission, and feeding the total of 1,500
odd mouths was a problem. The enemy had also made otf with
everything that was not nailed down in the way of equipment ; for
example, cutting the electric wiring in the X-ray laboratories close
to the wall, so as to leave not even a single inch of useful wire. His
spoils included most of the lights, so that much of the hospital was
in darkness, either partial or absolute, from 4 p. m. till morning.
The medical service had as its most serious work the care of acute
respiratory cases, many of which were complicated by pneumonia.
This was chiefly of the bronchial type, with varymg mortality. The
mortality rate in frankly lobar cases was quite satisfactory, for
pneumonia of all classes being about 25 per cent. There were very
few cases of diphtheria handled in this hospital, only four in all.
These pneumonias were complicated by empyema much less fre-
quently than those which the staff had observed in the States can-
tonments, and most of these empyemas were of the pneumococcic
variety with the correspondingly improved prognosis.
The unit was not exposed to any epidemic and had to deal with
nothing worse from a sanitary stanclpoint than the filth that the
Germans left in the hospital at Briey. At the same place there was
a striking example of the value of the " pale " in venereal prophy-
laxis. There were 54 prophylactic treatments applied for one month
by the detachment, most of whom stated that they had been exp>osed
in Homecourt, a town 6 kilometers from Briey. The men were then
forbidden to go there. All entrances to the town Avere guarded. The
next month there were only 4 prophylaxes given and no cases of
venereal disease developed. In all, with a medical detachment
averaging about 250 men, there have been four cases of venereal dis-
ease in six months of foreign service.
For some weeks after setting up at Briey the unit was the only
source of medical attendance for many kilometers and did an ex-
tensive civilian practice. The people had been sadly exploited by
the German medical officers, their only physicians for four and one-
half years, who charged very large fees and gave careless services.
In the hospital several operations were done and many medical cases
treated in addition to the out-patient dispensary. As the French
occupied the territory this practice has diminished, but we still have
three Avards of French ciAnlians.
A Aery interesting phenomenon the first few weeks in the Ameri-
can Expeditionary Forces was the gradual transformation of our
attitude toAvard the Hun. When the unit started from the States
this attitude might have been defined as a mixture of curiosity and
passive dislike, but after the service at Langres, when we watched
youth after youth horribly gasp out his life in the fatal broncho-
pneumonia Avhich complicated so many of the gas casualties, there
Avas no longer any passiveness in our feelings. They had changed
to a savage hatred for those who inaugurated such inhuman warfare
1724 KEPOKT OF THE SURGEON GENERAL OF THE ARMY.
and a great ambition si^urred ns on to get as close to the scene of
action as possible at the earliest moment.
O. EVACUATION HOSPITAL XO. 2 0.
The organization which was to be Iviiown as Evacuation Hospital
No. 20 came into existence April 17, 1918, at Fort Riley, Kans. It
was not until two months later that the first men reported for duty.
The unit arrived at Camp Grant, 111., June 21, 1018. On August
19 the order came to proceed to Camp Upton, N. Y., and there
await transportation for overseas. We arrived at Camp Upton
August 21, 1918.
We were fortunate in being assigned to one of the fastest ships
in convoy service, namely, Northern Pacific.
On the 8th day of September we landed at Brest and again took
up land quarters. AVe were due a rest after this more or less
strenuous trip and went for a stay of 40 days at Pontanzen Barracks.
On September 25, 1918, we arrived at Bazoilles.
The organization proceeded on October 2. 1918, to Souilly, where
a complete disorganization took place. The identity of Evacuation
Hospital No. 20 was lost temporarily. The disorganization of the
enlisted men was as complete as that of the officers. We had arrived
at Souilly with a strength of 219 men, the men were divided among
the neighboring hospitals. However, our identity as a working
unit was again established on November 18, 1918, when a general
order united us again at Fleury.
We arrived at Thonnance les Joinville, November 20, 1918, and
were billeted with the French. On Thanksgiving Day, November
28, 1918, we proceeded to Chatronrupt, a small village of the Marne,
about 7 kilometers from Thonnance. The order of December 18,
1918, taking us to Dax, was decidedly welcome. We understood that
we were to establish a convalescent hospital in one of the hotels.
With the closing of the hospital we were ordered to Beau Desert,
Januar}^ 12, 1919. On January 12, 1919, we arrived at Beau Desert
to relieve Base Hospital No. 22. We became known as the official
evacuating hospital for Beau Desert hospital center January 23,
1919.
p. EVACUATION HOSPITAL NO. 21.
The personnel of Evacuation Hospital No. 21 is composed of mem-
bers representing 22 States, 75 per cent of the enlisted personnel
being from the State of Oklahoma. Organized at Fort Riley, Kans.,
April 17, 1918. Transferred to Camp Custer, Mich., June 19, 1918.
Unit remained at Camp Custer, Mich., until ordered overseas on
August 27, 1918.
Arrived at Camp Upton, Long Island, N. Y., August 29, 1918.
Thirty-two officers and 235 enlisted men sailed from port of em-
barkation at 3 p. m., September 1, 1918. Arrived at Liverpool,
England, September 13, 1918; arrived at Southampton, England,
same date; arrived at Le Havre, France, September 16, 1918; or-
dered to hospital center, Rimaucourt, Haute-Marne, for duty per
General Order 254, headquarters Base Section No. 4, September 17,
1918. Arrived hospital center, Rimaucourt, Haute-Mame, Septem-
ber 20. 1918.
A. E. F. — EVACUATION HOSPITALS. 1725
In addition to evacuating patients receiving treatment at our
hospital all patients from Evacuation Hospital Xo. 14, located at
Les Islettes. were brought by ambulance to Villers Daucourt to
be evacuated by hospital train, these patients being handled by our
personnel.
On November 1, 1918, the gas annex of American Red Cross Hos-
pital No. 110 Avas taken over by Evacuation Hospital No. 21, from
Field Hospital No. 11. The function of the gas annex was to take
care of all gas patients coming into the center, thus making room
for the wounded in the main building of American Red Cross Hos-
pital No. 110; also at times the annex took care of the overflow of
wounded; there have been as man}'- as 260 wounded in the gas
annex at one time ;• these wounded were taken care of bj' surgical
teams of Evacuation Hospital No. 21.
The gas annex was set up in tents, 1 receiving ward tent, 1 de-
lousing and bath tent, 1 large ward of 165 beds, 7 small ward tents
of 30 beds each, and 1 kitchen tent.
Type of gas cases received : Burns, mustard gas, 64.7 per cent ; of
these 5 per cent were inhalation mustard; inhalation phosgene, 17.5
per cent; inhalation, not yet determined, 17.8 per cent. Of the inhal-
ation not yet determined, none developed severe symptoms while in
the evacuation hospital. About one-half per cent of the cases of
inhalation phosgene developed bronchial pneumonia while in the
hospital. Most of the burns from nmstard gas were of the scrotum,
face, and hands; also many had quite severe conjunctivitis. On
November 15:, 1918. the last patient was evacuated and the gas hospi-
tal closed.
All the operating was done in one large operating room, imme-
diately adjoining the X-ray department; it was a former large
ward, well lighted, from which all the usual ward furniture had
been removed. It was equipped with from 15 to 20 tables, arranged
in two rows, with no partitions between. Each team usually con-
sisted of one operator (an officer), a surgical assistant (an officer),
aneesthetist (usually an officer) , a female nurse, and an enlisted man
who acted as orderly. There was, in general, no specialization of
work by individual teams except for some head cases, and each
team was assigned to one or two tables and operated upon what-
ever cases were put on their table. As soon as one case was com-
pleted, another was placed upon the table, so that no time was lost.
Besides each table was a small instrument table, and on this were
merely one scalpel and one pair of scissors, one hemostatic forceps,
one anatomical forceps, a needle and a piece of catgut suture. At
the middle of the room was a large table full of sterile supplies and
a large table full of sterilized instruments of various kinds, in
charge of a nurse. At call she would go to any table requiring them
and supply additional instruments used in dressings as requested.
This greatly lessened the number of instruments used in and need-
ing to be cleaned after each operation and proved to be most prac-
tical. The operating teams worked in 12-hour shifts.
After the signing of the armistice on November 11, 1918, fcAver
and fewer surgical cases were admitted, though a considerable num-
ber continued to come in for the next 10 days or so. On the other
hand, the number of medical cases rapidly increased and during
1726 TvEPORT OF THE SURGEOX GEXERAL, OF THE ARMY.
the last two weeks our officers were there, the hospital Avas essen-
tially a medical hospital. The cases were chiefly acute pneumonia,
influenza, and dysentery cases. Surgeons formerly in charge of
surgical wards were now called upon to do medical work and one
of our officers acted as chief of the medical service during most of
this time. After the signing of the armistice the operating teams
left one by one. and our officers, who had previously been very busy
all the time, now had essentially all of the work of the hospital
on their hands. They were relieved on November 30, 1918, and then
returned to Villers Daucourt to their organization.
Some idea of the amount of work done at Fleury, at Red Cross
Hospital No. 114, can be gained from the following statistics: From
September 26, 1918. to Xovember 11, 1918. the total number of evac-
uations was 28,130; casualties, 21,078; total prisoners, 575 (casual-
ties), sick 6,477. Our 15 officers were on duty there from October
14, 1918, to Xovember 30. 1918. The total number of hospital trains
that left Fleury during this period was 93.
The typhoid problem Avas rather surprising in that four cases in
our first two months of activities were sufficiently pronounced- to
■warrant a clinical diagnosis ; we had a number of suspected cases, the
same having the jDresence of the typhoid organism in the feces and
urine. Unfortunately many of these cases would come to us as in-
fluenza and the disease was so far advanced that blood culture
proved of little value.
It was noteworthy that a large percentage of medical cases ad-
mitted to the hospital comiDlained of rather vague or at times definite
gastrointestinal symptoms, chiefly pain about the appendiceal re-
gion or disturbances after eating, leaving one to be suspicious of
appendix involvement or of ulcerative condition of the stomach and
duodenum. Exhausted clinical, laboratory, and X-ray work per-
formed on cases of this character demonstrated the surprising fact
that a great number were old chronic gall-bladder conditions, evi-
dently the patients havinor had an acute inflammatory condition at
some earlier date which they would invariably call stomach trouble.
One of the most interesting phases of the medical work was that
handled by the isolation ward which was used chiefly for vague,
undiagnosed conditions requiring exhaustive study before a definite
diagnosis could be made. Here cases such as angioneurotic edema,
the determined and undetermined skin .lesions, an occasional Kor-
sakofFs psychosis, general paresis, meningitis, or a malaria would
be found.
Q. EVACUATION HOSPITAL XO. 2 2.
Evacuation Hospital Xo. 22 was organized on the 6th of March,
1918.
This recruit company expanded and contracted until on April 1,
1918, the enlisted personnel of Evacuation Hospital Xo. 22 was or-
ganized, numbering 2 noncommissioned officers and 177 privates.
The company of 30 officers and 235 enlisted men entrained at
Camp Sevier, S. C. August 19, 1918. and arrived at Camp Upton,
X\ y.. August 21, 1918^ Left Camp Upton August 29, 1918, for
Hoboken, X. J., where the organization embarked on the U. S.
transport Kroonland and sailed at 4.30 p. m., August 30, 1918.
A. E. F. — EVACUATION HOSPITALS. 1727
The trip across was uneventful with the exception of an influenza
epidemic through which one enlisted man died (pneumonia, lobu-
lar). The Kroonland cast anchor in the harbor of Brest at 8 a. m.,
September 12, 1918. Organization debarked during the afternoon
of September 13, 1918, and were marched to Pontanezen Barracks,
where it encamped just outside the old wall.
On September 18, 1918, at 3.30 a. m., the organization entrained
at Brest and arrived at Allery (Saone-et-Loire) at 11.30 p. m., Sep-
tem})er 20, 1918, where temporary quarters were provided in the
hospital center. The company was quartered in Unit No. 6 of the
hospital center. Entrained at Allery, October 3, 1918; arrived at
Souilly October 6, 1918, where the pei-sonnel was broken up for tem-
porary dut}'.
Entrained January 12, 1919, at Joinville; arrived at hospital cen-
ter, Beaune (Cote d'Or), January 13, 1919. and were quartered with
Base Hospital Xo. 47, which was taken over by Evacuation Hos-
pital No. 22 January 23, 1919, and on January 31, 1919, all patients
were evacuated to Base Hospital No. 77.
Entrained February 13, 1919. at Beaune, and arrived at Coblenz,
Germany, on February 16, 1919, to take over Evacuation Hospital
No. 4, located on Oberwerth.
Believed Evacuation Hospital No. 4 on February 18, 1919, and
have functioned as a hospital since that date.
Organization ceased functioning as a hospital May 20, 1919.
R. EVACUATION HOSPITAL NO. 2 3.
This hospital unit originated at Camp Greenleaf, Chickamauga
Park, Ga., consisting on its birth date of five enlisted men of the
Medical Department. Two days later, on June 16, 1918, 150 enlisted
men were transferred to Evacuation Hospital No. 23 from the 157th
Depot Brigade, Camp Gordon, Atlanta, Ga. The organization was
then ordered to Fort McPherson, Ga., where it arrived on June 26,
1918.
On August 27 the organization left Fort McPherson for Camp
Upton with 170 men and 31 officers, where it arrived on August 29,
1918. All necessary personal equipment was then supplied, and on
the morning of August 31, 1918. the organization left Camp Upton
for New York, where it boarded the U. S. transport Baltic. After
spending the night in the harbor, departed for Liverpool, England,
the vessel being one of a convoy of 13 ships.
After an uneventful voyage of 13 days the steamer docked at
Liverpool, England, early on the morning of September 13, 1918,
and all men and officers debarked. The organization then marched
to the railroad station, where it entrained for Southampton. After
having arrived at Southampton they proceeded to a rest camp some
distance from the station, where they remained until the next day,
September 14, then the men with four officers boarded a channel
boat. The officers boarded another boat to proceed across the Eng-
lish Channel. The boat with the men aboard crossed the channel
during a severe storm, and arrived in the harbor of Le Havre 20
minutes late for the tide, making docking impossible, lying: in the
harbor until 6 p. m., when they docked and debarked. The boat
conveying the officers started for Le Havre, but, finding the channel
1728 EEPOET OF THE SURGEON" GENERAL OF THE ARMY.
too rougli, the pilot deemed it unwise to cross, and returned to the
docks, starting again the following day, this time landing safely
on the morning of September 16. Two days and one night were
spent at Le Havre, and the organization entrained and after two days
and two nights arrived at the large camp now being used as a uni-
versity at Beaune.
On October 1, 1918, the organization was ordered to start a con-
valescent camp, which entailed putting up of numerous Marquise
tents for the housing of convalescent patients. The convalescent
camp was under the supervision of Evacuation Hospital No. 23 until
October 8, when they received orders to entrain for Souilly. On
October 10 the organization arrived at Souilly, and was broken up
by command of the chief surgeon of the First Army and the per-
sonnel distributed as follows: Evacuation Hospital No. 9,V{iubecourt,
14 officers; Evacuation Hospital No. 10, 4 officers; Evacuation Hos-
pital No. 8, 7 officers; Evacuation Hospital No. 7, 2 officers; Neuro-
logical Hospital No. 1, 1 officer; contagious hospital, Verennes, 1
officer; Evacuation Hospital No. 11, 3 officers. The enlisted men
were divided and sent to various hospitals.
After six weeks of arduous work in the various hospitals the
organization was ordered to reassemble at Souilly on November 20.
On November 21 they left Souilly and arrived in Joinville, Haute-
Marne, on November 21.
S. EVACUATION HOSPITAL XO. 24.
Evacuation Hospital No. 24 had its origin at Camp Greenleaf, Ga.,
June 14. Under date of June 23, 1918, the officer in charge and en-
listed personnel was ordered to proceed to Camp Devens, Mass., to
complete the process of mobilization of the unit and for training at
the base hospital.
On August 27 the entire enlisted personnel were issued their over-
seas equipment and all those in training at the hospital, X-ray build-
ing, and the laboratory' were withdrawn from duty. On August 27,
1918, physical examinations for overseas service were held and out
of 330 enlisted men 237 were found to be physically fit and the
remainder were transferred for duty with the hospital at Camp
Devens. On August 29 the entire unit — officers, enlisted men, and
equipment — was thoroughly inspected and pronounced fit for over-
seas duty. Evacuation Hospital No. 24 left Camp Devens August
30 for New York, arriving at One hundred and twenty-ninth Street
on the morning of August 31, 1918. The unit immediately detrained
and went aboard the ferry, sailing around the Battery, up the Hud-
son River to Pier No. 56, and then boarded a British liner, H. M. S.
Gm^iania^ of the Cunard Line. The Carmania remained in the har-
bor until 4 o'clock on the afternoon of September 1. Tw^o daj^s out
of New York Harbor a submarine was encountered, and the Car-
mania fired two shots. It was not known whether or not the sub-
marine was sunk. The convoy, after an interesting voj'age, was met
on the morning of September 12 by a flotilla of British destroyers.
The ship arrived at Liverpool, England, on the morning of Septem-
ber 13, and at 6 o'clock that evening the unit debarked and marched
5 miles to a British rest camp located at Knotty Ash, and remained
there until the morning of September 18, at which time the unit
A. E. F. — EVACUATIOX HOSPITALS. 1729
marched to the station at Knotty Ash and entrained for Southamp-
ton. The unit arrived at Southampton on the evening of September
18 and went into a British rest camp, in which they remained until
the following afternoon at 1 o'clock, at which time the unit marched
to the dock Southampton and boarded the steamship Harvard^ aniv-
ing at Le Havre on the morning of September 20. 1918. The unit de-
barked at 8 o'clock and made a 5-mile walk to British Rest Camp No.
1, located outside the city of Le Havre. At 2 o'clock the following
morning the unit left by training, arriving at Mesves on the evening
of September 22, 1918. The personnel of the hospital at the time of
arrival at the center consisted of 32 officers and 236 enlisted men,
one of the enlisted men having been left in the camp hospital at
Knotty Ash, England, on account of illness.
Evacuation Hospital No. 24 was assigned to Unit No. 2, which was
in a very incomplete state of construction. The officers' barracks
were not built and the nurses' quarters were not completed.
As this was an evacuation unit, no nurses were assigned for duty.
Under date of October 1, 1918, the first patients were received, num-
bering 355, from which date they were received in great numbers.
On October 1, 27 nurses were assigned for duty from Base Hospital
No. 67.
The bed capacity of the hospital at this time was 2,000 beds. Under
date of October 17, Evacuation Hos])ital No. 24 took over Unit No.
7, increasing the bed capacity to 4,275. Evacuation Hospital No. 27
took over this unit after Evacuation Hospital No. 24 had operated
it for a period of over two months.
The total number of patients treated in Evacuation Hospital No.
24 to date is 8,841. The greatest number of patients in this hospital
at one time was 3.159. The number of primary surgical admissions
is 2,035. Medical primary admissions 2,792. No deaths have oc-
curred among the personnel of the unit with the exception of 3 en-
listed men Avho succumbed to pneumonia.
Of the 8,841 patients, about 50 per cent were surgical and 50
per cent medical. Special wards were provided for pneumonia,
gastrointestinal and maxillary cases, and a ward for chest and
abdominal cases in the surgical service. The gunshot fractures pre-
dominated numerically second only to simple wounds of soft parts,
there being 4 wards devoted entirely to these cases.
The X-ray equipment consisted of one portable bedside unit, with
which excellent work has lieen done. The cases requiring greater
penetration and special localization were made for us by Base Hospi-
tal No. 54. with their standard equipment. The laboratory com-
menced to function as soon as patients were received in the hospital.
The Red Cross hut was used for a ward for considerable length of
time, and therefore there was no opportunity for anything of a social
nature.
Under date of January 20, 1919, Base Hospital No. 67 ceased to
function, and their patients, numbering 422, together with 11 active
wards, were transferred to Evacuation Hospital No. 24. During the
past two or three weeks patients have been evacuated almost daily
and at the present time there are only 200 patients in this hospital.
1730 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
T. EVACUATION HOSPITAL NO. 2 5.
Organized Camp Greenleaf, Ga., June 16, 1918, per V. O. C. O.,
Hdq. & Hosp. Group, Camp Greenleaf, Ga. Evacuation Hospital
No. '25 left Camp Greenleaf, Ga., August 21, 1918, at 11.45 a. m. en
route to Camp Dodge, Iowa, with lOO enlisted men and 4 officers.
Arrived at Camp Dodge with all men and officers accounted for at
7.30 n. m., August 23, 1918. At Camp Dodge the necessary training
was begun and equipment obtained. About 50 men were sent to the
base hospital for instruction in ward and operating-room work.
Earl}' in October, 1918, the epidemic of so-called " influenza,"
which iiad been raging in the East, struck Camp Dodge with terrific
iiitensit}^ and suddenness. The medical officers, men, and nui-ses
of the camp and base hospital were terribly handicapped by the sud-
denness and enormous numbers of admission to the hospital. At the
very outset of the epidemic all available medical officers of Evacua-
tion Hospital No. 25 were sent to the base hospital to give what aid
they could in any way. Practically every officer of Evacuation Hos-
pital No. 25 and all men that could be spared were assigned to the
base for duty. Our organization left Camp Dodge October 29; ar-
rived at Camp Upton, X. Y., 12.30 p. m. November 1, 1918. Finally
left Camp Upton November 10, 1918, and went aboard the U. S. S.
Sierra at 11.30 a. m. November 10, 1918, with 228 enlisted men and
27 officers. We lay at dock on November 11, 1918, and listened to the
sounds of celebration of the signing of the armistice, and our hopes
of " getting over " died, to be revived later, however, as we got orders
to proceed, and sailed out of the pier at 12.30 p. m. November 12,
1918. After a rather rough but otherwise uneventful trip Evacuation
Hospital No. 25 debarked at Bastid, France, on November 24, 1918,
at 10.30 a. m., and w^ent into quarters at a rest camp outside of Bor-
deaux until December 3, 1918, when we left for Joinville, France.
Unfortunately, Evacuation Hospital No. 25 was not destined to func-
tionate as such, and the men and officers found it difficult to accept
their enforced inactivity. On January 11, 1919, the organization
entrained at Joinville for Vichy. Arrived at Vichy January 13, 1919,
at 6 a. m. While at Vichy about 139 enlisted men were detached and
transferred to duty, hospital center, Savenay. On February 21 the
remainder of Evacuation Hospital No. 25 left Vichy. February 23
arrived at St. Loubes at 3 a. m., detrained at 8 a. m., and proceeded
by trucks to Saliebouef , arriving about 12 noon, and went into billets
to await embarkation orders for the United States.
U. EVACUATION HOSPITAL NO. 2 6.
Evacuattion Hospital No. 26, organized at Camp Greenleaf, Chick-
amauga Park, Ga., on July 1, 1918. The personnel was assigned
from the evacuation group at that camp.
On August 30, 1918, the organization, then consisting of the com-
manding officer, 3 medical officers, and 100 enlisted men, was ordered
to Camp Jackson, Columbia, S. C, to prepare for service overseas.
The organization arrived at Camp Jackson on September 1. The
organization reported itself ready and was ordered to Camp Mills,
Long Island, N. Y., on October 11, 1918, arriving there October 13,
1918, and embarked October 17, 1918, on H. M. S. Olympic. The
A. E. F. — EVACUATION HOSPITALS. 1731
organization being the only medical unit on the ship, organized the
ship hospital. There was considerable sickness but no deaths, al-
though the voyage was accomplished during the influenza epidemic,
and there were approximately 8,000 troops on board.
On February 1, 1919, the organization was ordered to the American
occupied area, arriving at Xeuenahr, Germany, February 4, 1919, and
commenced functioning on February 7, 1919. with a bed capacity of
1,100.
The building used is known as the Kur-Hotel and is one of the
most modern of German hotels. It is well equipped and was easily
adapted for hospital purposes.
To date (Apr. 15) a total of 2,196 patients have been admitted to
the hospital, as follows:
February 1, 101
Dailj^ average 531
March 894
Daily average 768
Apr. 1-15 201
During February there were admitted 175 cases of pneumonia and
approximately 270 cases of influenza. During March there were
admitted 52 cases of pneumonia and 55 cases of influenza, these fig-
ures showing a marked falling off from the preceding month.
From April 1 to April 15 there were admitted 14 cases of pneumonia
and 19 cases of influenza. This makes a total of 241 cases of pneu-
monia admitted from February 4 to April 15, 1919, of which 58
cases died, giving a mortality of 24.06 per cent. At this time a
severe epidemic of influenza and pneumonia was prevailing in the
Third Army, so that from the moment the hospital was set up
the staff and personnel were very busy caring for these cases. Many
cases sent in as influenza later proved to be pneumonia, most fre-
quentl}' of the broncho-pneumonia type. The striking thing about
these cases of pneumonia was the very small number of cases of
empyema which developed.
We have had three cases of epidemic cerebrospinal meningitis, one
case of pneumococcic meningitis, and one case of tubercular menin-
gitis, all of which have died.
V. EVACUATION HOSPITAL NO. 2 7.
Fifty enlisted men detrained at Camp Greenleaf, Chickamauga
Park, Ga.. on June 16, 1918, and were assigned to Evacuation Hos-
pital Xo. 27, in the evacuation group. These men came from the
training companies at Camp Taylor, Ky., 25 from Company 25 and
25 from Company 26. On August 30, 1918, the unit proceeded to
Camp Pike, Ark., arriving at that station September 1, 1918.
October 22, 1918, the unit entrained at Camp Pike and proceeded
eastward, via St. Louis, Indianapolis, and Buffalo, to Camp Mer-
ritt, N. J. The Eed Cross at Rochester, N. Y., entertained the unit
with automobile rides and hot food.
Detrained at Camp Merritt October 25, 1918, at 10 a. m. and spent
the afternoon and night in completing the overseas equipment and
at 6 o'clock on the morning of the 26th marched to the Alpine Land-
ing, on the Hudson River, and was transported by ferry to Pier No.
5 of the Cunard Line, New York. On the pier the Eed Cross served
142367— 1&— VOL 2 48
1732 REPORT OF THE SURGEON GENERAL OF THE ARMY.
rolls and hot coffee. The unit embarked at 1 p. m. on H. M. S.
Leicestershire, which dropped to the lower harbor about 6 p. m. of
the same day. The trans-Atlantic voyage started about 5 p. m.
October 27 in a convoy of 14 transports.
Debarkation at Liverpool, England, November 8 and entrainment
for Southampton. Detrained at Southampton 2 a. m. November
9 and marched to the rest camp. Embarked at Southampton No-
vember 10 and debarked at Le Havre, Erance. November 11, at
7.30 a. m., and marched to the rest camp.
Entrained at Le Havre November 14 and reached the forwarding
camp at Le Mans November 15. Entrained at Le Mans December
13 and arrived at the Mesves-Bulcy hospital center on December 14,
This organization took over Provisional Unit No. 7 on December
19, consisting of 10 wards of 100 beds each and associated buildings.
The following ]3atients were in the hospital :
Class A from Uuit No. 7 ^___ 1,034
Class A from Base Hospital No. 54 245
Total 1, 279
Entrained at Mesves-Bulcy February 19, 1919, and arrived at
Coblenz. Germany, February 22, 1919. Took over the hospital area
and patients of Evacuation Hospital No. 6. This was a German mili-
tary hospital, about 2 kilometeis from the center of the city of Cob-
lenz, called the Garnison Lazarett Coblenz. Since the organization
took over this hospital on March 1, 1919, the total number of admis-
sions has been 3,030. There are about 250 acute- surgical and accident
cases operated upon each month. There are about 275 orthopedic
cases treated each month. The bed capacity on the orthopedic service
has increased from 88 to 284. The average length of hospital treat-
ment for fracture cases is 24.56 days.
W, EVACUATION HOSPITAL NO. 29.
Evacuation Hospital No. 29, consisting of 28 officers and 237 en-
listed men, mobilized at Camp Beauregard, La., during the month of
September, 1918. . . .
The organization first functioned in conjunction with the base hos-
pital, Camp Beauregard, La., from September 25, 1918, to October
18, 1918, during the influenza epidemic. An auxiliary hospital estab-
lished, utilizing Young Men's Christian Association huts, the Red
Cross convalescent home, garages, and tents, with accommodation
for 1,300 patients and treating, in all. 2,500 patients.
The unit departed for Camp Upton, N. Y., October 23, 1918, to
prepare for embarkation. The unit embarked November 1. 1918, on
the S. S. Aquitania. Evacuation Hospital No. 29 took charge of the
troop hospital on board ship and cared for 55 patients. Debarked
at Brest, France. November 9, 1918. and spent one week in rest camp
there at Pontanazen Barracks. November 17, 1918, the unit en-
trained for Joinville, Haute-Marne, medical concentration area, ad-
vance section. On December 19, 1918, organization entrained for
Bagneres de Bigorre. Haute-Pyrenees, arriving at destination De-
cember 22, 1918. Immediately proceeded to establish a 1,250-bed
hospital in 8 large hotels with camp hospital equipment. Hospital
A. E. F. — EVACUATION HOSPITALS. 1733
accommodation for 450 patients had been completed "svlien orders were
received. January 7, to proceed to Mesves hospital center, Mesves,
Xierve. France, arriving at destination January 14, 1919. On morn-
ing of January 18, 1919, Evacuation Hospital Xo. 29 relieved Base
Hospital Xo. 44, and operated as a hospital in the ^lesves hospital
center until January 31, 1919, when the remaining casuals and pa-
tients, some 30 in number, were transferred to Evacuation Hospital
Xo. 24. Then the hospital ceased to function. Evacuation Hospital
Xo. 29 is now imder orders to proceed to Prum, Germany, on the line
of communications from the Luxemburg frontier to the Ehine, to
relieve Evacuation Hospital Xo. 7.
X, EVACUATION HOSPITAL NO. 30.
Evacuation Hospital Xo. 30 was organized by Surgeon General's
Office at Camp Greenleaf. Fort Oglethorpe, Ga., on June 15, 1918.
Preliminary training such as drill, lectures, and hospital training
were given there. Mobilization for overseas was ordered by War
Department in August. 1918, at Camp Greene, X. C.
During mobilization influenza became epidemic throughout the
States. On October 4 a field hospital was established. The work of
the hospital relieved congestion at the base hospital and made pos-
sible the proper handling of the patients, and during 10 da3's over
1,800 patients were admitted.
The unit was also favored by a transfer of men from the base hos-
pital of the camp to its enlisted personnel, and thereby acquired the
services of about 25 experienced men. About 50 men of the detach-
ment were assigned to the emergency field hospital for influenza dur-
ing its period of operation.
The unit reported ready for overseas on October IG. 1918, but was
delayed by a quarantine of the camp, and later by inal)ility to secure
transportation to the base port, and finally left Camp Greene for em-
barkation at Camp Merritt on October 22, 1918. On October 26 the
unit boarded the steamship Lapland^ which was on© of 14 transports
in a convoy for Liverpool.
The unit arrived at Liverpool, England, Xovember 8, 1918, and
proceeded to the rest camp at Southampton, arriving there Xovember
9, 1918. Left for Le Havre, France. Xovember 10. 1918. arriving in
France morning of Xovember 11, 1918, and going to rest camp, that
city. Organization left Le Havre, France, on Xovemljer 14, report-
ing at Le Mans, Xovember 15, 1918, being assigned to the forwarding
camp for special gas training. Orders were issued for the unit to
proceed to evacuation hospital center at Joinville, but an embargo on
troop movements was interpreted to include evacuation hospitals also.
Organization left Le Mans, December 13, 1918, arriving at Mars-
sur-Allier, December 14. 1918. At this section tlie officers were tem-
jDorarily quartered in the area occupied by Base Hospital Xo. 131.
Enlisted men's quarters were first prepared, tlie detachment moving
into area Xo. 10 about January 3, 1919. Officers' quarters were then
completed and occupied January 15, 1919. Owing to the armistice,
engineering work had practically ceased in the center, and supplies
for construction were obtained with great difficulty, so that area
was not reported ready to receive patients until January 12, 1919.
A few days after the unit was ordered to relieve Base Hospital Xo.
1734 llEPORT OF THE SURGEOX GENERAL OF THE AEMY.
35, Avhich ^v;is operating in this center, the transfer being made Janu-
ary 15, 1910. On this date Evacuation Hospital Xo. 30 began oper-
ating with 500 patients, and continued as such until ordered trans-
ferred to Mayen, Rhineland, Germany, with the army of occupation,
February 13, 1919. Evacuation Hospital No. 30 was relieved at
hospital center by Base Hospital Xo. 123, at that time operating in
the hospital center at Mars. Left hospital center, Mars-sur-Alliei,
France, February 13, 1919, relieving Evacuation Hospital Xo. 8,
Mayen, Rhineland, Germany, February 20, 1919. The unit arrived
at Maten, Rhineland, Germany, February 17, 1919.
V. EVACUATION HOSPITAL NO. 3 3.
Evacuation Hospital Xo. 33 was mobilized at Camp Shelby. Miss.,
Septembci'. 1918. The detachment was made up of 234 enlisted men;
100 from Camp Greenleaf, Ga.: 125 from Canip Dodge, Iowa; and
9 from base hospital. Camp Shelby, Miss. Of the first 100 men re-
ceived from Camp Dodge. Iowa, 21 were sent immediately into the
base hospital at Camp Shelby, Miss., with influenza. This detach-
ment had worn no masks on the train. The next detachment arriv-
ing from Camp Dodge, Iowa, wore maslcs en route, and had a com-
paratively snuill incidence of influenza.
^ October 28 to October 31. 1918, en route to embarkation camp.
Camp Upton, X. Y. Accommodations consisted of ordinary day
coaches for officers and men. Each man w^as allotted an entire seat,
and the men were compelled to wear gauze face masks supplied
by the Red Cross as a precaution airainst influenza. Onlv one man
was sent to hospital at Hoboken, X. J., with influenza. Suspicious
cases were cubicled in the train.
This unit never functioned as a hospital in the United States.
The unit arrived at Camp Upton, X. Y., October 31. 1918, and on
November 10, 1918, embarked on steamship Sierra with Evacuation
Hospitals Xos. 25 and 35, and Medical Replacement Units Nos.
C8 and 69, bound for France. Sailed from Hoboken Xevember 12,
1918 ; landed at Bordeaux, France, Xovember 24, 1918. Xo influenza
on board.
The unit was quartered at Rest Camp Xo. 1, Grange Xeuve, for
nine days, then proceeded to Joinville (Haute-Marne), France.
The unit arrived at Joinville December 6, 1918. Here the unit was
divided in order to facilitate billeting.
Curel. France, was occupied by the 113th Sanitary Train. Other
organizations present or arrived soon after December 6, 1918, were
Evacuation Hospitals Xos. 34, 25, 26, 31, and 32, and Mobile Hospital
Units Nos. 100, 101, 102, and 103. There was almost continuous
rainy and cold weather. The Ri^-er Marne overflowed and the
valley was covered with water. The officers' mess hall was entirely
flooded out by a rise of a small stream back of it on one occasion.
The water for officers and men was obtained from one well, marked
"Eau potable." but later found to contain colon bacillus. There
was some delay in obtaining Lyster bags and chlorinating tubes,
and on one occasion after all the water was being chlorinated for
a day or two it was impossible to get chlorinating tubes. The second
week of our residence in Curel dysentery appeared and within a
week a large number of all the officers and men billeted here were
A. E. F. — EVACUATION HOSPITALS. 1735
affected. A conservative estimate of the number affected would be
75 per cent. The disease was checked with considerable difficulty,
and individual cases lasted for weeks.
Christmas Day our first case of suspected typhoid fever was sent
to Base Hospital No. 58, Eimaucourt. Within the next two weeks
26 men were sent to Base Hospital Xo. 58, Rimaucourt, and Mobile
Hospital No. 11, Donjeux, and 17 were reported back as positive
typhoid fever, confirmed by agglutination test and some with posi-
tive blood cultures. Of these 17 men, 6 died; a very high mortality.
It should be noted that the first case of typhoid was the mess
sergeant.
At Curel we had little trouble with influenza. It is a question
whether some of the cases of dysentery may not have had a mild
typhoid.
After arrival at Vichy, on January 28, 1919, nine more men who
were admitted to base hospital were reported as typhoid fever. This
brought our total number of cases up to 26. The cases at Vichy all
ran mild courses, and no new cases developed after the inoculation
period, beginning at Curel, was over. All the men were again vac-
cinated against typhoid in January at Vichy.
One case was reported to us by Base Hospital No. 109 as typhoid
carrier. The entire detachment was examined by the laboratory at
Vichy for the presence of possible carriers.
January 11, 1919, the unit left Curel to proceed to Vichy to re-
place Base Hospital Unit No. 1. The unit reported at Vichy
January 13, 1919, but the order to replace Base Hospital Unit No. 1
was revoked.
This unit was on no special duty at Vichy, France.
February 21, 1919, to February 23, 1919, en route from Vichy to
St. Loubes (Gironde), France, Base Section No. 2, to await embark-
ation. Arrived at St. Loubes, Base Section No. 2, February 23, 1919.
This organization has never functioned as a hospital. The organi-
zation suffered little from the influenza in both the United States and
in France. On occasions masks were worn and cubicles used. There
was an occasional case of mumps, but no outbreak of any infectious
disease, excepting the typhoid, and no deaths aside from the six
typhoid. Venereal : Only one case of gonorrhea in the States and one
case in France.
Z. EVACUATION HOSPITAL NO. 35.
Telegraphic instructions were received from The Adjutant Gen-
eral's Office, War Department, dated August 11, 1918, ordering Evac-
uation Hospital No. 35 to be formed.
The first step in the evolutions of the organization took place when
four of our officers were ordered to report to Camp Wadsworth, S. C,
from the base hospital at Camp Dodge, Iowa.
On September 26, 1918, the base hospital at Camp Wadsworth be-
gan to show evidences of an epidemic. The cases at first were fcAv,
but conditions, instead of improving, grew worse, and assumed such
proportions that on the morning of October 1, 1918, Camp Wads-
worth was placed under a very rigid quarantine for Spanish in-
fluenza.
1736 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The epidemic Avas of a very severe type, and one which proved to
be of a ver}' high virulence. The spread of the disease was universal
througliout the camp, and the various organizations in the camp
placed their commands under their own separate quarantine. The
Young ]\Ien's Christian Association houses, the hostess house, the
movies, etc., were all closed — even the canteens — so as to prevent
large croAvds from gathering, thus disseminating the spreading of the
infection. Gauze masks were ordered to be used.
The base hospital was taxed to overflowing, and our Evacuation
Hospital No. 35 officers devoted their entire time trying to help check
the epidemic. Three of our officers were taken ill with it and con-
fined to a ward, but soon afterwards recovered. It was our sad mis-
fortune to lose one of our corps men, who succumbed to an attack of
broncho-pneumonia, following influenza, on October 21, 1918. Al-
though several of our personnel were seized by the epidemic, luckily
all the others recovered.
On October 23, 1918, pursuant to telegraphic instructions, all the
officers and enlisted men of Evacuation Hospital No. 35 were relieved
from temporary duty with the base hospital at Camp Wadsworth
and placed in isolation tents in one of the extreme sections of Camp
Wadsworth.
Our week in the isolation tents was a very busy one, for all the
overseas equipment had to be issued, and all the details carefully ar-
ranged for our departure. At this time some of our enlisted men had
failed to pass their overseas examination, which necessitated their
being transferred, and with the new men transferred to Evacuation
Hospital No. 35, our personnel was now completed, numbering 237
men.
On November 1, 1918, Evacuation Hospital No. 35, consisting of 31
officers and 237 enlisted men, proceeded by rail to Camp tJpton,
N. Y., where we arrived November 3, 1918, at 2.30 a. m.
At 3.30 a. m., on the morning of November 10, 1918. we boarded
a train and left for Hoboken Pier, where we were to go aboard our
transport, the U. S. S. Sierra.
The officers of the Sierra expected to sail in the early hours of
November 11, 1918, and consequently many of us arose early so as
to get a parting glance at the Statue of Liberty and New York Har-
bor. Instead of sailing in the early morning orders had been re-
ceived postponing our departure and our ears received the terriffic
noises of foghorns, whistles, bells, etc., and the cause of it all was
the armistice had been signed on that memorable November 11, 1918.
At noon on November 12, 1918, we were towed to midstream, where
we leisurely steamed along on our journey " over there."
On the morning of November 23, 1918, we dropped anchor at the
mouth of the Gironde River, opposite Royan, and waited until about
7 a. m. on the following day.
It was almost noontime when we tied up alongside of the dock at
Bassons.
We disembarked about 3 p. m. that afternoon, and in a downpour
of rain marched 5 miles to the Bordeaux Embarkation Camp No. 2,
whi( h was to be our " rest camp " for the following week.
. On the evening of December 3, 1918, we boarded a special train and
proceeded to Joinville (Halite-Marne). We arrived there about 10
A. E. F. — EVACUATION HOSPITALS. 1737
p. m., December 5, 1918, so we stayed in the coaches until the morn-
ing of December 6, 1918.
After a stay of 34 days started on the morning of January 10,
1919, for Blois (Loir-et-Cher).
Upon our arrival in Blois we found Base Hospital No. 43 occupy-
ing and conducting seven buildings as annexes of their hospital,
and had in addition to these a nurses' home and a headquarters build-
ing. All of the buildings were located in diiferent parts of the city
and were French public buildings, most of them being school build-
ings.
The officers and enlisted men in Evacuation Hospital No. 35 were
at once assigned to the different sections of the hospital for duty so.
as to become thoroughly familiar with the work and methods of the
hospital before the transfer from base hospital to Evacuation Hos-
pital No. 35 was to be made.
On the morning of January 20, 1919, the official transfer of the
hospital from Base Hospital No. 43 to Evacuation Hospital No. 35
was made, and the hospital at Blois was then known as Evacuation
Hospital No, 35.
The hospital then consisted of five sections, and were designated as
follows :
Annex 29.— Used for general medicine.
Hospital Mixte. — Infectious and contagious diseases and genitourinary-
cases.
Ecole Superior. — General surgery, X-ray, orthopedics, and eye, ear, nose,
and throat.
Ecole Normal. — For convalescents.
Annex 115. — For convalescents, medical cases, and " brig " cases.
When our unit left for overseas no nurses had been assigned to our
unit. Consequently, our nurses were assigned to use from Base Hos-
pital No. 43, and 44 of them were made a part of Evacuation Hospi-
tal No. 35 Avhen the official transfer of the hospital took place.
Hospital Train Unit No. 39, complete, with 2 officers and 30 enlisted
men, formerly attached to Base Hospital No. 43 and on duty with
them, were left and attached to Evacuation Hospital No. 35.
Immediately upon taking charge of the hospital our efforts were
concentrated upon the evacuation of the patients from the hospital.
Many of the patients had been in the hospital for a considerable
length of time and were carried on the records as convalescents.
One of the first acts was the creation of a classification board, con-
sisting of three medical officers, which immediately began the task of
classifying all the patients in the hospital preparatory to sending them
out. There were not very many new admissions to the hospital, and
the casserne at Blois, before it was evacuated on February 15, 1919,
was the main source of our supply.
On the 13th of February, 1919, Hospital Train No. 65 was sent to
Blois, and 432 of our patients were sent out on it.
During the few days following the departure of the hospital train
approximately 200 Class A patients were dismissed, the majority of
which were sent to St. Aignan.
Hospital Mixte still continued to be the infectious and contagious
hospital, and with the removal of the surgical department, X-ray
department, and the dental infirmary to annex 29, the medical as well
as the surgical work was carried on in that annex. By the 1st of
1738 KEPOET OF THE SURGEON GENERAL OF THE ARMY.
JNIarch the evacuation of patients had increased so rapidly that less
than 200 patients remained in the hospital.
Our history from February 15, 1919, on must deal with the gradual
dissolution of our organization, Avhich began to take place immedi-
ately after our hospital was lessened in size and the number of our
patients gradually decreased.
By the end of the first week in March Evacuation Hospital No. 35
became merely a shadow of its original self.
On March 10, 1919, orders W'ere received for Evacuation Hospital
No. 35 to cease as an active organization in the American Expedi-
tionary Forces, and to be replaced by Camp Hospital No. 25, which
•would be officially established in Blois. The official transfer took
place at midnight on March 11, 1919, and Evacuation Hospital No.
35, consisting of 26 officers, 35 nurses, and 150 enlisted men became
Camp Hospital No. 25 and had 156 patients under their care in the
hospital.
Al. EVACUATION HOSPITAL NO. 36.
Evacuation Hospital No. 36 was organized at Camp Greenleaf , Fort
Oglethorpe, Ga., in the evacuation-hospital group of that camp. On
the following day enlisted men drawn from Evacuation Hospitals
Nos. 28 and 32, and from headquarters evacuation-hospital group re-
ported, forming a total of 145 men.
Entraining at Lytle Station, Chickamauga Park, on September 9,
1918, at 6.30 a. m, the organization arrived at Camp Wheeler 10
p. m. same date. On October 26 the hospital entrained for Camp
Upton; on October 30 was transferred to Hoboken, N. J., the port of
embarkation, and immediately embarked on the transport George
Washington^ sailing from New York Harbor on November 1, 1918.
After an uneventful trip the ship docked at Brest on November 9.
Late in the afternoon of that daj' half of the company were taken
ashore in lighters, the remainder being landed on the morning fol-
lowing, and thereupon the whole organization proceeded to Camp
Pontanezen.
On November 27 the hospital entrained and arrived at Eennes,
being quartered in the Cazern Duchess Anne. On December 26 the
hospitals were ordered closed and the organization returned to
Cazern Duchess Anne. A few days later orders were received, and
on January 3 the organization entrained for Nantes, France, to re-
lieve Base Hospital No. 34. On January 14 a number of the officers
of Base Hospital No. 34 were transferred to Evacuation Hospital
No. 36 and the work of managing the hospital was officially taken
over by this unit.
Base Hospital No. 34 w^as relieved by Evacuation Hospital No. 36
January 16, 1919. At that time there were 890 patients in the house,
and it was thought then that no more patients would be received ex-
cept from local commands in and about Nantes. But soon after this
large convoys of patients began to arrive from hospitals in the ad-
vance and intermediate sections. Services of Supply, which were
under orders to close, so Evacuation Hospital No. 36 was soon func-
tioning as an active evacuation center.
The war surgery consisted almost entirely of removing foreign
bodies, especially shrapnel fragments and bone sequestra, incisions
A. E. F. — EVACUATION HOSPITALS. 1739
for better drainage, and skin grafts. The civil surgery consisted to
a great extent of appendectomies, herniorrhaphies, hemorrhoidec-
tomies, and operations for the cure of varicocele.
In all there have been 3,883 patients handled by this hospital and
127 operations have been done. There has been one death on the
surgical service.
This being an evacuating hospital, the patients handled were
mostly convalescents. The acute respiratory cases, i. e., influenza
and pneumonia, were housed in barracks which were well ventilated,
having a door in each end, windows on each side about 4 feet apart,
and ventilators 4 feet apart in each side of the roof. Beds were 3
feet apart and separated from each other by screens suspended from
a wire to prevent cross infection. All convalescent patients out of
bed, ward surgeons, nurses, and orderlies were required to wear
masks. Owing to the fact of pneumonia being such a frequent com-
plication of influenza, the pneumonia ward was situated near and
connected to the influenza ward by a corridor. This facilitated the
transfer of patients with a minimum amount of handling.
The cases of contagious diseases were also treated in barracks
built and ventilated as those already described and subdivided into
smaller wards with small rooms opening into them for cases requir-
ing absolute isolation.
Complications. — Several interesting complications were noted.
Among the cases of mumps one patient developed an inflammation
of both breasts, which subsided with the disease. Another developed
a discharge from the penis following an orchitis, which was proven
to be nonvenereal by microscopic examination and which disappeared
when the orchitis subsided. A third case developed an abscess of the
parotid gland on the affected side, which was opened and drained.
NETJBOPSYCHIATEIC DEPAKTMENT.
As regards the mental aspect of cases, by far the largest number
encountered were the psychoneuroses. It is a noticeable fact that
many of the cases of hysteria and neurasthenia, and the so-called
" war neurosis," were men who had been under constant shell fire
and all kinds of exposure during the war, and did not show at that
time any trace of these diseases, but several months after the armi-
stice developed typical cases. The following case illustrates this
class :
Private "A" : Well developed and nourished ; physical condition very good.
He fought with the Infantry during the operations at Chateau-Thierry, Belleau
Woods, and later in the Argonne ; had been under constant shell fire and actual
battle conditions for a period of three months ; had fought with especial bravery
and said that he "did not know what fear was." Two months after the armis-
tice, he became markedly retrospective, constantly thinking of incidents of the
battle. Upon examination he exhibited marked coarse tremor, involving all
parts of the body. This tremor was so marked that patient was unable to sit
in chair. ^Moderate degree of apprehension, no psychomotor activity. Stam-
mering speech defect, at first hardly noticeable, but shortly so marked that
words were scarcely intelligible. During course of examination, patient started
to weep, followed shortly by hysterical laughter. Diagnosis : Phychoneurosis ;
hysteria.
Bl. EVACUATION HOSPITAL TsO. 37.
Organized at Camp Greenleaf, Ga., War Department order Sep-
tember 1, 1918, by the transfer of 2 medical officers and 100 enlisted
1740 KEPORT OF THE SURGE0:N GENERAL OF THE ARMY.
men from evacuation hospital group at Camp Greenleaf , Ga. Organ-
ization left for Camp Grant, 111., same date, arriving at Camp Grant
September 3, 191S. Between Sej)tember 3 and November 2, 1918,
15 officers — 10 medical officers, 3 sanitary officers, 1 dental offi-
cer, and 1 quartermaster — and 182 enlisted men joined the
organization, 40 of the original 100 enlisted men being trans-
ferred to the development battalion and 5 having died during the
" influenza " epidemic. Of the 182 enlisted men, 8 were noncommis-
sioned officers from the base hospital at Camp Grant, 111., the balance,
making a total of 237 enlisted men, being transferred as privates from
the 161st Depot Brigade and privates and noncommissioned officers
from the replacement depot. A table of organization was made, each
enlisted man being assigned according to his qualifications and expe-
riences gained by duty in the base hospital. Camp Grant, 111. While
stationed at Camp Grant, the majority of the officers and enlisted men
were assigned for temporary dutj^ at the base hospital. Camp Grant,
to assist in combating the " influenza " epidemic raging there at the
time.
The organization left Camp Grant, almost completely equipped,
records having been passed upon by the personnel adjutant as per-
fect, the final check being completed in less than six minutes, for the
port of embarkation on November 2, 1918, at which point 9 addi-
tional medical officers joined.
Organization left Hoboken. X. J., aboard U. S. transport Northei^n
Pacific^ 3 p. m. November 12, 1918. The commanding officer Evacua-
tion Hospital No. 37 being appointed by the commanding general
port of embarkation commanding officer of troops aboard ship.
After an uneventful voyage organization arrived at Brest, France,
November 22, 1918, 16 officers and 237 enlisted men, 7 officers being
detailed aboard another transport. They joined at Brest, France,
five days after our arrival overseas.
Organization ordered to proceed to medical concentration area at
Joinville, Haute-Marne, arriving at Joinville December 1, 1918.
Organization did not function prior to January 1, 1919, still being
stationed at Joinville at this date.
Cl. EVACUATIOX HOSPITAL NO. 4 9.
The commissioned personnel of Evacuation Hospital No. 49 was
assembled ]:)ursnant to War Department orders during the latter
part of August and the first of September, 1918, at the evacuation
hospital group, Camp Greenleaf, Chickamauga Park, Ga.
The enlisted personnel was not assigned until late in September.
It consisted of 237 noncommissioned officers and men. A large major-
ity of the men had enlisted early in September, consequently had
had no hospital training, and but a small amount of training on the
drill field: a few of the noncommissioned officers had been trained
on the drill field and in paper work, while the majority were pro-
moted from the ranks without having attended noncommissioned
officers' school. Only about six of the men had had any hospital
training.
Late in September Spanish influenza became prevalent in camp.
On October 3 the unit entrained for the port of embarkation, and
arrived at Camp Merritt, N. J., October 5, 1918. While en route
A. E. F. EVACUATIOX HOSPITALS. 1741
and in Camp Merritt 3 officers and 36 men were attacked by influenza
and transferred to the base hospital, Camp Merritt.
On October 13 the unit, with the exception of 1 officers, was put on
board the S. S. H. R. Mallory. The vo3'age was uneventful : those
Avith minor ailments apparenth' improved. No serious sickness
occurred on board. The convoy landed at Brest, France, October 26,
1918. We were quickh^ debarked and marched to a rest camp.
Owing to the prevalence of Spanish influenza in camp, many of the
junior officers were again assigned to duty in various parts of the
camp. The men were assigned to duty at the docks.
On November 3 we received orders to move and were entrained
for Joinville. Haute-Marne, France, arriving at our destination
November G. This was a medical concentration area.
Hotels had been leased for the purpose of a convalescent hospital,
eight in number. These were well located and their appointments
were well suited to the purposes for which they had been leased.
Under rush orders, buildings were equipped to accommodate 1.000
patients.
Convalescent cases failed to arrive ; a few patients from organiza-
tions on duty in the area and from among men taken ill while on
leave were admitted. In all, about 125 patients were admitted; 45
was the largest number on hand at one time.
On arrival at Menton 6 officers and 66 men who were on duty in
connection with making preparations for the hospital were attached
to Evacuation Hospital No. 49. They were detached, however, be-
fore the unit moved away.
On February 13, 1919. orders were received to close the hospital
and prepare for early movement. The unit was next ordered to
Coblenz, Germany, for the purpose of taking over the work of
Evacuation Hospital No. 2. We were entrained February 15, 1919,
arrived at Coblenz. February 19. and formally took over the work
of Evacuation Hospital No. 2 on February 23.
The hospital had a normal capacity -of 1,725 beds. On February
23, 1,571 patients were in the institution.
The hospital was housed in 11 masonry buildings formerly used as
German barracks, located at the edge of the city of Coblenz. The
buildings were of such a type as to be adapted to the purpose of a
hospital with great difficulty. Heating facilities were poor, coal
stoves being used : no hot-water facilities except stoves, and marmites
were installed. Plumbing was poor and inadequate.
Wliile the unit was designated an evacuation hospital, it fvmc-
tioned as a base hospital. Its evacuations were to duty or to the
rear when crowding made such evacuations necessary. Patients were
evacuated to the Services of Supply when they would not be able to
return to duty within a specified time.
The following classes of patients were handled : General medical,
contagious diseases, and genito-urinary.
The hospital was also appointed to take care of demobilized Ger-
man soldiers who were permitted to pass to the rear through the
lines. These men were kept under observation for seven days or
longer; at the end of the seven days they were evacuated, provided
no symptoms of typhus or other acute illness was evident. As many
as 452 such cases have been in the institution at one time. One thou-
1742 REPORT OF THE SUEGEOX GEXEEAL OF THE AKMY.
sand eiglit liimdred and ninetv-two were admitted from February
23 to May 15, 1919.
The hospital continued quite active until April, when the number
of admissions markedly declined. A total of 4,246 patients were
admitted from February 23, 1919, to May 23, 1919.
2. Hospital Traixs.
a. train no. 53.
This hospital train was organized at Camp Greenleaf, Fort Ogle-
thorpe, Ga., on December 5, 1917.
From the date of organization until January 29, 1918, the date
on which the organization left Fort Oglethorpe, Ga., for the port of
embarkation, the time was spent in the training of the men and in
preparation for overseas service. The train reached Camp Merritt,
N. J., on February 1, 1918, and embarked on February 7, 1918, on the
steamship Finland, for France, and disembarked at St. Nazaire,
France, on February 25, 1918. The organization left St. Nazaire
on February 27, 1918, for Nevers, and arrived at Nevers on March
1. On March 9, the organization took over Hospital Train No. 53,
at Nevers, and at the same time dropped the organization number of
Hospital Train No. 28.
Between March 31, 1918, and October 5, 1918, 24 trips were made
carrying a total of 9,251 patients.
Loading of train. — The standard hospital train in use by the
American Army is designed to accommodate 260 lying cases. Dur-
ing a driA-e this load is often greatly increased. The following is a
scheme for a balanced load when it becomes necessary to carry 600
or more patients. First, reserve the 120 top bunks for litter cases;
then the middle and lower bunks can be arranged for sitting cases
and without overcrowding each car will accommodate 48 sitters and
12 lying cases, making a total load of 600. Seriously ill cases, who
are apt to require much attention, should not be placed in top bunks,
but should be put in the pharmacy car, which has a capacity of 12,
and may be reserved for these cases. The commanding officer should
be given a list of the seriously ill cases entrained so that the}' may
get immediate attention. In times of stress the capacity of each car
could be increased three litter cases by the use of stretchers placed
across the door and secured by hooks placed on the end rods of the
bunks. We have used this arrangement, securing the stretchers by
straps.
Orthopedic cases. — Orthopedic cases should alwaj's be given the
middle and lower bunks for the reason that these cases almost always
need some slight adjustment of dressings during the trij), and to ride
comfortable they should be carefully packed in with pillows and the
injured member carefully immobolized before the train starts. There
is also considerably less jar in these bunks when the train is in
motion.
Mental cases. — When carrying mental cases the windows and doors
should always be kept closed and the car ventilated by the electric
fans and roof ventilators. A guard should be placed in each end
of the car. This guard is in addition to the orderly on duty in that
car. Wlien it is necessary for an insane case to go to thv> toilet, the
A. E. F. — HOSPITAL TRAINS. 1743
door should always be sufficiently opened as to permit the ^ruard to
keep him constant!}^ under observation. Mental cases should also be
carefully searched before loading by the hospital authorities for fire-
arms and razors. I recall one case where each mental case was sup-
plied with a razor by the Red Cross just before they boarded the
train. It should always be kept in mind that an insane man is apt
to act on impulse. Patients from the front should always be dis-
armed when they enter the train regardless of their apparent mental
condition.
Chest cases. — Chest cases bear transport badl}-. Empyemas usually
drain freely and their hearts must be watched carefully.
Dressing of amputations. — New amputations and large dressings,
where there is danger of a secondary hemorrhage, should always
be dressed while the train is not in motion.
Gas cases. — Gas cases should always be litter cases, and while on
the train should not be permitted to smoke.
Transport of cases to train. — On transporting sick or wounded men
in ambulances, they should have sufficient cover under them as well
as over them. AVe have received men badly chilled at times when this
was not kept in mind. If preventable, cases suffering from shock
should not be ])laced on a hospital train.
Unloading of train. — The detraining officer should always see that
sufficient blankets and sti-etchers are at hand so that the train need
not be delayed while waiting for the return of its property. In times
of stress this is important. Seriously ill patients should be detrained
first.
Supplies to the front. — Hospital trains should be equipped to ex-
change all property brought on the train by patients at the front.
This includes pajamas, crutches, splints, air pillows, rubber tubing
for Carrol treatment, material for Dakin solution. This exchange
should be made either with or without the use of receipts. Hospital
trains should then receive the same amount of splints, etc., from the
base hospital as that which is delivered with the patients. One car
in the train should be designed to carry sick officers' baggage and
supplies to the front. This car and also the stock car for rations
should have heavier springs than the regular ward cars.
Feeding the patients. — The method of commutation of rations is
the most practical for use on hospital trains. The patients should get
their food hot, well cooked, and decently served. Because patients
are on a hospital train such a short time, the meals can be standard-
ized. This standardization enables the cooks to prepare the meals
■with greater proficiency, prevents the accumulation of unsuitable
articles, minimizes waste, and furnishes a basis on which to calculate
the needed supplies.
B. TRAIN KO. 5 4.
Organized December 8, 1917, as Hospital Train No. 22, at Camp
Greanleaf, Ga. Embarked on U. S. S. Finland, from Hoboken, on
foreign service, February 10, 1918, arriving at St. Xazaire. France,
February 25, 1918. March 24, 1918, this organization took charge of
Hospital Train Xo. 54. On April 1. 1918, the initial trip was made,
carrying 300 patients from Toul to Dijon.
Recommendations. — Two types of hospital trains were recom-
mended: (1) One emergency, easily improvised, easily- fumigated.
1744 EEPOET OF THE SUEGEON GENEEAL OF THE AEMY.
and cleaned, for short liauls from front to a base within three to
six hours' ride. Tlie reoUlar train used by us meant more time neces-
sary to its cleaning than we could give it, this being especially true
during period of stress when they had to be cleaned on the return
journey, a method productive of poor results. This type was neces-
sary because of aforesaid sanitary question and lack of a larger num-
ber of the up-to-date type. (2) The regular hospital train for long
journeys plus an attached baggage car and a small ice-making plant
easily installed in the present store car, at a slight cost, and run from
power obtained when train is running.
C. TRAIN NO. 5 8.
United States Hospital Train Unit No. 33 was organized at Camp
Greenleaf, Chickamauga Park, Ga., January 10, 1918.
Orders for foreign service were received March 28, 1918, and on
April 22, 1918, the organization embarked at Hoboken, arriving at
Bordeaux May 7, 1918.- On May 13 it was assigned to Hospital Train
No. 58. '
A great delay in the evacuation of the trains, with its resultant
inconveniences to the patients, was experienced at many base hos-
pitals. The main cause of this appears to be :
1. Lack of proper notification given to the base hospital of the
train's expected arrival.
2. Insufficient litters, blankets, and ambulances.
3. Sorting and tagging of patients on train by the detraining med-
ical officer.
The remedy for 1 and 2 are evident. In order to avoid delay in
unloading patients, as outlined in 3, it is suggested that this work be
carried out in a " receiving or sorting " ward for each hospital cen-
ter, as employed very successfully at La Chapelle Station in Paris.
Experience has shown that patients evacuated from front-line hos-
pitals are easily satisfied and want hot soups and hot drinks. Pa-
tients evacuated from intermediate hospitals or other base hospitals^
especially if they have been at hospital for some time, are harder to
please and demand a larger variety of food. This, owing to the lim-
ited kitchen facilities, is a difficult matter to provide. It is especially
difficult for lying patients to handle plates, knives, and forks. It has
therefore been the practice on this train to make a thick soup, con-
taining the ingredients which w^ould otherwise be fed on plates, such
as beef, potatoes, beans, hominy, etc. With this were given sand-
wiches, together with tea or coffee.
Water. — The water question is a difficult one, especially on long
trips, which require more than four meals. The facilities for obtain-
ing potable water along the railroad lines in France are very poor,
and for cooking purposes it has in most instances been necessary to
fill the kitchen reservoirs with the ordinary hydrant water obtain-
able at the railroad stations. There apparently had never been an
understanding with the French authorities, for the French chef de
gare was usually very reluctant about allowing the train to stop to
take water, and in many instances refused absolutely to permit even
a slight delay for this purpose.
The hook-and-bumper coupling system as used on these trains at
the present time permits of much play between the cars, which on
A. E. F. HOSPITAL TRAINS. 1745
every trip results in a severe shakins; up and jarring of the patients,
and is especially detrimental to fracture cases. In several instances
it has also resulted in breakage of various articles and property, as
well as in the spilling of food from the stove onto the floor.
Experience has shown that the present personnel of 31 men is
insufficient for the proper conduct and thorough cleansing of the
train, especially during long trips, when changes for night work
have to be made. The following suggestion for the personnel, of hos-
pital trains is submitted :
Officers 2
Nurses 2
Sergeants 3
Cooks 4
Pharmacist 1
Others 30
42
D. TRAIX XO. 59.
Hospital Train No. 59 was organized at Fort Oglethorpe, Ga., on
December 8, 1918. After five weeks of intensive training, consisting
mostly of military drill, instructing in first aid, and nursing of pa-
tients, the organization left the States and arrived in France Febru-
ary 24, 1918. The personnel at that time consisted of 3 officers and
33 enlisted men.
Sixty-three trips have been made up to the present writing, of
which 37 were from the front, 1,5 between base hospitals, and 11 to
base ports. A total of 25,333 miles has been traveled or a little more
than the distance around the earth. The number of patients evacu-
ated up to date is 26.667, of which 735 were officers. Of the en-
listed patients 14.834 were medical cases and 11,098 were surgical,
16,300 lying and 9,632 sitting. Of the officers, 422 were medical,
313 surgical, 356 sitting, and 379 lying. Five patients died en route.
E. TRAIN NO. 6 0.
United States Hospital Train No. 25 was organized at medical
officer's training camp. Fort Riley, Kans., on November 19, 1917, and
was reported ready and equipped for foreign service late in Decem-
ber, 1918. The organization left Fort Riley INIarch 28 and left Ho-
boken April 23, arriving at Brest, France, May 6.
Up to January 1, 1919, Train No. 60 had made 35 trips, carrying a
total of 15,971 patients, of whom 5,751 were litter cases and 10,220
ambulatory; sick 7,046, wounded 6,520, gasses 2,405; French 23,
English 2, Italian 5, Belgian 1, Russian 1, German 59. There were
2 deaths of patients en route.
Among difficulties encountered, one of the most constant and try-
ing Avas the slowness and delays of the schedules given the trains.
On double-track roads such, as prevail in France, any intelligent
dispatching system should greatly reduce the time for trips without
the expenditure of much effort. To double the efficiency (carrying
capacity) of the trains in emergency, it is only necessary to cut down
the schedules by one-half.
1746
EEPOET OF THE SUKGEON GENERAL OF THE ARMY.
F. TRAIN NO. Gl.
United States Hospital Train Xo. Gl Avas organized at Fort Ben-
jamin Harrison, Ind.. on November 7, 1917, under the name of
Hospital Train Xo. 4, to be nsed for domestic service. The latter
part of December, 1917, the mimerical designation was changed to
Xo. 31 and orders were received to prepare for overseas service.
The unit embarked for France on April 19, 1918. During the time
spent in the United States the personnel received training for hos-.
pital-train work. Hospital Train Xo. 31 landed at Bre?t on April
28, 1918, and after several days spent in Pontanazen Barracks was
sent to Xevers (Xievre), where Train Xo. Gl was received. After
completely stocking the train w^ith medical supplies, rations, etc., it
was sent to Pantin (Seine), arriving on May 11, 1918. The train
remained in garage at this point until May 25, 1918, on which date
the first journey was made from the hospitals at Paris to those at
Xantes (Loire Inferieure).
The unit was then assigned to service with the British Expedi-
tionary Forces, leaving Pantin on May 30, 1918, for Epernay
(Marne), from which point an evacuation was made to Virth-le-
Francois (Marne). After fumigation at Mailly (Aube) the train
was sent to Troyes (Aube). where a convoy of English patients were
received and evacuated to Rouen (Seine Inferieure). From Rouen
the train was sent to Abbeville (Somme), a British railhead, ana
from this point was sent to the various casualty clearing stations.
Evacuations were made from these stations to the bases, Rouen bsing
the destination in most instances, though there were some evacuations
made to coast towns and base ports, viz, Etretat, Le Havre, Boulogne,
Etaples, and Le Treport. While in the railroad yards at Abbe-
ville on the night of July 13 and 14. 1918, an aerial torpedo fell
within 45 yards of the center coaches, breaking the majority of the
windows in the train, throwing the berths from their supports,
and some of the coaches being pierced by shrapnel and flying tim-
bers. One journey was made after this event, the broken windows
being covered with blankets. After this journey orders were received
to return to Pantin (Seine), and at that point further orders sent the
train to the American railway shops at Xevers (Xievre) for repairs.
The train was sent out on the road again on August 9, 1918, and
from that time has b.een in service with the American Armies. On
December 14. 1918, the train arrived at Coblenz, Germany, return-
ing on December 22. 1918. Xew Years Day. 1919, found the train
en route from Virton and Arlon. Belgium, to Mars-sur-Allier,
France, with a load of German patients and hospital personnel.
LTp to January 1. 1919, the patients carried by this train since in
operation totals 13,987, divided as follows :
Officers.
Nurses.
Enlisted men.
Lying.
Sit-
ting.
Sick. Wound-
Lying.
Sit-
ting.
Sick.
Woimd-
ed.
Lying.
Sit-
ting.
Sick. Wound-
American....
British
French
Germans
Others
172
123
3
3
0
173
75
5
28
0
139 206
129 69
4 4
25 6
0 0
1
0
0
0
0
4
0
0
45
0
5
0
0
45
0
0
0
0
0
0
4,049
1,922
97
246
22
5,095
1,487
136
241
70
4,128 5,016
2,4.58 i 951
97 126
229 1 258
82 ' 10
1
A. E. F. HOSPITAL, TKAINS. 1747
Under the classification " Others " are inchided British "We^t In-
dies, Cliinese, Kussians, Italians.
Ail kinds of conditions were met with in the entraining and de-
training of patients. At some points patients were entrained and de-
trained from platforms level with the cars" floors, while at others the
loading Avas froni the ground. P'rom past experiences the British
lias proven the most efficient in entraining and detraining patients.
In one instance it was necessary to carry the patients up an incline
to the level of the railroad tracks from which they were loaded into
the cars. In this manner a full load of litter patients were taken
abroad in 1 hour and -15 minutes, and at the detraining point the
same convoy was detrained in 45 minutes. This naturally meant
that plenty of litters and litter bearers were on hand to receive the
patients. Good time has also been made at various American hos-
pitals, and at others the time of entraining and detraining was very
.slow. This slowness was due to several causes. At entraining points,
it might be that the patients were brought to the train in small
groups and at the detraining point it might have been the desire of
the detraining officer to have one man taken off at a time, and to
personally check the number aboard. Another hospital center has a
system b}' which the patients are tagged while still on the train,
thus assigning them to the different hospitals of that center and
eliminating confusion in the central receiving ward. When the
patients are detrained after being tagged, they are taken in charge
by men from the hospital to which they have been assigned. Thus if
vne hospital is assigned 15 litter cases out of a total of 25, that hospital
is longer in unloading its consignment than the other. The ratio of
assignment has been as high as four to one, and under this system a
period of four hours has elapsed from removing the fii'st patient until
the train was emptied, the load consisting of approximately 80 per
cent walking and 20 per cent litters. It is believed that the entrain-
ing and detraining of patients should proceed in such a manner that
the time required is reduced to the minimum, always keeping in
mind that the patient should be handled in such a manner that will
cause him the least disturbance.
Few operations were done on the train, a few ligations of arteries
being among them. However, dressings of all kinds and sizes were
done at all hours of the day and night. Patients who were walking
cases went to the pharnuicy to l)e dressed which facilitated matters,
while litter cases, as a rule, had their dressings done on their bed.
Some surgical cases that required dressing xerj often were extremely
difficult to dress in the ward cards, and it was found necessary to
carry them to the pharmacy car. A portable operating table in the
pharmacy car would have been of much help.
Little trouble was experienced in the handling of mental cases,
but it appears that a separate compartment in a few of the ward
cars for a few of the more violent cases would have been better, both
for the patient himself and those around him.
G. TRAIN NO. (5 2.
Hospital Train No. 62 was organized at Fort Benjamin Harrison,
Ind., November 8. 1017. and desisruated as Hospital Train No. 29,
December 29. 1917. Hospital Train No. 29 left Fort Benjamin Har-
142367— ID— VOL 2 49
1748 REPORT OF THE SURGEON GENERAL OF THE ARMY.
rison. Ind.. April 30. 1918. and arrived at Bordeaux, France. May
17, 1918, and was assigned to duty with Hospital Train No. 62.
American Expeditionary Forces. May 22, 1918.
Plospital Train Xo. 62 made 63 journevs during the period from
May 22. 1918. to April 30, 1919. carried 27,501 patients, classified
as follows :
Lying patients 10, 601
Sitting patients 16, 900
Total 27,50]
Sick patients 15, 363
Wounded patients 10, 860
Gassed patients 1, 101
Injured patients 177
Total 27,501
■ Patients listed above were all American soldiers, with the excep-
tion of soldiers shown on list below :
French 96
Russians 26
English 10
Italians 33
Serbian 1
Belgians 3
Germans 108
Total 277
H. TRAIN NO. 63.
United States Hospital Train No. 63 was organized December 9,
1917, at Camp Greenleaf. Chickamauga Park, Ga., being known at
that time as Hospital Train No. 27. The commissioned personnel
consisted of 3 officers of the Medical Department, the enlisted per-
sonnel of 31 men, including 3 noncommissioned officers. After four
months of strenuous training the unit was ordered to France, arriv-
ing at Brest on April 15, 1918. On April 22. 1918, the personnel
was installed in the present train, and became Hospital Train No. 63,,
medical department, American Expeditionary Forces.
The first trip was made on May 12, 1918, from Vichy to Bordeaux^
with 399 patients. Shortly after this date the train was ordered into
service with the British armies, and proceeded to Pantin, Seine, ar-
riving on June 1, 1918.
Later, during the work behind the British lines, the train's trips
were made to points between Bergues. near Dunkerque. and Trou-
ville. Air raids were of common occurrence. At Etaples. scene of
the bombing of St. John's Hospital, the entire personnel of the train
was ordered to proceed each night to dugouts well outside the camps,
and to sleep within a few yards of the entrances. Perhaps the fart
that numerous air raids occurred while this train lay at Bergues,
Arques, Blendecques, Calais, Boulogne, and other places, and that on
one occasion a hostile plane pursued the train near Abbeville, may
furnish an indication of. the activity of enemy aircraft behind the
front lines. On many occasions shrapnel from the antiaircraft bar-
rages fell about the train.
A. E. F. — HOSPITAL TRAINS.
1749
BetTveen June 8 and July 15, 1918, while in the British service, 10
trips were made, carrying 3,690 patients.
Herewith is a summary of trips made in the British service, and on
a following page a chart classifying the patients carried on these
trips.
From—
To—
Date.
Number
of pa-
tients.
Total.
Rouen
Boulogne
Boulogne- . amiers
< alais
Boulogne
do
June 8-9, 1918
June 16,1918
June 23,1918
June 24,1918
July 4, 1918
July 6, 1918
July 10,1918
July 13-14,1918
July 14-15,1918
Jul> 15,1918
367
464
461
185
389
412
401
■ 615
133
263
367
Femes
831
ex. Omer
1,292
Samiers
1,477
1,866
Bergues and St. Omer
2,278
Do
do
2,679
Trou\ iile
3,294
3,427
Trouyille
Rouen
Le Hayre
3,690
On July 22, 1918, United States Hospital Train No. 63 was re-
turned to the American service, and proceeded to Pantin. The
second trip in the American service was made on July 27, patients
from the Chateau-Thierry activit}' being entrained at Coulommiers
and evacuated to Chaumont. Later the evacuation hospital was
advanced to Chateau-Thierr}', and evacuations were made from that
city, patients being entrained at the station. In the latter part of
September the train carried patients from the St. Mihiel advance,
working rearward from the base hospitals at Vittel and Contrexe-
ville.
During the activity in the Argonne the evacuation hospitals at
Souilly, Vaubecourt, and Fleury furnished all the patients carried
by this train from the Argonne. For some time subsequent to the
signing of the armistice the train was occupied in clearing out the
hospitals near the lines. Early in 1919 trips from base hospital to
base hospital, or to port of embarkation, began to supplant the
former trips from evacuation hospitals.
While in service as a hospital train, " U. S. 63 " covered 11,837
kilometers, or 26,135f miles. Almost every section of France has
been traversed, from Bergues to Cannes, and from Souilly to Bor-
deaux.
From observation of the many patients carried on this train, may
state that there are three classes which are of most concern, viz,
head, abdominal injuries, and pneumonia. The first two types should
not be evacuated until all danger of secondary hemorrhage and in-
fection is past. The latter should by no means be evacuated until
the stage of convalescence has been reached.
The arrival of contagious cases in company with other patients
and without advance notice was often a source of delay, as these
cases were segregated in a special contagious-ward car. Unloading
was often unnecessarily prolonged because of insufficient size of
fatigue details from base hospitals.
Suggestions as to several points which might be improved, and
the efficiency of the train raised thereby, follow :
(a) Toilets in ward cars are at present provided with buckets
which must be frequently emptied, often in places which should not
1750 EEPORT OF THE SURGEOX GEXER.\L, OF THE ARMY.
be fouled by fecal matter. Arrangements whereby a hopper leading
to the track could be used Avhile en route and buckets substituted
while train lay in stations would be a noticeable improvement.
(h) Steam heat is not obtained from long radiators in each car.
A continuous steam line, after the style in use in the United States,
along the foot of each wall would make cleaning of cars easier and
would obviate the overheating of the lower bunks.
(<") Door knobs are located on the outer side of doors only, and it
is necessar}' to lower windows to open the car doors. Door knobs
should be operated from inside as well as out.
The necessity of evacuating on almost every trip a number of pa-
tients greatly in excess of the bed capacity of ward cars made it
necessary to use various expedients to increase the comfort of such
men as could not be given bunks. Litters were laid in the aisles
and held in tiers of three in the center doorways of cars. Even with
these means in use, less severely wounded patients were sometimes
forced to spend the night sitting up, or rolled in blankets on the
floors.
In all, 56 trips with patients were made by this train, 10 in the
British service and 16 in the American. Of a total of 23,601 patients
carried, only 2 deaths occurred while en route.
I. TIJAIX NO. 0 0.
Hospital Train No. 66, organized as Hospital Train Xo. 31, came
into existence at Camp Greenleaf, Ga.. on February 1, 1918, left for
Europe April 23 and arrived at St. Nazaire May 13, 1918, taking
over United States Hospital Train No. 66 at Nevers.
On the 21st of May, after all the necessary equipment had been in-
stalled and the proper inspections made, the train was sent to the
British servii e and remained with them until July 24. when the
Americans began their first unified operations at Chateau-Thierry,
and tlie train was called into American service.
Our maiden trip was made June 2, from Kouen to Le Harve, with
377 patients. This same run was made 16 times during June and
July. In the British service we made 35 trips, hauling the following
patients : British, 9,135 ; Australians, 981 ; Canadians, 231 ; New
Zealanders, 111: German (prisoners of war), 98; Americans, 82;
West Indians, 29; nurses. W. A. A. C. and Y. A. D., 14; South Afri-
cans, 8; Portuguese, 4; Newfoundlanders, 2; French, 1; Eussians, 1;
and Y. M. C. A., 1. These figures were divided as follows : Olhcers,
sick 312, wounded 209; enlisted men sick 6,165, wounded 3,183.
These were again divided: Officers lying 294, sitting 268; enlisted
men h'ing 5,839, sitting 6,286. Of the 35 loads hauled, 20 came from
base hospitals. 6 from convalescent hospitals, 4 from casual clearing
stations, and 1 from the port at Le Harve. Twenty loads were un-
loaded at ports. 9 at base hospitals, and 6 at convalescent hospitals.
On July 23 we went to Coulonnniers, where we received our first
American wounded from the Chateau-Thierry front and took them
to Chaumont. Up to January 1, 1919. while in the American serv-
ice, 29 trips were made.
At the beginning of the hospital-train service supplies were se-
cured with difficulty. This was due mostly to lack of supplies and
the fact that the trains at that time had to pick up all supplies liter-
MEDICAL DEPARTMENT, U. S. A., DISTRICT OF PARIS. 1751
?]!}• on the run. In the British service they, learning by their
years' experience and using only a few base ports and hospitals, had
a system which keep the trains well supplied at all times. Hardly
had the train pulled into a base port or hospital when the detail ap-
pointed especially for this service were there ready to place on board
anything needed in the way of supplies.
In the American service we had more to contend with. Using as
we did so many base hospitals, our bases of supplies were widely
scattered. In the larger towns or cities the supply depot would in
most cases be situated in parts of the town that were more or less in-
accessible, and with the little time the trains were occupied in unload-
ing and the difficulty in securing transportation it was almost im-
possible to draw necessary supplies. True, they could be ordered
from the supply depots, but all had to be shipped by French freight,
and in many cases were so slow in reaching the destination that the
trains had departed for other sectors long before the supplies came.
J. TRAIX XO. 7 0.
The personnel of Hospital Train No. TO is composed of members
of Hospital Train Unit Xo. 41, which was organized at Fort Ogle-
thorpe, Ga., April 14, 1918.
This unit was trained at Fort Oglethorpe and departed from that
camp August 13, 1918, arriving in Europe September 4, 1918.
November 22 the unit was ordered to Xevers for duty on United
States Hospital Train No. TO.
During the short time that this train has been in service we have
made T journeys, transporting a total of 2,9T9 patients, of Avhich
number 113 were officers, classified as follows: T6 sick, 3T wounded;
20 lying and 93 sitting. The balance, 2,866 enlisted men, were classi-
fied as follows: 278 lying and 2,588 sitting; 1,155 sick and 1,T11
wounded.
This tiuin traveled approximateh- 2,000 miles during the period
covered by this report.
3. District or Paris.
MEDICAL department, UNITED STATES ARMY.
The city of Paris had three hospitals, each operating independently,
jnevious to the estal)lishment of the military district of Paris, namely,
the American ambulance, subsequently known as American Red Cross
Military Hospital No. 1, at Neuilly; the American hospital, subse-
quently known as American Red Cross Military Hospital No. 2, at 6
Rue Piccini : and the officers' hospital, subsequentlj^ known as Ameri-
can Red Cross Military Hospital No. 3, at 4 Rue Chevreuse. Also,
there existed the office of the attending surgeon at 10 Rue Ste. Anne.
The office of the attending surgeon dated back to the time when the
Americans first came to Paris with Paris as headquarters, i. e., from
July 22, 191T. The office of the attending surgeon was transferred
from 10 Rue Ste. Anne to 32 Boulevard des Batignolles in January,
1919, when American Red Cross Military Hospital No. 9, which had
been located at this site, closed its doors.
1752 REPORT OF THE SURGEON GENERAL OF THE ARMY.
In the latter part of July, 1917. the United States Army took over
the three hospitals of Paris in one week.
Two months later, on May 5, 1918, the military district of Paris
was inaucrnrated ; the district to include Paris itself and the Depart-
ment of Seine, as Avell as the Department of Seine et Oise. At once
centralization of all medical atfairs was accomplislied, with head-
quarters at Room 510. Elysee Palace Hotel.
The importance of the office of the district surireon was at once
manifest and the increase of work caused a parallel increase in per-
sonnel. A change in the liaison officer being necessary, the office of
the liaison officer and the offices were joined to the office of the dis-
trict surgeon on May 28, 1918, and put under his direct jurisdiction.
The radiological office moved into separate quarters.
While this healthy growth was taking place at headquarters, the
hospitals in Paris showed enormous activity and increase, caused in
part by the oflensive of May 27. Hospital trains were called into
service for evacuations from Paris to base hospitals and for bringing
patients directly from the front to the Paris hospitals. These hos-
pital trains were handled, for the most part, from the office of the
district surgeon, and the transfer of the patients from the stations
to the hospitals and from the hospitals to the railroads was done
entirely bj^ the American ambulance service with the French Army in
]^aris.
On May 27, 1918, in the Champs des Courses at Auteuil, American
Eed Cross Military Hospital No. 5 sprang into existence, at first with
only 300 beds. The number of beds was soon doubled, and within a
few days a total of 1,000 beds was installed. Six weeks later this
hospital had a capacity of 2,000 patients. The wdiole institution was
entirely under canvas, excepting onh?^ the operating pavilion and the
kitchen.
At the same time and on the same gTounds Mobile Hospitals Nos.
1 and 2 were set up, having been taken over from the French. The
effective work done by the operating department of Mobile Hospital
No. 2 must ahvays be remembered. The sterilizing camion and op-
erating pavilion of this unit served as the only operating facilities
for the whole of American Red Cross Military Hospital No. 5 during
the time the operating pavilion of that organization was in the proc-
ess of construction. Mobile Hospitals Nos. 1 and 2 moved into action
at the front in July for active duty there.
On May 24, 1918, Camp Hospital No. 4, in Joinville-le-Pont be-
gan to receive patients.
At St. Germain-en-laye on June 10, 1918. a detachment of 12 men,
2 of whom were sergeants, was placed in conjunction with the
French at the railroad station, Grande Ceinture. They received
wounded and sick Americans for distribution to Paris hospitals.
At La Chapel le station in the city of Paris, where practically all
the sick and wounded, both French and American, arrived for the
city, the district surgeon stationed two medical officers for alternate
and constant duty under the French medecin chef of that station.
At the same time an officer of the Sanitary Corps was added to the
staff to take charge of the evacuations to and from the different rail-
road stations of Paris. During the months of June, July, and
August all the hospitals of Paris ran to an emergency capacity.
MEDICAL, DEPARTMENT, U. S. A., DISTRICT OF PARIS. 1753
On July 20, 1918, American Eed Cross Military Hospital No. 9,
at 32 Boulevard des Batignolles, "was opened with a capacity of 120
beds. This hospital served only for the care of venereal diseases and
diseases of the skin, and was established in a Turkish-bath establish-
ment. Sixty serviceable bathtubs were used for scabies treatment,
and the plentiful supply of hot water and steam was of excellent
service in the sterilization of lousy clothing and the treatment in
general of pediculous and venereal diseases.
On August 6, 1918, in the Pavillion Bellevue in the suburb Sevres,
American Red Cross Military Hospital Xo. 6, with a capacity of
650 beds, was opened. This hospital served for the care only of cases
that had been gassed or burned by gases and operated in an hotel
which was taken over by the American Red Cross from its owner.
On August 17, 1918. at St. Denis in the Ecole de la Legion d'Hon-
neur. United States Base Hospital No. 41 was opened with a ca-
pacity of 2.500 beds and handled all the types of patients. This base
hospital operated in the spacious buildings and grounds of the mag-
nificent school of the Legion of Honor. Barracks and tents to ac-
commodate the large number of cases were erected in the gardens of
the school.
On September 9, 1918, American Red Cross Military Hospital No.
8 at Malabry, with a capacity of 800 patients, was openecl for the
care of all types of cases. This formation was located at the Chateau
de Malabry, a small residence in a large park in which fifty-odd cot-
tages of four rooms each had been constructed of wood, originally
intended by the American Red Cross for the housing and care of
tuberculous families. The chateau itself served to lodge the officers
and administrative offices. The cottages were used as isolation wards,
and barracks and tents set up on the grounds served as wards for
800 patients. Operating pavilion, kitchen, and mess halls were also
constructed.
On September 14, 1918, a convalescent home for officers was
opened at Chateaux Villegenis, near Verrieres-le-buisson, and was
known as American Red Cross Convalescent Home No. 8, where
officers from any of the Paris hospitals were received during their
period of convalescence. There was accommodation for approxi-
mately 50 officers in the chateau proper.
At the same time a convalescent home for enlisted men was estab-
lished at St. Cloud and was known as American Red Cross Conva-
lescent Home No. 4. This institution was small, with a capacity of
only 30 beds, and was closed in December.
On September 19, 1918, United States Base Hospital No. 57 was
opened in the Lysee ]Montnigne, 17 rue Auguste Comte. with a ca-
pacity of 1,800 beds. This splendid base hospital was established in
a large municipal school, a very handsome stone building with two
large courtyards, a small paved garden, and a glass-inclosed sim
parlor. In each of the large courtyards three barracks were erected,
one of which had a plentiful supply of hot and cold shower and tub
baths.
On October G, 1918, the officers' hospital, American Red Cross Mili-
tary Hospital No. 3, proving to be too small, the buildings at 12 rue
Boileau were added as an annex. This property consisted of four
1754 REPORT OF THE SURGEON GENERAL OF THE ARMY.
small houses in a garden, fonnorly a private sanatorium, with excel-
lent water facilities, it havino- been previously used as an hydro-
therapic institute.
On October 12, 1918, Base Hospital No. 85, at Cliirnancourt Bar-
racks, with a capacity of 1,500 beds, was opened. This base hospital
was located in a large military barracks of the French Army. The
wall-inclosed space is situated on the Boulevard Ney. and is an in-
tegral part of the walls of the city of Paris. Within the high stone
walls were six three-story stone structures and five one-story build-
ings, also of stone. There were two good-sized kitchens, a bath-
house, and two prisons. All of the personnel were lodged within the
walls of this institution.
On November 1, 1918. a convalescent camp at the race track, le
Tremblay, Nogent-sur-Marne, was opened with a capacity of 2,000
beds. The French turned over to the Medical Department of the
American Army this large tract kitchen and mess hall with seating
capacity of 1,200 men. The stone grand stand and a small stone
pavilion were also put at the disposal of our men.
While all of these hospitals were being brought into service, it was
found necessary to maintain an emergency medical supply depot.
On June 13, 1918, the first emergency medical supply depot was
opened at 41 Boulevard de Stains, Aubervilliers. Afterwards, hav-
ing been temporarily placed at Pare des Princes, this depot was
definitely reestablished at 45 Quai del la Gare on December 2, 1918,
in a large warehouse rented for that purpose.
After Mobile Hospitals Nos. 1 and 2 had left Paris m July, Mobile
Hospitals Nos. 3 and 4 were set up in the polo grounds in the Bois de
Boulogne. This location not proving satisfactory as an instruction
pai-k for mobile hospitals, the Pare des Princes in Boulogne-sur-
Seine, at the St. Cloud Gate, Paris, was iopened on September 4, 1918,
as an instruction and assembly park for mobile units, Medical De-
partment.
The Medical Department Eepair Shop No. 1 moved on October 12,
1918, from Avenue de la Kivolte, Neuilly, where it had existed since
the organization of the District of Paris, to Pare des Princes, leav-
ing only the Medical Department X-ray repair shop at Neuilly. The
Central unit was moved from Neuilly to Pare des Princes at the
same time the Medical Department repair shop was moved. At the
Pare des Princes, eight mobile hospitals were organized, of which
seven were sent to the front. Mobile Hospital No. 12 being the only
one which, after organization, did not go to the front lines. This
unit, however, was sent for active service to Le Mans replacement
depot.
At the time of the signing of the armistice hospitalization, which
had begun with the three) original hospitals antedating the estab-
lisliment of the district of Paris, reached a total of 18,000 beds.
There had been also taken over by the Medical Department of the
United States Army the following buildings ; they were never occu-
pied and were subsequently returned to the French Government
with the exception of Ecole Duvignau de Laneau and T. M. 1400,
which were taken over by the commanding general, district of Paris:
A. E. F. — HOSPITAL CENTERS. 1755
Beds.
Cour Dupanloup 700
Chateau de P.ry-sur-Marm' 260
Institution Kalis, Xo^^ent-sur-I\Iarne 300
Institution ZSIontliion, Fontenay sous Bois 250
Institution Feret, St. Maur 350
In.stitution Notre Dame, Boulogne 400
Ecole Reale 150
Ecole Duvignau de Laneau 600
Convent de rAssomption 400
Ecole Laeordaire and St. Dominique 500 ■
Ecole rue Boi.ssiere 400
Ecole de Filles de St. Honore d'Eylau 400
T. M. 1400 1,000
A list of hospitals and Medical Department organizations in the
district of Paris follows, with the name of the commanding officer
of each, the capacit}^ of each hospital, and the total number of
patients treated in each. Also the dates of opening and closing of
each formation, where closure has already taken place, are notated:
4. Hospital Centers,
a. hospital center, vittel.
The hospital center of Vittel dated from November, 1917, when a
medical officer was detailed to arrange for the lease of such buildings
in the watering places of Yittel and Contrexeville as were available
and suitable for hospital purposes.
Troops were being rushed from the United States as fast as ships
could transport them, and it was necessary to provide hospitalization
for them as they arrived. It was the intention of the higher authori-
ties that the Americans occupy the sector from Toul and Nancy to
the Alsace border, and it was in this region the American divisions
were sent for their combat training with the seasoned French troops.
This explains the establishment of our first hospitals in the east of
France, seemingly. Far from the culminating struggles of the Great
War, the two toAvns of Cittel and Contrexeville are in the Department
of the Vosges, in the foothills of the mountains of the same name,
about 60 kilometers south from Nanc}', 55 kilometers southeast from
Toul, GO kilometers east from Chaumont — the location of general
headquarters of the American Expeditionary Forces — and about 90
kilometers west from the Alsace border. The hospital center of
Vittel-Contrexeville was at that time the nearest to the front, and at
all times the farthest east of any of the base hospitals of the American
Expeditionary Forces.
Vittel and Contrexeville have a cold, rigorous climate, with winter
coming early and remaining long, the temperature falling as low
as —1'2° centigrade. Spring and late autumn are continuous rains,
but stinuner, during the months of May, June, July, and August, is
simply ideal.
Vittel is a small town of about 3,000 population normally, with no
industries unconnected with the hotels and springs. Contrexeville,
4 kilometers to the southwest, on the same railway, has a normal popu-
lation of about 2,000, and is likewise composed principally of hotels
and hydrotherapeutic establishments.
1756 KEPORT OF THE SUKGEON GENERAL OF THE ARMY.
Yittel has an excellent water supply derived from springs in the
hills ahove the town, which, though at times taxed to the utmost, was
beyond suspicion as to purity. Contrexeville was not so fortunately
situated with respect to its w\ater supply. Practically all water sup-
plies in Contrexeville were determined to be nonpotable. These sup-
plies were not labeled " nonpotable," as is customary, but signs were
posted forbidding patients and personnel drinking any but treated
water. Inadvertently a "" nonpotable " sign was placed upon one of
the well-knov.n springs. Complications, assuming almost interna-
tional importance was the result, with a call upon the commanding
officer by the mayor and other dignitaries.
Prior to the arrival of the Americans and for a short time after the
establishment of our hospitals the French occupied some of the hotel
buildings for hospital purposes. Building and plumbing Avere in
extremely poor condition.
By the time of the arrival of the first unit, November 17, 1917, suffi-
cient buildings had been provided for a normal capacity of 5,500
beds, with villas for quarters for officers and nurses, and the large
gambling house, the Casino, for barracks for the men.
All buildings were of the usual French constructions, concrete and
stone, more or less fire-resisting in some cases: in others, especially
in Contrexeville, veritable fire traps.
Practically every hotel building had its own kitchen range in-
stalled and in fair working condition.
All buildings were piped for water and had a sewage system
wholly inadequate for the number of patients in each during crisis
expansion. Cesspools were situated under the kitchen floor, and
whenever the capacity of the cesspool was exceeded, the inevitable
result was a flooding of the floor of the kitchen. By continually
pumping out the cesspool this was reduced to a minimum.
In each building, rooms were reserved for the use of the proprietor
for the storage of his furniture and personal property, and in the
basement of each was a room said to contain wine. Some one, either
French or American, would enter these rooms, with the result that a
" proces-verbal " and a complaint and claim for damages would be
served upon the commanding officer. Many of these claims were
groundless and were the result of the mercenary aims of the owners.
Every claim necessitated the appointment of a board for its in-
vestigation, and subsequent settlement by the rent requisition and
claims service.
On account of the difficulty of obtaining furniture and kitchen
utensils, authority was obtained for the purchase of those articles.
A considerable amount of these articles were thus obtained upon the
promise to the proprietors to resell to them after the war. Heavy
solid copper kitchen utensils from 5 to 30 kilogi^ams were purchased
at the uniform price of 10 francs per kilogram. Upon the abandon-
ment of the center, it was found that on account of the increase in
price of copper, the original purchase price was obtained. Other
articles were sold at a depreciation of 20 per cent for the use for
the year or more.
Base Hospitals 23, 36, 32, and 31, assigned to the towns of Vittel
and Contrexeville. were originally equipped by the American Eed
Cross; that of 36 being intended for a capacity of 1,000 beds, while
the other 3 were intended for 500 beds.
A. E. F. HOSPITAL CENTERS. 1757
November 17, 1917, the first of these units arrived in Vittel
Base Hospital 36 was organized in Detroit, Jklich.
December 18, 1917, the second unit arrived in Vittel. Base Hos-
pital 1*3 was organized in Buffalo, X. Y.
Decern! er 26, 1917, Base Hospital 32 arrived in Contrexeville.
January 1, 1918, Base Hospital 31 arrived in Contrexeville.
March 13, 1918, each unit, with the exception of Base Hospital 30,
received as reinforcement (;ne of the lettered hospital units. Unit
"B," organized at Yonkers, X. Y., joined Base Hospital 23. Unit
'•R,'* organized at Fairfield, Iowa, joined Base Hospital 32. I^nit
"G," organized at Syracuse, X. Y., joined Base Hor^pital 31.
At this period there was very little action at the front. This was
a trying time. Xot sufficient patients Avere received to keep officers
and nurses professionally occupied; many were homesick, mails were
not arriving Avith regularity, and the war was not progressing very
satisfactorily to the allied cause.
The increase in total capacity from 2.500 beds, which Avas the num-
ber originally intended for all four units Avhen organized, to the
5,500 new schedule necessitated requisitioning additional equipment.
Each unit had its OAvn quartermaster and medical supply officer and
controlled its OAvn transportation. It soon became a race as to Avhich
unit could get the most equipment. Transportation Avas running Avild,
touring cars went as far as Paris and Bordeaux on pui-ely joy-riding
trips, and ambulances were out on tAvo or three days" trips Avith oHi-
cers. Acting upon the suggestion of the chief surgeon of the advance
section. Service of Supph'', in Avhich the hospitals were located, and
under AAdiose jiu'isdiction they then were, a major in the Medical
Corps, on January 17, 1918, assumed command of the group of hos-
pitals. This Avas the first suggestion of the centralization of the ad-
ministration of the group of hospitals. Each unit earnestly avoided
any relations with the other organizations, and this extended to jier-
sonal relations among officers, nurses, and enlisted men. There Avas
a distinct tendency to carry on the normal rivalry of the various
cities in which the units Avere organized. This rivalrj' at times be-
came jealousy, and it became necessary to station men at the station
to preA^ent one unit taking property arriving for another unit. Each
unit avoided performing any duty which might in any manner per-
tain to any other unit.
April 2o, 1918, the commanding officer of the group detailed a cap-
tain of the Quartermaster Corps as " acting quartermaster for the
hospital center of Vittel."
The commanding officer assumed control of all transportation of the
various hospitals and restricted its use. Up to this time each imit
considered the transportation it had as its oAvn property, not to be
available for any otlier unit. Later all transportation Avas collected
into the large garage in Vittel and controlled by the group <|uarter-
master. . . ,
The result was at once evident in the imin-ovement in service and
the saving in gasoline. The opposition to the centralization of the
transportation^t times Avas rather amusing. Officers who formerly
had a car at their disposal to make official trijis Avould make as many
calls as possible upon the center quartermaster for transportation,
and if there were tAvo to make the trip they would Avait and call for
cars at different intervals. An attempt to break down the system was
1758 REPOET OF THE SURGEOX GENER.VL OF THE ARMY.
made. To overcome this a bus service was established between the
two towns, and those who had business were required to use it in-
stead of calling for a touring car.
From the first the centralization of the administration of the center
met with opposition from all of the units. They had started their
work independently from any other organization and resented any
central control. This to a great extent was increased by the fact that
the officer in command of the center was also in command of one of
the units. The commanding officer of the center therefore, upon his
OAvn request, was relieved from duty with Base Hospital 23 and
placed in command of the center alone by paragraph 132. Special
Order Xo. 148, Service of Supply, August 7^ 1918.
During the winter and spring of 1918 patients were admitted prin-
cipally from the surrounding training areas and from Baccarat and
Luneville, where our trooj^s were in the trenches, and where actions
with the eneni}" were often taking place. Numerous gassed cases
were admitted to the center at this time. It seemed as if every new
organization had to have its lesson in gas warfare before being cau-
tious, and several times a sudden call for help on account of the
number of gassed cases would come from Evacuation Hospital No. 2.
situated at Baccarat.
During this period of adjustment considerable restlessness was
manifest, especially among the officers and nurses. Not enough pa-
tients were arriving to keep them busy, and the keenest rivalry de-
veloped in obtaining patients. This at times reached the stage of
soliciting patients from organizations at the front. Convoys would
arrive by ambulance with instructions '' not to stop at Base Hospital
No. — , iDut to go direct to Base Hospital No. — ." A receiving office
was established and all arriving ambulances were required to report
there, where all distributions were made by direction of the com-
manding officer of the center.
Central lahoratory and morgue. — Each base hospital was originally
equipped with a full laboratory equipment, and each established its
own complete laboratory. It was soon seen that it would not be
practicable to have a complete laboratory. It was therefore decided
by the officer in charge of laboratories to have one central laboratory
in each center, well equipped, and smaller laboratories in the indi-
vidual hospitals for the routine work. This idea met with tremen-
dous opposition on the part of the various hospitals. However, the
central laboratory was established, taking sucli e(juipment from the
individual base hospitals as was necessary to organize and equip one
central laboratory in each of the towns, Vittel and Contrexeville. At
first the central laboratory was in charge of one of the laboratory
men detailed from one of the units. This was unsatisfactory to the
other unit in the town. No confidence was placed in the work of an
officer from another unit. It Avas seen that an officer not connected
with any unit would be necessary. As a result, an officer was ordered
to the center as laboratory officer of the center laboratory, remaining
in charge until the close of the center.
For some time the French kept a railroad artillery train parked in
the city. Considerable time was required to get this removed.
Again, the British attempted to establish a motor lorry park in the
city. This was later abandoned. It was not considered in keeping
with the provisions of the Geneva convention to attempt to construe!
A. E. F. HOSPITAL CEXTERS. 1759
a cross for protection so long as those combatant organizations were
Avithin the city. After these organizations were ordered away tlie
cross was constructed. All the surrounding towns were repeatedly
bombed. German planes Avere overliead frequently and it was be-
lieved that this center sooner or later would be bombed. Fortunately
this never occurred.
Convalescent cw;i/>.— Early in the history of the center the com-
manding officer obtained 10 Marquee tents' as a nucleus for a con-
valescent camp. These were later ordered shipped to Bazoilles and
the idea of a camp was abandoned. During the month of Septemlier
definite steps were taken to establish a convalescent camp for l.^JOO
patients to serve the center. A piece of land 50 acres in extent was
leased and construction started. A total of l-l huts was erected by
the engineers and 40 type Henry tents obtained. This camp was
ready to take in patients when tlip arini-.tiro wn^ <iLnii'<I. and the
project was abandoned.
BASE HOSPITAL NO. :M.
Administration. — Despite frequent changes in commanding olHcers
the admini (ration policy of Base Hospital No. 31 has been almost
unchanged, except for progressive evolution of plans, during its entire
history.
In its relation with the remainder of the American Expeditionary
Forces, Base Hospital No. 31 functioned through the headtjuarters of
the hospital center of which it was a part.
American Red Cross. — From the moment of inception of the plan
to send a base hospital from Youngstown and the auxiliary unit from
Syracuse the Red Cross was in the forefront of activity.
"After arrival in France there came the thousands of dollars" worth
of equipment purchased in the name of the Ked Cross.
To the casual onlooker who watched the long lines of wounded and
sick American soldiers filing into the bathhouse, their faces drawn
and frequently besmirched with blood or smeared with dirt, there
was a most pathetic sight.
AAHiat a change there was, when a few minutes later, perhaps even
before the last of the line had passed into the bathhouse, there ap-
peared the first, divested of all material substances with which they
had entered, except perhaps a few trinkets, or a picture of a mother
or best girl. With clean face, cleansed body, and revivified heart, a
new pair of pajamas, a real bath robe, a pair of slippers, and a nice
cozy, warm blanket thrown over all. There was a change m appear-
ance, but it was as naught compared with the inner metamorphosis.
The primary step having been taken at the bathhouse, we next find
the patient tucked between the white sheets of a Ked Cros^s hosiutal
bed Because quiet is the prime essential, he is left alone for all the
first day. On the second day, or maybe the thn-d in rush times, the
cheerv voice of a little lady is heard in the corridor. A^ ith a smile
showing genuine happiness in the deed, she hands the bag "f ".ys er>
to the cunous lad. who could lose not a minute in opening it, to hnd
a toothbrush, treasure of all treasures to the American soldier-his
last one had been lost in the fighting: a pad of paper, a pencil and
some envelopes: a chocolate almond bar and some raisins: a p'-
tal
1760 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
card; a large O. D. handkerchief; a package of ready-mades and
some Bull.
Perhaps the next day is the scheduled occasion for the tobacco dis-
tribution; another day, the latest magazine, a copy of the Stars and
Stripes, or the daily papers. Able to get about and out of doorSj the
place he thought of first was the Red Cross hut. At least three times
each week at 2.30 o'clock the boys were served a steaming bowl of
delicious chocolate or coffee, such as Army kitchens never produced^
and a little package of cakes.
It was not infrequently that a Red Cross searcher received request
from anxious relatives to trace some lad lying too ill to make his
whereabouts or condition known. Invariably the proper information
was forwarded and the lad put into direct communication with those
who were most entitled to know.
Much of the activity among the patients was carried on under the
direction of the searching and house communication service. The
general duties performed by the searching in this department were:
1. Attending the funeral of each American soldier.
2. Writing a letter to the family of the deceased.
3. Malvins weekly reports on the seriously sick and wounded.
4. Writing letters for the soldiers.
5. Searcliing for men reported to he missing or dead, among their comrades
in the hospital, to ascertain possible whereabouts, if alive, and, if dead, details
of death and burial.
6. Social work among the seriously sick.
The theater opened on May 2, 1918, was a popular attraction almost
nightly until it was closed on October 14. Inability to heat the place
during the winter and the opening of the hut led to its abandonment.
Among the French. — "Wlien Base Hospital No. 31 arrived in Con-
trexeville it was found that all the luxuries of life had been given up
"Pour la Patrie." There was no heat, some food, little light, no
music, and no sanitation. In one res^ject, however, Contrexeville
was better than her sister villages in that a French military hospital
cared for her sick.
Soon, however, all the French physicians were taken away with their
hospital unit, thus leaving the community without a native doctor.
Then requests began to come to us asking for medical care. Some
of us who spoke and understood a few French phrases volunteered
our services, a step which will never be regretted.
It afforded us an opportunity to see at first hand with what forti-
tude mothers, wives, and children bore the vicissitudes of war. We
saw anxiety give way to joy when good news came from the loved
ones at the front. We saw mothers bravely dry their tears when
official notice of the son's death was published. We soon saw that
these people were very much like us, if not in habits of living, in their
deeper emotions. We believe that they meet sorrow w^ith a dignity,
reserve, and resignation greater than our own people. Their ex-
pressions of joy, although not as spontaneous, last longer than ours.
Our policy was to do emergency work only among the civilians, and
this we held to strictly during rush times.
For the first few months we were permitted to use a small auto or
Ford ambulance to visit patients in near-by villages. One crippled
old man who had lived in his poor one-roomed hovel for a week was
found to be suffering from pneumonia. He had been without food for
A. E. F. — HOSPITAL CENTERS. 1761
six days and there was no one to care for him. He Avas sent to the
Red Cross hospital at Xeiifchateau, Avhere he made a speedy recovery.
There Avas very little abuse of the privilege of coming to us for
medical advice. The Sisters of Charity took care of alf minor ail-
ments and did it well and faithfully. Obstetrical work of the com-
munity was done by a midwife, Avho called us only Avhen there Avas
some complication.
Aside from the satisfaction of alleviating suffering and receiving
the little gifts of eggs, strawberries, Avild game. an<l mirabellc offered
by the grateful' patients, we found that we had been protecting our-
selves in caring for them. There were some one from nearly *e\'ery
house in town Avho Avorkcd in the hospital or laundered for the per-
sonnel. We spotted several cases of diphtheria and other contagious
diseases, established an effe;tive quarantine, and prol)ably prevented
some epidemics.
llie Army nurse. — At no time during periods of emcrgcncv op-
eration was there a large enough number of nurses available, altliough
the unit brought to France the nunibci- then allotted to base hospitals
and later Avas augmented by the addition of an auxiliary unit of 21
members.
Included in the roster Avere a number of nurses Avho had had con-
siderable experience in institutional and executive Avork. When lios-
pital unit " G " joined. 21 nurses aa-Iio had been assembled brouglit to
the hospital much valuable ability, a large part of the administrative
department of a hospital having enli-ted Avith that nriranization.
It Avas only a short time after the liosjntal was organized that the
first call for nurses for duty elscAvhere Avas received, six being ordered
to Base Hospital No. 9, at Chateauroux for temporary duty.
Eight more nurses were sent to Evacuation Hospital No. 2 at
Bacarrat for emergency duty, returning after a Aveek of intense
actiA^ty in caring for gas and liquid-fire cases. An evidence of the
devotion displayed by the nurses of Base Hospital Xo. 31 is found in
the citation Avhich mentions for exceptional bravery under shell fire
when Evacuation Hospital Xo. 4 Avas shelled on tAvo occasions. Xo-
vember, 1918.
When, as Base Hospital Xo. 31 Avas about to close, there came a call
for volunteers for continued service Avith the American forces, 10
nurses responded and were sent to Germany as part of the army of
occupation.
In many respects Base Hospital Xo. 31 Avas better equipped than
Avere many of the Regular Army bases, because the fund subscribed
in YoungstoAvn had furnished much desirable equipment not avail-
able through Army sources.
In the medical Avards, particlai'ly those devoted to ])neum()nia cases,
and in which the secret of success Avas lodged in the problem of
l)roper nursing, the very finest Avork Avas done. Infectious and con-
tagious diseases were always properly attended be -ause there were
enough unselfish young wonien always eager to do more tlian their
share.
But all this was not accomplished at a cheap price.
At the very top of the Avind-SAvept hill Avhich ovei-looks the valley
of ContrexcA-'ille a simple marker designates the final resting place of
one beloved member of the Xurse Corps, Avho gave her life in the ful-
fillment of the duty sacred to her profession.
1762 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Characfei'S. — After all, our clearest uiemoriert of Contrexeville will
center about the native men and women and children who formed so
intimate a part of our life during the year of hospital service. I
deem it a duty to attejupt to peri)etuate them, confessing at the out-
set that the task is worthy of Balzac; that the courage I have in
starting is the courage of those Avho rush in — ^ * * *_
The dental sei'-vice. — The total number of patients treated was l,-680,
making this department one of the busiest of the specialtj' services
attached to this hospital. Sittings given totaled more than 2,5G0.
The department has been called into consultation in a great many
cases of suspected Vincent's angina, positive diagnosis being made in
15 such cases. An almost uniform method of treatment has been fol-
lowed in these cases, consisting of a thorough prophylactic treatment
of the mouth, employing 10 per cent solution of copper sulphate
applied every other day. In most of the cases the condition was
cleared up in from seven to eight treatments.
The most important surgical work done b}' the department was in
connection with 35 jaAv fractures, battle casualties, and 27 impacted
teeth, 5 of which were associated with abscess of jaw. Jaw-fracture
cases were usually from four to five days' old before reachiiig this
base and had had only very little treatment en route from the lc^hj
of casualty. Practically ail these cases were compound communltMl
fractures, with loss of substance in many instances. There was only
one casualty among this number, the majority of cases being evacuated
for convalescence after jaw had been splinted and all infection
removed.
The drug room. — Plans to make, the pharmacy of Base Hospital
No. 31 as completely furnished as possible were made before the unit
left Youngstown. when, with money furnished by the original hos-
pital fund, considerable equipment and small stocks of some drugs
were purchased.
During the year which has transpired more than 30,000 orders have
been filled. Approximately 7,500 signed prescriptions have been
compounded, each prescription carrying an average of four separate
orders.
To facilitate the workings of the department all refilled prescrip-
tions wei'e sent to the pharmacy in the morning, giving the com-
pounders an opportunity to profit b^^^ the possibiity of having more
than a single order for the same compound from the difl'erent wards.
In addition to the preparation of the prescriptions for hospital
usage, the department maintained a stock of standard drugs to be
issued on proper requisition to such other military units as did not
possess adequate pharmacy facilities. American forestry outfits and
near-by British units were supplied frequently. Indigent French,
with no other source of supply, were regular customers, and, their
worthiness established, were enabled to get the medicines prescribed
for them by the American medical officers under whose care they had
come.
One of the most important functions of the department was the
preparation of Carrol-Dakins solution, more than 5,000 gallons of
w^hich was used during the history of the hospital. When the first
convoy of surgical patients was received in May, the first Dakins
were prepared. At no time from that date to the closing of the hos-
A. E. F. — HOSPITAL ce:n^ters. 1763
pital were surgical wards allowed to be without an ample supply of
this solution.
A double check on the titration of the solution was made possible
through arrangements with the central laboratory.
Dichloramine-T need in goodly quantities by the surgical service
was prepared by the pharmacy. JDuring the latter months, following
the Argonne, it was necessary to use chlorozone as a substitute for
chlorinated eucalyptol and chlorinated paraffin. The results proved
entirely satisfactory.
In Vne of duty. — On the morning of Xovember 2, 1918. Evacua-
tion Hospital No. 4 was stationed at Fromeryville, a wholly aban-
doned and badly wrecked village a few miles from Verdun. By
virtue of its position it was exposed to the euomy artillery fire even
more than the village itself, which had been bombarded frequently
during the four years of war. Artillery fire might well have been
expected, for on the slopes of a neighboring hill and overlooking
ruined Fromeryville were giant allied guns, then in use against the
enemy.
Shortly after 11 o'clock on the morning of the 2d the officers
on duty in headquarters heard the shriek and subsequent explosion
of a shell of large caliber. The officers and men left the building to
see what damage had been done. It was well for them tliat they
were out of the building. Three minutes later a shell landed squarely
in the center of the old heap of ruins. Two enlisted men asleep
there were killed.
Guided by accurate observation the enemy shells falling at three-
minute intervals crawled up the long slope toward the liospital, with
its tents full of wounded men. Clearly the wards would have to be
emptied and the patients removed to a place of relative safety.
Emei-qency anestJiesia. — From personal observation in the more
than 2,000 cases in which I have b en the anesthetist as a membt-r of
Surgical Team Xo, 10, and in the great number of other operations
witnessed, it has not been difficult to allow my previous personal
convictions to undergo a thorough metamorphosis. This is true,
particularly, on the use of chloroform.
Soon after our team was ordered to active service with the French
we visited a French hospital at Beauvais. On entering the operating
room we became aware of the presence of chloroforni. A case was
being operated with this anesthesia in use. It was being used nuich
more freelv than Americans ever have seen it used.
Inquirv brought the answer that chloroform was b.-ing used en-
tirelv and that fatalities under its immediate influence were very rare.
After watching a great number of operations in which this method
I was used we decided on the use of chloroform for our team, and
the results obtained were entirely satisfactory. Accidents were few
land in the total number of cases' we operated there was not a single
death due to anesthesia.
Our first cases presented their proldems, however. Frequently we
were aware of some difficultv in breathing and in a few cases breatli-
m<r stopped. Kesuscitation was rapid, however, and no damag.' was
done. At first it Avas thought the grade of chloroform was respon-
sible. This contention was'disprovcd when we used U. S. P. chloro-
form with the same results.
142367— 19— VOL 2 GO
1764 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
Observation during this period proved that ovir difficulties had
been caused b}' too great a concentration of chloroform rather than
its use over a long period. As soon as the practice became stand-
ardized all such irregularities were removed and chloroform became
the anesthetic of choice in all cases. Even cases of shock with re-
sultant loAv blood pressure due to hemorrhage or trauma, responded
beautifully under chloroform anesthesia. Many thoracotomies for
removal of F. B. of lung, for lacerated diaphragm and F. B. in
liver, were performed with the best of results.
There was one patient in great shock, with blood pressure 70, on
whom the original operation was a high hip amputation. He
rallied nicely and the following day was returned from the ward
for amputation of the arm at the shovdder. On the third day an
eye was removed and all the results were entirely satisfactory.
An appliance known as "Appareil pour anesthesie, a I'ether d'Om-
bradma " controlled etherization by mechanical means, with great
success. A large metallic ball, with a bag attached, was the prin-
cipal part of the apparatus. By means of a series of stop cocks on
this metallic ball the quantity of ether given a patient is governed
by the air intake.
This method of etherization was used only on cases of excep-
tionally low physical condition caused by gas infection or highly
supperative womids.
Ethyl-chloride in its abstract form was used not infrequently.
Many cases were operated within half a minute after the patient
had been adjusted on the table. Tubes of ethyl-chloride, about 6
inches long, were always handy. One of these was broken into a
gauze, which had been placed inside a suitable cap. A single grasp
after the cap had been slapped over the patient's head rendered
him ready for operation. We never used this because our hearts
were not strong, although we never saw a fatality with it.
It was not until our team joined an American evacuation hospi-
tal that the De Pauges method was used, and there its success was
not really pronounced, because our surgeons would not operate a
case while there was any muscular tension.
The De Pauges method as we used it at the evacuation hospital
consisted of this mixture, always prepared immediately before ap-
plication : 1 cc. chloroform ; 23 cc. ether, and 5 cc. ethyl-chloride.
A dry piece of flannel was placed over the face. Above which
was placed another piece of flannel saturated with the solution. A
rubber bag, completely covering the face, except for a small hole
at the top, resembled the old style closed method of etherization.
This method was dubbed the " raus mit em " anesthetic by other
teams, because properly trained enlisted men or nurses went from
table to table, and prepared cases with minimum of delay.
The great lesson to be learned from war anesthesia, however, is
that there is not as much reason for fear of the anesthetic, providing
it is administered by one who truly understands the method.
Feeding a hase hospital. — Increasing prices, uncertainty of supply
sources, and restrictions on purchases have tended to make diffi-ult
the problems of feeding the thousands of patients, personnel, nurses,
and officers of Base Hospital No. 31.
In many instances prices more than doubled during the year we
have been in the market for such articles as green vegetables, fruits,
A. E. F. — HOSPITAL CENTERS. 1765
eggs, and some meats. In no cases has there been a reduction in
price, even during the height of a growing season.
Experience in the purchase of eggs has been ilhistrative of the
problem which has had to be met. In order to get enough eggs to
keep the diet kitcliens supplied it has been necessar}' to go into every
small town within a radius of 40 kilometers and seek the most enter-
prising woman in the place. For a certain margin of profit such
women have been willing to undertake the collection of all egga in
that immediate vicinity, to be gathered by the mess truck.
This system worked out nicely until other hospitals and army
organizations entered the same locality and adopted the same means
of getting supplies. Competition immediately developed, the de-
mand outgrew the supply, and prices increased despite agreements
previously made.
The individual American soldier also has been a factor. There
are few men in the command who have not found a certain place
" out in the country " where they could buy enough eggs at almost
any time to provide a few omelettes at their favorite cafe in town.
Individual purchases of this sort have had a tendency to raise the
price at the source.
Dealers who had been glad to sell eggs at 3 francs 50 per dozen last
winter and early spring now find a ready market for their supply at
from 8 francs to 9 francs per dozen. Every variety of fresh vege-
table has jumped in price beyond all bounds.
By cultivating a war farm according to the plans of the gardening
department a purely local source of supi)ly was created. Because of
the unfavorable weather, croi^s were not bountiful. Less than $50
spent for seeds produced more than 280 bushels of potatoes, which
i-epresented a gross value of approximately $700.
The farm also provided a considerable supply of meat. Early m
the year large pigs were purchased for 2.000 francs. They were fed
on mess-hall leavings and when killed showed an average weight of
330 pounds, or approximately 4.000 pounds. Later 21 smaller pigs
were purchased for 2,830 francs and gave an approximate total of
3 000 pounds, dressed weight. The total amount of pork received
from this medium is about 7.000 pounds. Pork caii be bought for jin
average price of 3 francs 50 in French markets m tins part of the
count rv. , .. i r
There have been times when it has been necessary to go a long dis-
tance to get even canned goods. With the establishment ot an issue
connnissary in this center, however, this difficulty has been alleviated
to a great extent. , ,, ,
Until recentlv a single kitclien has prepared food ^r all the
hospitals, except that hospital building which housed officers n-
abilitv to get coal ffood enough to maintain suficientlv hot hies
'and difficulty in procuring a suitable water ^.';Pl^>-y,"^^^^^^^,;^\.";;'Z
sarv to abandon the sinde-kitchen system after it had been p oxen the
most economical. ^Miile a good coal supply was available it w". .
possible to prepare meals for more than 200 persons in a single
iitchen. Up to 500 were served directly froin this "^^^" l5^*J^^7;- ^^
Bv the establishment of an issue storeroom it was possib e to ke^ep
an accurate check on the quantity of foodstulf used l,y ^«^^; ;!;;•>*'":
Centralization has permitted the maintenance of large supplies of
all available staples, thus simplifying purchasing.
1766 KEPOKT OF THE SURGEON GENERAL OF THE ARMY.
When Base Hospital Xo. 31 was oriianized in Youngstown, the
Ked Cross fund furnished equipment for the operation of a 500-bed
unit, this including six double-burner and three single-burner
ranges of excellent type, together with adequate utensils and all
manner of table^Yare. Upon expansion it was necessary to more
than double all equipment for kitchens and more than four times
the original table equipment was required. Although it was pos-
sible to get sufficient ranges to meet all needs it was difficult to ^if^i
the proper utensils.
The French surgeon. — Members of Surgical Team Xo. 16, United
States Army, organized soon after our arrival in Contrexeville,
had a splendid opportunity to observe the habits of the men of
the medical profession with the French Army and to learn much
from them.
The French had suffered great losses among their medical men
in the German drive which began on the 21st of March, 1918, and
which had as its objective the channel ports, with Amiens the first
step. Our orders came on April 9 to proceed with haste to Beauvais,
Department of Oise. and report to the French in that city; no
other instructions. We arrived in Beauvais the evening of the 11th.
After spending a night in widely separated parts of the town, each
person in a different French home, we wandered around the town
from hospital to hospital where we saw the Avounded being In'ought
in by the hundreds and watched the war surgery, which was different
from any surgery we had ever seen.
The following morning we were told we were to work with the
First French Army, which was under command of Gen. Debeney,
and receiving orders to report at Creveceuer, with three other Amer-
ican teams which had just arrived. From Creveceuer we traveled
in camions with a team from Base Hospital Xo. 8 to Compuis. a
village of about 300 inhabitants, southwest of Amiens and north-
west of Montdidier. There we found two " auto-chirs," Xo. 1 and
Xo. 20, our team being attached to the latter.
Our quarters settled and our baggage deliA^ered we prepared for
dinner, which they told us would be at 7 o'clock. It was just a
bit before 7 o'clock when we went to the old school building, find-
ing there about 20 officers, about half of whom were administra-
tive officers. The formality of presentation completed, and the
effort to remember names we were unable to repeat given up, we
enter the " salle a manger," an old schoolroom. After the dinner,
of several courses, and which we suspected was in our honor (we
were later disillusioned, when we learned this was a daily affair),
we felt we knew the whole bunch; we had also learned what we
sought to know : "Wliat is an " auto-chir " ?
A French auto-chair resemliled our mobile hospital and was the
]>attern followed by tlie Americans. They were formed the first year
of the war, 22 existing when we joined Xo. 20. Several had been lost
in the great offensive shortly before our arrival.
The entire hospital equipment is carried in five especially built
camions, moving thus: Xo. 1, large steam boiler and portable operat-
ing building, to which is attached a large delousing sterilizer. Xo. 2,
X-ray equipment, with portable building. Xo. 3, parmacy and
laboratory. Xo. 4, litters and tentage. Xo. 5, cots and mess outfits, to
A. E. F. HOSPITAL CENTERS. 1767
which is attached a large field kitchen. The entire hospital could he
taken down, packed, and prepared for moving within three hours,
and could be put up, ready for full operating duty within five hours
after arrival.
In anticipation of the possibility to fall back still further the
French practiced the forced removal of their hospital much as we
would prepare for a complete personal inspection by the conunand-
ing general.
It was here that we learned to admire the French people, for it was
here that these men, Avho had worked four long years under trying
circumstances, aM-ay from their families, seing their fellow country-
men killed and crippled and their country devastated, poured out
their hearts to us. Wonderfully congenial and hospitable to us they
sought to have us believe they were hardened to it all.
We found the medical officers of No. -20 to be the leading surgeons
(*1 Paris, a few of them teachers in the medical department of the
liiiversity of Paris. The medecin chef, or chief surgeon, was Maj.
Shevasceau, professor of surgery at that school. They knew surgery
as they might know their alphabet and we were inspired l)y them.
The nurses seemed to be a puzzle on the medecin chef's hands. He
did not use nurses in the operating room and we did not care to have
them used as ward nurses so it was decided best that they, with the
nurses of all the American teams, return to their respective cases.
The operating rooms were in small portable houses, canvas covered
end built against the large camions, which contained the sterilizer,
with a small tent close by. The equipment was of tlie best and sup-
plies of everything were in abundance.
We had taken operating equipment, and tried, at first, to keep ours
a]xirt, but soon turned all in to the competent sterilizers, who ar-
ranged trays with every necessary instrument and dre>sing for each
i\Y>e of case.
The wounded were carried into the triage tents wliere the necessary
paper work was cjuickly done, male orderlies removeil the patients'
clothes by cutting away most of it, placed valuables in bags, which
were properly cared for, and bathed the patients with warm water.
Carried into the preparation ward the patient was i)laced on a
table where a culture of the wound was taken to detect gas bacillus,
tlie wounded parts were thoroughly cleansed and shaved. This work
of preparation completed the laboratory report was ready showing
the nature of the infection. Appropriate serums were injected, il
positive reports were made, together with antitetanic serum. If
negative, only antitetanic serum was injected.
The patient was classified as heavdy or lightly wounded. Ihe
toiiously wounded went to the main operating room, the others benig
taken to auxiliary rooms, where they could be handled (iiufkly and
started on their way back to the larger hospitals in the rear.
Up to this time the patient had not come mto contact with the
gentle hand of woman, but now these too seriously ill to be sent to
the rear came under the care of the wonderful type of French wonien.
These girls were trained in the hospitals of large cities in a few
weeks and sent out in groups of 10 under the direction of one o der
woman acting as directress and chaperon. The group at our hos-
pital was made up of women between the ages ot 22 and 30, and
we thought they were particularly pretty and attractive. Ihey
1768 EEPOET OF THE SUEGEOX GENERAL OF THE ARMY.
usunlly served as nnuli as 15 hours a day, working at full tilt in rush
periods, often reuiainino; longer without a word of complaint.
They could do any and all dressings, and did them well. They
did not know what an orderly's duties were, because no work was
heneatli them. Above all they were ahvays cheerful. Nearly every
day wild flowers were to be found in the wards, the girls picking
them in the near-by fields. They did everything as though attracted
by the novelty of it all. but in questioning them we discovered nearly
all had been doing the same thing for three and four years.
Our team worked from 7 o'clock a. m. until noon; rested until 8
o'clock p. m. and worked until 7 o'clock the next morning: rested
until noon and then worked until 7 o'clock that evening. This ar-
rangement made 16 hours of service of the first 24 and 7 hours the
next 24 and assured us a full night's sleep every other night.
We had heard and read much concerning '* primary suture of
wounds," but we had not been with the auto-chir 24 hours before we
discovered that that was a thing of the past — a nice i^rocedure in
so-called " peace-time surgery," which mean when the activities in
the trenches were almost nil and only a few men were being wounded.
But now that wounded were coming in so rapidly the only primary
suturing was upon head, chest, abdomen, joint, and hand wounds.
The wounded we worked upon were a cosmopolitan lot. Our rec-
ords show French. English, Belgian. Kussian, Spanish, Portuguese,
Algerians, Senegalese. Sudanese. American, and German patients.
Our cases were preponderantly French, but every now and then a
stranger would come through and would be handled in the same
manner — even the Germans, who we sometimes thought were handled
a little better than were the rest. Germans came through frequently
and sometimes in great numbers.
We had no wounded Americans until the battle of Cantigny, the
first coming from the 1st Division, which played such a glorious joart
in tliat initial American attack northwest of Montdidier. A great
many of our own brave boys were brought to the gas hospital, situ-
ated near by and which we visited. We were the only American
mourners of many who died, and we had built quite an American
cemetery on the hill before we had a single American on our own
operating table.
We experienced a few air raids while with the auto-chir. The
first raid on an April night came after we had gone to bed. I was
awakened by thundering detonations. I would have" taken an oath
the Germans had broken through and were now in the village with
all their artillery. The window had been jarred open and I looked
out. I could hear airplanes and see bursts of fire in the air, so I
decided it was the finish of the village. Later I came to look upon
this occurrence as a mild disturbance; French officers had not even
heard of it. and so I decided never to mention anything that
happened.
The next air raid, Capt. and I went into a field so we could
see evervthing. We could see no planes, but could hear them directly
over our heads. The air was filled with flying flashes of fire, and
the vibrations almost deafened us. Next day the French officers were
alarmed when we told them of the little experience. We soon learned
their alarm was occasioned by their concern lest we be killed by a
repetition of a foolish prank. '
A. E. F. HOSPITAL CEXTERS. 1769
Our hospital never was touched, but another— at Grand Villers,
one-half mile away— was bombed twice, killing several persons each
time.
Throughout our experience English was the language of conver-
sation.
Gerdto-urhuiTy.— The " G. U." department of Base Hospital Xo. 31
was opened with the arrival of the first convov of cases, on May 12,
1918, and continued to handle all venereal diseases and special genito-
urinary cases.
One wing of building Xo. 7 (Martin-Felix) was reserved for the
use of tliis department, the capacity being 37 beds.
In addition to its regular genito-urinary work, the department
maintained a prophylaxis station for the post.
The regular United States Army antisyphilitic treatment of ar-
senic and mercury was followed, the only variation being that we used
slightly larger dosage of either arsenic or mercury, particuhirly in
cases of primaiy syphilis. Rarely was there a patient that had
nausea or vomiting or a severe reaction following the intervenous
administrations of nov-arsene-benzol, even in the larger doses.
The prophylaxis station gave 141 treatments with only 1 failure.
Prophylaxis had been taken 10 hours after contact in this instance.
Hixtory of ward " X." — During the summer and fall of 1018 there
was ahnost always a potential if not actual scarcity of hospital beds,
and this made it imperative that patients be sent out as rapidly as
gossible, especially in the front line of base hospitals, of which Base
[ospital Xo. 31 was one.
Early in our experience with men from the combat organizations
we realized that valuable time was being lost and valuable beds
occupied by those cases who had received all the medical and surgical
attention required but who were not strong enough to be returned
to their organizations.
There were at this time no convalescent camps established, or, if
established, none were available for the receipt of this type of case
from Base Hospital Xo. 31. The cases were being held in hospital
beds, and were taking a nice rest cure, which is rather poor as a
muscle builder. These patients were in a way quite a liability.
They were being used as hospital orderlies and sporadically for out-
side details. They were exposed to any infection which might be
present, and. lacking the training of the regular corpsman. did not
understand or take the proper precaution against infection.
But more dangerous was the psychial infection to which they were
subjected from listening to the complaints of their •' buddies." In
order to remove them from this atmosphere and to shorten their hos-
pital days, it was decided to establish a convalescent ward.
Ward "X," as this convalescent ward was to be called, was also
to receive and test out tho^ who were apparently well, but who de-
veloped various cardiac and respiratory symptoms upon exertion or
under unusual strains, that class where the medical officer could not
be sure that they were ready for duty, but still could not conscu-n-
tiouslv hold them as hospital case''.
For the surgical cases it Avas to serve in the same way. Here were
to be taken the men whose wounds were healed but who had some
muscles bound down bv scar tissue: a postoperative joint case which
required some especial exercise or some peculiar form of work; the
1770 EEPORT OF THE SUEGEON GENERAL OF THE ARMY.
postoperative abdominal cases who. althou^li well enough to do very
light duty, Avere in danger of hernia formation if too heavy Avork
was attempted.
In the early part of July it was discovered that there was a part
of one of the buildings Avhich, due to some mis-understanding with
the French authorities, had not been utilized as hospital space. This
was immediately surv^eyed and the necessary beds and cots put in.
By July 12 ward " X " had ceased to be a theory and was a definite
part of Base Hospital No. 31 with the capacity of 74 beda It was
now necessary for some workable division of patients into classes to
be made. These men were potentially the hardest sort of soldiers to
handle. They felt well and were more or less impatient at being
held in hospital.
Four groups were formed, classes A, B, C, and D. It was in-
tended that the officer in charge of ward " X " make this clas'-ifica-
tion. but it was soon found much better to have the classifying done
by the surgeon in charge of the cases. As classes C and D were so
nearly the same, it was found that they could be merged into one
class quite readily, and class D was abandoned within a month after
the opening of ward " X."
It was decided to use as few as possible of the ward " X " men for
inside dut}', leaving this to better-trained corpsmen, but to use ward
" X " men on as many outside details as possible.
For this- class of work the following occupations were available t
Work on the Eed Cross farm, trucking details, sanitary details, car-
penter and plumbing work, distribution of the gifts of the Red Cross,
help in running the Eed Cross hut, K. P. duty, tran^q^ortation of
stretcher patients, police work in and around the buildings, orderly
duty at headquarters, etc. With this range of work to be done and
with its various divisions, there was little difficulty in finding just
the character of work suited to the individual case or group of cases.
Each morning from 15 to 30 minutes were given to calesthenics,
no one particular routine of exercise being followed, as it was found
that variations served to maintain interest. Sometimes the men were
given a short run or some orame instead of the setting-up exercises.
No one was excused from these exercises, absence without good rea-
son being punished with confinement to quarters. Three times a
week hikes were made.
Sick call held each morning was most simple. If a patient became
really sick, he was returned immediately to one of the hospitals.
Everything possible was done to take away the hospital atmosphere
and to make these men realize that they were well, only not quite
strong enough to rejoin their organization.
Three times a week all class A men and those on the border line
between class A and B were sent out for a hike, for from one to two
hours, usually conducted by a convalescent commissioned officer.
The men were marched for intervals of 20 to 30 minutes, with 5 to
10 minutes' rest, either at attention or route step. The last lap of
at least 30 minutes was done at attention and 120 steps to the minute.
Those men who had been on tAvo or more hikes and showed no
marked acceleration of pulse or respiration were reported as ready
for return to duty, and were usually sent to the -replacement camp
next day. Anyone showing any bad effects from this exercise was
held and given more hiking.
A. E. F. HOSPITAL CENTERS. 1771
With increasincy demands from the wards that more eases be
taken, it became necessary to enlarge ward " X." The first increase
was to 88 beds and finally to 288 cots or beds. Every effort was
made to keep ward " X " men separated from men actiially sick or
wounded, and, although scattered, the various parts of ward " X"
were nowhere in direct contact or communication with hospital
wards. With the decentralization of the men it was increasingly
difficult to maintain discipline, but it is of interest to note that dur-
ing the whole of its existence there was only one summary court case
in ward " X,"
One of the most interesting and important class of cases which we
had were the D. A. H. (disordered action of the heart) or effort
sj-ndrome cases. These cases were most trying. The men would be
apparently well and fit and so long as they took things easy there
was no reason to doubt them, but on exertion some would devolop
quite an alarming tachycardia, and woidd gasp for breath.
They were placed in class C or B, and were given the very lightest
kind of work, but always in the open air. They were required to
take the morning exercises, but to quit whenever they felt an}' cardiac
distress. After a few days of this they were put in class B, pro-
vided they had progressed normally.
They were usually in class B for about a week, gradually increas-
ing the amount of work. Another interesting class was the convales-
cent gassed patients, many of whom had the effort syndrome, but
the majority of whom were especially the mustard-gas cases. They
would report at sick call with a history of being unable to sleep
becauseof a pain variously described as dull, short, lancinating,
migratory, etc., somewhat in the neighborhood of the heart. Xo
cause for this pain was ever found on physical examination, but
the men were too positive in their statements fov one to doubt that
it was a real thing to them.
Xumerous remedies were tried, but the only real results achieved
were from generous counterirritation with iodine applied over the
whole precardiac area, accompanied by the assurance that this pain
would soon disappear.
Postoperative cases offered another fruitful source of worry.
The men with gunshot wounds of the hand, arm, or shoulder, with
the resulting interference to the functioning of the various muscles,
formed this class. These cases were soon well, so far as their general
condition was concerned. The problem was finally solved by pro-
curing a box of car[)enter's tools and putting these men to work
making stools, bedside tables, 6tc.
Concentrating on this one type of work, these cases were in con-
dition to return to duty at least two weeks earlier than had they
remained on routine details and at least a montli sooner than had
thev remamed in hospital wards.
The one type of case in which ward X was practically a complete
failure was in the flat-foot group. Wearing of the orthopedic strap
helped some, but we were never able to really benefit their condition.
Probably the inost marvelous cure worked by the ward X treat-
ment was on the group of some 14 hysterias affected with the so-
called "shell shock." These men came into ward X just at a tune
when the quartermaster had several cars of coal to be unloaded.
Classed as "A" these men were put under a " hard " noncomnnssioned
1772 REPORT OF THE SURGEON GENERAL OF THE ARMY.
officer and sent to imload this coal. Within less than a week all
were on their way to rejoin their oroanizations. cured and carrying
with them the impression that " shell shock " was viewed, in the vast
majority of cases, as an evidence of a " yellow streak."
From the 12th of July to 3d of December, 1,424 ])atients passed
through ward X, 922 coming from the medical service and 502 from
the surgical side. The average number of days for all cases was
7.37 days.
On December 3d, due to our inability to return cases to duty,
there were more than 250 men in ward X, absolutely cured. On this
date they were formed into a casual company and ward X was dis-
continued, the bed apixce being required for the casuals. AVard X
personnel continued in charge of this newly created department.
Laboratory facilities. — Although the central laboratory at Con-
trexeville did the laboratory work, not only for Base Hospitals Xos.
31 and 32 but in some instances for other hospitals, the record of its
activities from the date of its establishment, on April 8, 1918, is a
fair chronicle of the laboratory needs of Base Hospital No. 31 and
the method of meeting them.
Although for several weeks following inception the central labora-
tory was under the general direction of an officer of another unit, the
period of greatest activity saw officers of Base Hospital No. 31 in
executive charge. Detail work in various departments were car-
ried on with absolute satisfaction for both hospitals.
During the 15-day period before the establishment of the central
laboratory little laboratory work was demanded, the patients being
for the most part convalescents from other hospitals. A few hun-
dred specimens were examined. On April 8. 1918. the director of
laboratories and infectious diseases, American Expeditionary'
Forces, recommended the pooling of the laboratory equipment of
Base Hospitals 31 and 32 and the formation of a central laboratory.
He also recommended the formation of a number of smaller sul)sidi-
ary laboratories in the wards of the two hospitals for the handling
of clinical pathologj\ The fact that the two hospitals occupied 13
distinct and somewhat separated buildings necessitated some such
arrangement.
Enlisted men were trained to do clinical patholog3\ These men
were selected from medical students, pharmacists, and prospective
medical students.
The laboratory organization was in good working order by June
1, 1918, with the exception of the proposed serology department.
This department was established July 20, 1918. From that time it
has done the serology for the center, Base Hospitals 31, 32, 23, 36.
In addition, this department has charge of the anatomic-pathology
for Base Hospitals 31 and 32.
The volume of work increased steadily from June 1 to November
1, 4,500 tests being done in the month of October. This included 121
post-mortems.
Sterile test tubes, sterile swabs, and glass slides were placed in each
ward. Also a sufficient numl^er of wide-mouthed bottles for such
specimens as urine and feces was furnished. Specimens were brought
to the laboratory by ward orderlies. Routine reports were sent out
by messenger twice daily, morning and afternoon. Urgent reports
were telephoned.
A. E. F. HOSPITAL CEXTERS. 1773
Central lahoratory. — Duplicates were kept of all reports sent out.
All reports were given a serial laboratory number and entered in one
book. Reports were signed for by the' sergeant of the ward upon
delivery. Wasserman reports were indexed alphabetically according
to name of patient. Post-mortem reports were given a separate
number in serial order.
All duplicates were filed of lists of expendable and nonexpendable
property concerning the laboratory. All communications and orders
from the central department laboratory were filed in one place
according to date.
Duplicates of requisitions, official letters, communications to com-
manding officers, sanitary reports, etc.. were kept in appropriate files.
General and wound bacteriology records were kept separately accord-
ing to serial number. Monthly reports were filed.
Suhsidiary JaljoratorieH. — Each specimen was recorded in a ledger,
with name of patient and other clinical details. A duplicate was
kept of the results of the test. Reports were signed for by sergeant
of ward upon delivery.
Six laboratories for clinical pathology were established. The
work done mainly by enlisted men trained by laboratory officers.
This plan succeeded very well, the enlisted men doing unusually good
work. An average of 1,500 tests were done monthly.
A total of '231 post-mortems were done May 21 to December 1,
1918. During the month of October 121 post-mortems were done.
There was little demand for surgical pathology.
Bactenoloijy. — This department has probably been of more stn-vice
than any other laboratory department. An average of 550 cultures
were made monthly.
Serology. — This department was not established until July 15.
Previous to this time specimens were done at U. S. A. Laboratory
No. 1. From this time on an average of 140 tests were done monthly
from the 4 base hospitals, 31, 32, 23. 36.
There was little demand for the more elaborate tests of physio-
logical chemistry. The central laboratory was not equipped to han-
dle this work.
Epidemiology and sanitary survey. — The sources of water supply
were checked from time to time for determination of potable and
nonpotable waters. The personnel of the two base hospitals were
subjected to the Schick test for the handling of possible diphtheria
epidemics. During the latter part of November and December the
personnel of Base Hospital 31 were revaccinated with typhoid-para-
typhoid vaccine. This was occasioned by the development of four
cases of tvphoid among the personnel of Base Hospital 31. At the
same time%tools of all persons handlintr food, cooks, kitchen helpers,
etc., were examined for typhoid carriers. Rigid rules regarding
drinking water, uncooked foods, and milk were made.
From time to time search for diphtheria and meningococcus car-
riers upon occasion of the findings of isolated cases of these diseases
was made. No epidemic occurred. .
Seven hundred and eightv-two operative procedures were carried
out from June 1 to December, 1918, including under this head,
Schick tests, vaccinations, spinal punctures, administration of anti-
sera, etc.
1774 EEPOET OF THE SURGEON GENEEAL OF THE AEMY.
The medical service. — On the arrival of the hospital in Contrexe-
ville, January 1, 1918, two hotels, the Continental and the Martin
Aine. with the capacity of 500 beds, were assigned for the care of
medical cases, exclusive of officers, wdio were to be cared for at the
Hotel Thier}".
Adinlnist ration. — It is obvious that the problems of administration
of medical services in base hospitals must vary somewhat w^ith each
hospital, according to personnel, types of cases received, housing
facilities, transportation, distance from the front, rapidity of evacua-
tion, etc.
Conditions tended to vary rapidly. Officers were frequently or-
dered awaj' and not replaced. The unit was forced sometimes to
function as an evacuation hospital. The number of patients changed
within wide limits rapidly from time to time, and might be prepon-
clerately medical or surgical.
Until the last month of the war it was seldom known until a train
arrived what tj^Q of patients were to be expected. During the
Chateau-Thiery drive, one train supposed to be carrying wounded
brought 500 gas cases.
When the unit reached Contrexeville two buildings, the Hotels
Continental and Martin-Aine were tentatively assigned to the med-
ical service. The capacity of these buildings calculated according to
the American Army standards was 500 beds; later, owing to ne-
cessity for increased hospital facilities, 200 extra beds and cots were
added, filling all available corridors and closets.
All officer patients, whether medical or surgical,. were sent to the
Hotel Thiery. Usually this gave sufficient beds for medical require-
ments, but often it became necessary to encroach on the surgical side,
and vice versa.
The chief of service was given a free hand in the administration
of the department. He was responsible to the commanding officer for
the medical care and disposition of each case in the service.
It was therefore his duty to see that all possible efforts be made in
the diagnosis and treatment of cases ; that all cases ready for duty be
returned as rapidly as possible ; prevent return to duty of those men
not yet ready : to prevent spread of contagious diseases ; battle with
the vermin and skin diseases; see that cases were properly classified
for evacuation; that all consultations, treatment, and transfer from
other departments be promptly attended to ; that all orders in so far
as they applied to the medical service be faithfully obeyed; that
records be properly kept; and, on the other hand, to handle the inter-
esting clinical material in such a w^ay that as much as possible be
available to each officer of the service.
Hence it seemed best that the chief of service should not have
charge of any building or direct charge of patients, but should utilize
any spare time he might have helping where he could be of most
assistance.
The administration of each building was entirely in charge of the
officer to whom that liuilding had been assigned. He was responsible
for the property, policing, and discipline in addition to his responsi-
bility for the medical care of patients. Each ward officer in turn
was responsible to the officer in charge of the building.
Perhaps the administration, in so far as it touched the patient,
could be best shown by tracing the course through the hospital. The
A. E. F. HOSPITAL CENTERS. 1775
soldier, whether American or belonging to the allied forces, came
either by train or ambulance. If by train he came either from evacu-
ation or field hospitals anywhere along the French or American
front ; if ambulance, the distance traveled was usually between 50 and
80 kiloiiieters, from that portion of the line more or less directlv in
front.
All lying cases were taken directly to the hospital buildings. Sit-
ting cases were sorted as to desirability of bathing before sending
them to the buildings. It was found best not to bathe iiuniediately
any case suffering from respiratory diseases, gas (except old or ob-
viously mild cases), or any patient who was weak or had rapid pulse.
All those taking the bath were at this time inspected for skin diseases
and vermin.
As soon as the patients reached the building they were seen by one
of the medical staff. Those cases requiring immediate' attention were
taken care of at this time. After being seen by a medical officer the
cases were assigned by the ward master to the proper ward and bed.
The patient might gl) to the detention room for observation for con-
tagious diseases, the respiratory ward for gassed cases, etc.
It seemed important to separate contagious-disease suspects and
contacts, pneumonia, influenza, typhoid fever, keep gassed cases as
far as possible from respiratory infections, and to separate the war
neuroses from medical cases in general.
The ver}' excellent laboratory and X-ray facilities, the ease of pro-
curing examinations along any special lines desired, together with
frequent examinations and discussions among the members of the
meclical staff, made it possible to give the soldier satisfactory medi-
cal attention. The facilities w^ere in some respects better than those
obtainable in any but the best civilian hospitals.
While the number of nurses was far below the standard of peace-
time civilian hospitals, this was in part compensated for by the fact
that the nurses were all graduated and that the corps men detailed
as orderlies quickly learned their duties and were able in part to
substitute satisfactorily as nurses.
As far as possible each case was seen every day by the ward officer,
as he deemed necessary. The chief of service attempted at first to
make complete rounds and see every case once a week.
It was found that occasional complete rounds, together with daily
visits to each building to see those cases which the building officer
wished to have seen, consumed far less precious time for all concerned.
Approximatelv once a week visits were made by the consultant for
the district, to whom were brought all the unsolved problems.
Usually as soon as a patient's examination was complete he was
grouped according to the condition found either as nontransportable,
for evacuation to the United States, for reclassification by the dis-
abilitv board, for transfer to some special ho.spital, or to the rear by
hospital train, or in the duty class to be sent as rapidly as possible to
the convalescent ward. Contagious-disease cases were immediately
sent to the hospital for contagious diseases at Vittel.
Special efforts were made to dispose of cases rapidly. Evacuation
was practically always by hospital train, excepting those cases going
direct to special hospitals or returning to duty.
The criterion for evacuation to the rear varied, depending upon
transportation facilities, hospital space in the rear, and expected de-
1776 REPORT OF THE SURGEON GENERAL OF THE ARMY.
mand for beds in this particular area. Usually those cases whose con-
valescence "would require more than two weeks were evacuated when-
ever trains were available. Occasionally all Avere evacuated who
were not expected to return to duty in four days. This would natu-
rally empty the hospital quickly and prepare us for heavy admis-
sions of battle casualties which, so far as the medical service was con-
cerned, consisted principally of gassed cases.
As soon as the patient no longer required medication nor close ob-
servation and would be benefited by some exercise he was sent to the
convalescent ward.
The convalescent ward was organized for the purpose of building
up, as rapidly as possible, the strength of the soldier weakened by
disease or wounds and combating the tendency toward " Mauvais
esprit." The result was a success bej'-ond our expectations. Later,
when the convalescent camps were organized in certain areas, none
was available to us. We were never inconvenienced by the lack of a
convalescent camp.
The question' as to when a soldier was ready to be returned to
duty was sometimes a very nice one. Justice to the soldier demanded
that he be well hardened before going out to endure the hardships
and exertion incident to his work in the line.
Each man was sent out on a prescribed hike of 7 to 10 kilometers,
ending with a 30-minute march at 120. At the end of this hike the
medical convalescents were rapidly examined for evidence of undue
fatigue, dyspnea, or tachycardia.
Later each man was stripped and inspected for skin diseases and
given careful examination of the heart and lungs. All who passed
the various tests and examinations successfully were then recom-
mended to the disability board for discharge to dut}'.
Throughout nine months, during which the hospitals functioned
3,413 patients were handled by the medical service. The average
stay, including time in convalescent ward, was 24.72 days. This
gives a total of 84,369 hospital days.
Medical oh sensations and statistics. — The medical records of Base
Hospital Xo. 31 show that with the exception of poison gas and the
neuroses incident to war the same types of disease are found as in
civilian hospitals. Yet there are surprising variations from the per-
centages usually found.
Out of 3,413 cases admitted to the medical service, 1,125 were suf-
fering from the effects of poison gas, 1,149 from acute lower respira-
tory tract infection (including influenza), 398 from gastro-intestinal
disorders, and 147 from the war neuroses.
If 30 mental and 63 dermatological cases be excluded, there remain
only 501 cases scattered among other conditions admitted to a medi-
cal service.
Perhaps the most interesting group comprised those suffering from
the effects of j^oison gas. Accurate statistics as to type of gas en-
countered was not possible. The records show 551 cases of mustard
gas intoxication, in which the chief symptoms were due to inhalation
and 198 due to body surface contact.
Most of the cases showed effects both from inhalation and contact.
Of the 376 cases due presumably to the other types of gas, the vast
majority were caused by chlorine and phosgene. A few cases due
A. E. F. HOSPITAL CEXTERS. 1777
to the eifects of lachrymatory, arsenical, and certain rare gases were
seen.
The cases coming to this hospital very quickly demonstrated the
value of the alkaline bath treatments. Those thoroughly treated
showed remarkably few skin burns, while those untreated often
sliowed extensive burns, some of which required prolonged stay in
hospital.
When acute lower respiratory tract infection occurred in gas-in-
halation cases, the condition was liable to be severe and prolonged.
It was therefore considered wise to keep gassed cases as far away
as possible from all types of respiratory disease.
The troublesome cough was benefited occasionally by inhalation,
but most by sedative mixtures ( ontaining opiuui derivatives. It was
necessary in many cases to push the sedative treatment in order to
prevent the development of bronchiectasis of the small tubes. This
condition fairly frequent in certain units was rare among our cases,
possibly on account of the free use of sedatives.
Perhaps the most troublesome condition found during convales-
cence was the effort syndrome wdiich developed as the patient began
physical activity. While there can be no doubt as to the genuineness
of the curious pains usually referred to the region of the precordium,
the psychic element played a large part, sometimes the most impor-
tant part, in the clinical picture.
The "soldiers were apprehensive as to the effects of gas in striking
contrast to their nonchalance toward wounds. All had heard stories
as to how men inhaling gas dropped dead without warning. Conse-
quently the onset of any unusual pain, particularly in the region
of the heart, frightened them. It was therefore necessary to recog-
nize this psychic factor.
They were assured and reassured that the pains, shortness of breath,
etc., were to be expected during convalescence from gassing; that
they were temporary and of no particular importance. As soon as a
nuin was able to run up two flights of stairs without persistent
tachycardia or breathlessness he was removed from the hospital
and sent to the convalescent wards.
In the convalescent ward he was no longer treated as a sick man,
but as merely undergoing process of hardening. He was put through
a regime of gradually increasing exercise and work. If the iuiprove-
ment was not as rapid as looked for. the activity was cut down again
and very carefully increased. Duriug this tage the precordial pain
and pains in various parts of the trunk were frequently markedly re-
lieved by the application of iodine over large areas.
Impressive visual effects were sought in the application of iodine
and possibly were responsible for the benefits. Under this regime the
percentage of cases of effort syndrome that did not yield to treatuient
was small. If we exclude tliese cases with previous history of this
condition, the nuuiber of cases requiring reclassification for effort
syndrome or disordered action of the heart following gas intoxicatu)n
was almost negligible.
Diseases of the respii^atori/ .^f/sfem. — As was to be expected the
transportation of large numbers. of troops froui the comparatively
dry climate of the United States to the wet. raw conditions of France
resulted in numerous respiratory infections. This was evident even
1778 r.EPOET OF THE SUEGEOX GENERAL OF THE iUlMY.
before the pandemir of influenza and bronclio-pneiinionia swept over
the world. Avhieh, curiously enough, was less severe among the
• soldiers in nianj' sections of France than at the cantonments in the
United States.
The bronclio-pneumonia seen at this hospital belonged to the type
seen everywhere.
There could be no doubt that the condition was in some way con-
nected Avith influenza.
During the mild epidemic of influenza in May, 1918, one typical
case of broncho-pneumonia was seen. There were no further cases
until the second outbreak of influenza, beginning in the latter part
of August. In quite a number of cases the broncho-pneumonia de-
velpode during what appeared to be an attack of influenza, and some-
times occurred during the convalescence from that disease.
But frequently the disease seemed to be a definite bronch-pneu-
monia from the start, showing no apparent clinical or bacteriological
relation with influenza except for its occurrence during an influenzal
epidemic.
The predisposing causes seemed to be principally those conditions
which tended to lower vitality, such as unusual exposure and exhaus-
tion, lack of sleep, bad hygienic conditions, especially overcrowding,
poor food or lack of it. Cases badly cared for or allowed out of bed
too soon were very liable to be attacked.
From the ver}^ large amount of bacteriological work done in this
hospital on sputum, blood cultures, lung punctures, pleural fluids,
culture of heart's blood and lungs at autopsy, the organism found
most frequently seemed to be a nonhemolj^tic streptococcus with
constant cultural characteristics. The influenza bacillus was found
not infrequently, but usually in association with pneumococcus or
streptococcus.
In one case influenza bacillus was found in pure culture in a
pleural effusion. It was not found in any other specimen of pleural
fluid. Pneumococcus was frequently found in sputum and occasion-
ally in blood cultures and pleural fluids. Hemolytic streptococcus,
staphylococci, and other organisms were sometimes reported. In
one case lung puncture yielded a pure culture of micrococcus ca-
tarrhalis. The meningococcus was not reported here.
Autopsies usually revealed an extensive broncho-pneumonia fre-
quently involving all the lobes. Small areas of necrosis and abscess
formations were not uncommon. Almost every one showed more or
less extensive pleurisy with varying amounts of exudate. The spleen
was frequently somewhat enlarged, weighing from 250 to 400 grams.
In these cases it was softer than normal and gi-ayish in color. The
kidneys and liver rarely showed evidence of degenerative changes.
Occasionally the right side of the heart was found dilated, but
the left rarely. The muscle seemed to be in as good condition as
could be expected following an acute severe febrile illness.
There was a marked uniformity in the clinical manifestations as
definite as that of t3'phoid fever, wdiich, in the early stages, it greatly
resembled. The onset was gradual, sometimes preceded by what ap-
peared to be an attack of influenza.*
Phj^sical examinations might show slight cyanosis, a few scat-
tered fine moist rales or localized showers of crepitant rales over
A. E. F. — HOSPITAL CENTERS. 1779
the bases of the lungs posteriorly or in the axilla. Frequently no
pulmonary signs could be elicited for several days.
As the disease developed the cyanosis and a gradually increasing
dyspnea became prominent features. The more severe cases tended
to have gastro-intestinal disturbances. Tympanites was not uncom-
mon. The temperature was irregular, showing wide variations and
pseudocrises. The pulse rate tended to stay down and was usually
of good volume, even in the fatal cases. The blood. pressure was fre-
quently lowered. As a rule no dilatation of the heart could be deter-
mined. The pulmonary signs tended to increase gradually. The first
sign of importance was localized showers of high-pitched subcrepi-
tant rales. Then developed, gradually, the signs of incomplete con-
solidation.
Only occasional areas showed the clear-cut signs of a lobar pneu-
monia. The process almost always involved both lungs and, in the
fatal cases, usually spread to all the lobes. In nearly all cases a
pleural friction could be found by careful auscaltation.
Out of a series of 155 cases of this type of broncho-pneumonia 5
required rib resection for empyema. No pulmonary abscesses were
recognized clinically in our cases nor were any except very small
ones found post mortem.
In those cases which recovered, the temperature subsided by lysis.
One case underwent a second attack immediately after the first. The
fairly mild cases required as a rule at least two months' convalescence.
Even after nutrition was well established, physical exertion tended
to cause dyspnea and tachycardia.
The mortality in a series of 155 cases treated in the medical service
was 20.67. The series included those cases in which the broncho-
pneumonia supervened upon some previously existing disease, such
as typhoid; also surgical cases that could be transferred to the medi-
cal wards for treatment. Naturally the mortality in such groups was
higher than in the uncomplicated cases.
The combination of broncho-pneumonia with typhoid fever seemed
particularly fatal, three out of four cases dying. Two, however, were
admitted practically moribund. The association with major wounds
also increased mortality very greatly. Out of 13 such cases. 7 died.
Previous state of health and physical condition seemed of less im-
portance in prognosis than in most other diseases.
Prophylaxis is of unusual importance on account of tli? leady
transmission of the disease. All who come in contact with the patient
should wear gowns and have the nose and mouth well masked with
several thicknesses of gauze. In a hospital ward the patient's bed
should be so screened as to avoid possibility of spraying his neighbor
with droplets when he coughs.
The patient should not be transported any more than absolutely
necessary and that only in the earliest stage of the disease. Trans-
portation by ambulance or truck over long distances was responsible
for several deaths in our series. The patient should be placed in such
a position that he gets plenty of fresh air, preferably with the chill
taken off. He should be made as comfortable as ])ossible and not dis-
turbed by frequent examinations. One a day is ])lenty.
Careful nursing saves lives. Orderlies should be iuipressed with
the fact that the life of a man may depend upon the deftness and
gentleness with which they handle him.
142367— 19— VOL 2 51
1780 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Feeding was always more or less a problem. HoweA^er, a limited
amount of eggs and milk could always be had.
About 1,500 calories per day Avere given if the patient desired that
much food. If gastro-intestinal disturbances or tympanites occurred
diet was immediately cut down. But the rapid emaciation on low
diet made an increase desirable when it could be taken.
The administration of water at stated intervals was made part of
the treatment. The usual amount given was 200 cubic centimeters
every two hours when the patient was awake. The fluid intake was
noted on the chart.
For temperature over 103°, or restlessness, cool sponges were tried.
They were given in such a manner as to disturb the patient as little
as possible. Some cases were benefited, others distressed by the
procedure.
In the medicinal treatment the one valuable drug was opium. If
cough was troublesome, sufficient codeine or heroine was given to
relieve the patient of his distress. This was often sufficient to enable
him to get a good night's sleep.
On account of the almost universal incidence of pleurisy pains in
the chest were common. They were sometimes relieved by strapping,
but the quality of adhesive furnished was so poor that the straps
were constantly slipping and became useless overnight. Conse-
quently morphine was necessary in most cases to relieve pleural
pains. At least enough was given to insure a few hours sleep every
night and to take the sharp edge from the pain at other times.
When there was a tendency toward tympanites the opium deriva-
tives were administered with extreme caution but not withheld.
Tympanites was probably less frequent than in ordinary lobar
pneumonia, but was not rarely seen. The treatment consisted of
cutting down food, turpentine stupes to the abdomen, and various
kinds of enemata. Drugs of the type of eserin and pituitrin in our
experience were of little or no permanent value. In the stubborn
cases castor oil seemed to be the most efficacious remedy.
Digitalis was routinely employed in one of our wards and in the
other on selected cases only. The indications were tendency toward
rapid dilatation of the heart. In a few cases it seemed to be of
value.
On the other hand, the routine administrations of large doses
caused gastro-intestinal disturbance, which complicated the manage-
ment of the cases. The indication for the use of this drug in patients
with a disproportionately low pulse rate seemed rather dubious.
The use of type 1 serum, therapeutically, was not possible in this
series of cases Ijecause in not a single one was type 1 pneumococcus
reported. A few experiments were made in transfusion from con-
valescent cases to patients seriously ill due to infection with the same
types of organism. All the cases selected were considered abso-
lutely hopeless. Each- showed a marked temporary improvement,
probably due to the effect of the transfusion per se.
In one case, in which death had been expectedly quickly, improve-
ment was remarkable and persisted for 36 hours. The cyanosis al-
most disappeared, the extremities which had been cold became warm,
the pulse which had been thready regained good quality, and the
patient recovered temporarily from his stupor. The results were so
promising that the possible therapeutic value of transfusion in severe
A. E. F. — HOSPITAL CENTERS. 1781
cases deserves investigation. It is a vastly more powerful circulatory
stimulant than any drug.
All cases had to be watched closely for pleural effusion. If the
effusion was small or moderate it was not removed. If it embar-
rassed respiration or circulation it was slowly withdrawn as often as
necessary.
But few cases went on to frank empyema requiring rib resection.
Local anesthesia was employed. In those cases too ill to be moved
the operation was done on the patient's bed without ver}' much in-
convenience and with very little discomfort to the patient.
There Avas no operative mortality, but one case died 10 days later'
due to the development of empyema on the other side.
Lobar pneumonia. — But 37 cases of lobar pneumonia were cared
for on the medical service. Of these 8 died, giving a mortality of
21.6 per cent. The incidence of the disease was greater during the
influenza epidemic. It seemed probable that some of the cases had
a relation to influenza similar to that of broncho-pneumonia. Bac-
teriological study usually showed pneumococcus in the sputum, but
in only one case was a type 1 found.
Infnenza. — The influenza here as elsewhere occurred in two dif-
ferent waves. During the epidemic in May the disease was of trivial
character, lasting only a few days.
The pulmonary complications were slight. As a rule no rales
could be elicited. Out of 66 cases there was but one case of broncho-
pneumonia. The cardio- vascular system was priictically unaffected.
The epidemic beginnmg the latter part of August was of mora
serious character. As a role the course was much prolonged. The
majority had bronchitis, which not infrequently went on to a definite
broncho-pneumonia.
Acute sinusitis and otitis media were not uncommon. The cardio-
vascular system was usually affected, sometimes profoundly. A few"
cases had to be reclassified on account of post influenzal myocarditis.-
Influenza, except in so far as it predisposed to pneumonia, was
not found to be a fatal disease among healthy young adults. There
was not a single death due to influenza or any of its complications
except broncho-pneumonia.
Bronclnth. — Various forms of bronchitis were common and except
for influenza the most frequent conditions encountered. The climatic
conditions of France, together with overexposure, exhaustion, over-
crowding, and other factors tending to lower vitality, seemed of most
importance etiologically. Most cases responded readily to treatment
in hospital.
Tuberculosis was an extremely rare condition until after the in-
fluenza pandemic, Avhen it became very noticeably more frequent.
In this hospital 22 cases were proven to have pulmonary tuberculosis
and 39 others were sent, after short periods of study here, to the
observation centers for tuberculosis. Of the latter group, nearly all
tluit could be traced were later invalided to the United States as
cases, of tuberculosis.
G astro-intestinal diseases. — Of the gastro-intestinal disorders most
Avere acute disturbances accompanied by diarrhea. The principal
causes Avere bad food, bad Avater, and exhaustion. These cases usually
responded readil}- to simple measures such as rest in bed, castor oil,.
low diet, and simple diarrhea mixtures.
1782 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
It was always necessary to be on the lookout for dysentery as it
was constantly being reported. In this hospital, although many
specimer.s Avere sent to the laboratory no cases of bacillary dysentery
were discoAered. Five cases of amebic dysentery were found by
the method of examining plugs of rectal mucus at the bedside. Of
these ca-^es one died as a result of perforation of the bowel. The
others recovered.
. Cardlo-vasctilar diseases.— The number of cases of cardio-vascular
•disease was remarkably low in view of the amount of valvular heart
disease and effort syndrome seen by the writer and others who acted
as cardio-vascular examiners in the cantonment.
Xcphritis. — Nephritis was comparatively rare. There were but
five cases of acute nephrities of which perhaps three might have
been classed as trench nephritis.
Disea,ses of endocrine glaiuls and metabolism. — The tremendous
phj'sical exertions, terrific nervous strains, and dietary irregularities
incident to fighting might have been expected to cause increase in
metabolic disorders and disturbances in glands of internal secre-
tion. There were two cases of exophthalmic goiter, two of simple
goiter, one of gout, and not a single case of either diabetes, mellitus,
or insipidus.
Acute infectious fevers. — ^Until the time of the Argonne drive,
typhoid fever was very rarely found. During this battle many of
the men were forced to drink water from whatever source it could
be found. Consequently the admissions for typhoid and ])aratyphoid
increased somewhat.
At the same time there was a mild attack in Contrexevilie. Four
of the enlisted personnel of the organization developed typhoid.
Two patients developed typhoid and one paratyphoid beta. All of
them had been in the hospital too long to have acquired the infec-
tion previously.
It was found that two of the cases among personnel might have
been acquired through the violation of the technique established
for the care of typhoid. None of the others could be explained by
contact. A rigid control of drinking water and revaccination of
the personnel stopped the local epidemic completely.
There were no deaths among the uncomplicated cases: two were
admitted moribund, with a combination of typhoid fever and bron-
cho-pneumonia. The other case who died had severe intestinal hem-
orrhaoes, was greatly improved following transfusion, then devel-
oped broncho-pneumonia and bilateral parotitis.
In all, '25 cases of typhoid and 1 of paratyphoid were handled by
the service.
Trench fever. — There were but three cases in which the diagnosis
of trench fever seemed fairly certain. There was no way of prov-
ing the diagnosis in these eases, but the clinical picture closely re-
sembled the description of that disease. A fairly large number of
cases were sent in the hospital labeled as having trench fever, but
further observation showed the diagnosis to be erroneous.
Contagious diseases. — Among the 8,762 cases handled by this hos-
pital there were admitted or developed after admission 15 cases of
of diphtheria, 14 of scarlet fever, 2 of measles, 5 of epidemic menin-
gitis, and 10 of mumps. These cases, except mumps, were sent, if
transportable, to the hospital for contagious diseases at Vittel.
A. E. F. HOSPITAL, CENTERS. 1783
Intestinal parrmfes. — These conditions were relatively unimpor-
tant, tlie only one of any consequence being the hookworm, of which
seven cases were discovered in the medical service. It was necessary
to keep this condition in mind, especially among the southern troops,
when the symptoms were vague and no definite evidence of disease
were disco^•erable by the usual examinations. A history of ground-
itch could usually be obtained.
N euro-psychiatric. — This work was of no particular medical in-
terest, except the group of cases sent in with some diagnosis indicat-
ing that the condition was thought to be due to some form of war
neuroses.
Of the 147 cases diagnosed here as psychoneuroses, the vast ma-
jority responded quickly to a regime of instruction, plenty of work
and exercise. First the" men were taught that the neurosis or shell
shock of which some of them were rather proud was an evidence of
weakness to be greatly deplored and overcome as quickly as possible.
Out of one series of 114 cases all but 7 were returned to duty in less
than 4 weeks. In the refractory cases a history of previously exist-
ing nervous instability would usually be obtained.
MILITARY STKGKKY AT THE JHOXT.
(From a review of the work of surgical team No. 17.)
Because the lessons learned in the emergency work near the front
lines, and the larger work at. the bases, must have a bearing on the
future policy of American Army surgeons, it is interesting to trace
the workings of the various Army hospital formations as we have
experienced them.
On arrival at Contrexeville there came a call for the organization
of surgical teams from staffs of all base hospitals. One of those was
made up from the personnel of hospital unit " G."' Its chief was
sent to Evacuation Hospital Xo. 1 for observation.
Evacuation Hospital Xo. 1 was located at Sebastopol, about 6
kilometers north of Toul and about 20 kilometers behind the lines.
During the period spent there practically all operations peculiar to
war surgery were exemplified and daily visits were made in the
wards.
After the chief's return our team held itself in preparedness for a
call to active duty. The call came on the 9th of July, when Surgical
Team Xo. 17 was ordered to proceed to Evacuation Hospital Xo. 4,
at Ecoury. 5 kilometers east of Chalons.
Arriving at Ecury during the night of the 9th, it was found that
the hospital was in course of erection. Xo officers were present.
Tents had been pitched, and the members of the team got a few
hours' sleep under rather trying circumstances.
The hospital was without supplies or light or Avater. The French
would not give light before the erection of permanent poles or water
without laying pipes in trenches 2i feet deep.
On the iotli work started to come from the front. Tlie operating
tent and all was in readiness when at G p. m. the first four surgical
teams started on their first 12-hour shift.
There was a great variation in the skill and rapidity with which
some teams worked. While one team would do 40 or even 50 cases
1784 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
in a 12-lioiir shift, another would do but 10 or 12. After a short
time certain teams ^yere being called upon to do all the most severe
v<;ases.
At times as many as 100 to 150 cases were awaiting operation,
while new ones were coming continually. Teams got tired under the
-strain and worked slower. The threats of bombing added to the
fatigue; Chalons, 5 kilometers away, being bombed every night.
The Boche never failed to fly over our heads at such times, and this
-was followed by showers of antiaircraft shrapnel, necessitating wear-
ing metal helmets even when operating. The camp was bombed one
night, one large bomb falling 100 yards from the two officers' sleep-
ing tents. The following night this was followed by machine gun-
ning, but without casualties.
The shock work during this period was particularly fine, and the
^triage work was better than at any time later. When the American
fighting southeast of Rheims relaxed we were ordered to La Ferte.
The trip was made by auto, over 70 French camions being required
to move equipment. (Officers and nurses filled 12 ambulances.
During this trip we became impressed that specialists should be
treated with protective care, as one does a race horse, instead of
liaving to spend a night on foot on the road looking for an ambulance
loaded with nurses which had been lost on the journey. A night's
rest would have better fitted one for the morrow's intensive work.
'No food was available from noon one day to the next during the
trip.
Five kilos from La Ferte and 15 kilos south of Chateau-Thierry
^e found ourselves stationed in Chateau Pereuse, a fine building
-with spacious grounds, owned by a French woman working there as
a nurse ever since the commencement of the war.
The chateau proper, a large brick and stone building with a beau-
tiful outlook, was used as the operating pavilion, shock wards, and
sterilizing room. Here we learned the mistake of grouping all shock
vases in a single ward. Shock cases should be divided into at least
three groups, new arrivals requiring heat baths, noisy and delirious
patients, patients resting and quiet after treatment.
When the German retreat had gotten well under way, plans were
made for us to follow the advancing lines. Our next move was made,
as before, by auto and camion, to Coincy.
Our location was on the site of aii old French " auto-chir " that
liad been captured and burned down bj^ the Germans. With a French
supply dump a hundred rods away, an airdrome not a half-mile
away, and a magazine dump and American naval gun emplacement
in the woods behind us, it seemed an admirably chosen spot to in-
vite bombing, but had too many advantages to be refused. We were
:set up and working in 48 hours.
During the rushes our team split up and took care of three tables.
One sergeant and one nurse anesthetized.
All instruments furnished were according to Army specifications,
nnd many needed modern instruments were lacking. Later we
"bought some in Paris, for chest and head work, being unable to obtain
them otherwise.
At Coincy our wounded came from the Vesle in large numbers, at
first, but later the numbers decreased from day to day. Here we had
many gas cases. We saw 1,500 at one time in one field hospital.
A. E. F. — HOSPITAL CENTERS. 1785
While at Coinc3% just as I had finished an operation in the Chateau
Pereuse, I was hurriedly called by an attendant into the hall. There
on a stretcher, one of a triple row along the great hall, and all filled
with badly wounded, was a young man who, in his restlessness, had
loosened the bandages around his neck. This had started a severe
hemorrhage and great spurts of blood were shooting from his wound,
covering his face, his chest, and pooling in all the folds of his clothes.
One could see at a glance his carotid must have been cut, and if not
quickly stopped he would bleed to death. The wound was on the
left side of his neck. I compressed that carotid, but without stopping
the flow. With a knife I quickly laid open the wound. It did not
extend to the left, but behind the trachea. Plunging my fingers in
the wound I encountered a large piece of shell imbedded deep in the
right side. It had cut the right and not the left carotid. Before this
could be exposed he was dead.
I learned a lesson in this case that I think saved at least one other
case. Without losing time tr^-ing any other means, first follow the
wound tract with the finger to the point of hemorrhage and expose
immediately. Of course, I am not speaking now of wounds on the
extremities, where a tourniquet can always be used.
The struggle to get to this bleeding point before life had ebbed,
the misleading location of the wound, the strong handsome son of
some mother dying there when a minute's time could possibly save,
the ghastly surroundings and the work we had come from and must
go back to. made a traffic moment.
Most soldiers who overcome abject fear do so by becoming fatalists,
and so in a way stoics. Consequently there was minimum of com-
plaining and no opposition to such suggestions as operations. Too.
when they took their anesthetics, while few talked, those who did
almost invariably showed their true and dominant feelings in this
war at a time when they felt the moment for them was a question of
life or death.
I remembered for a time many things said. They grouped under
two headings : One, " Down with the Boche ! " "At them, boys ! "
and not because they were the enemy, but because of what they had
done. " He sank the Lusitania " ; " He kills prisoners " : " He mur-
ders women and children." And the other thought: "Yes, I want
to do my part " ; " I mean to stick, never mind the wound " ; "I don't
care what happens to me " ; "I mean to do my share " ; " Mother
wants me, I want her, but she knows why I am here and she sent me."
This I write down at the time also : " I want to go back, but not until
it is all finished and the Hun is licked."
On September 9 word came that no more patients should be re-
ceived and to get ready to move. I asked permission to take the team
to Base Hospital 31 for new supplies and to join the hospital at the
new station.
Almost immediately after our arrival at the base heavy trains of
preoperative cases began to arrive at our own center and the team
went to work here. This work continued up to the time of the arm-
istice.
The problem of first aid to the wounded at Contrexeville was much
different than at the front. Though some trains contained cases but
two days wounded the cases were for the greater part four or more
days old when they reached this base. Some had traveled directly
1786 EEPORT OF THE SUEGEOX GENERAL OF THE ARMY.
from the front dressing stations, riding three or four days in trucks,
and were nnich the worse for it.
Properly selected cases not in shock suffered little from an addi-
tional delay of a day, but in other cases it was often well-nigh fatal.
Especiall}' was thus true if the delay were more than two days and
the patient suffered marked physical exhaustion from previous expo-
sure to cold and lack of food.
In cases of gas infection received under these conditions, whether
as preoperative or infection secondary following previous operation,
operative methods that had been employed successfully at the front
failed and high amputations gave the only chance.
In the cases received, previously operated at front hospitals, we
experienced ample proof of the poor ultimate results of hurried or
improper work, which justify the statement that whatever the press
of work a front hospital should only operate in so far as the work
can be carefully, properly, and thoroughly done, and that further
work should be sent on to a properly equipped hospital base. If
these cases are at all carefully selected the additional delay is less
disadvantageous.
In the use of debridement I noticed two points particularly that
have not been emphasized in most writings on debridement: (a) In
its application in front surgical hospitals many men employed a gen-
eral technic of debridement, without apparently any true apprecia-
tion of its limits of applicability or what they were undertaking to
accomplish : i. e., render a wound sterile by mechanically removing
all contaminated tissue, without reinfecting his wound or injuring
nature's defenses in the tissue remaining, (h) The technic was fol-
lowed in cases when, due to the general condition of the patient or
multiplicity of wounds present, the time element necessary should
have deterred.
L ah oratories. — Bacteriological laboratory work in front hospitals
was of little value in tlie treatment of a case that called for inmiediate
operation, and would be evacuated within a few hours thereafter, but
was of great value in corroboration or correction of the operator's
deductions for the improvement of his judgment in future cases.
THage. — The officer who reviews, classifies, and decides the ques-
tion of immediate disposition of the case has the most important
position in a front hospital. It is his duty to divide cases into the
following general classification : Those that do not need operation,
those that can safely wait if necessary, cases for shock ward, and
those that need immediate operation. Another class could include
those that need both shock treatment and immediate operation.
X-ray. — Essential to tell presence and size of foreign body, espe-
cially chest, head, abdomen, and pelvis. Exact localization very
valuable but not essential if one follows tract and dissects in laj'^ers
by which method the tract need never be lost.
Joint cases. — Much argument has arisen over the proposition of
early and continuous active motion being employed in all joint cases.
My own opinion is that after closing without drainage, a joint that
has been thoroughly cleaned motion should not be employed for
four to seven daj's, unless the advent of infection has required re-
opening, when active action will keep the synovial pockets emptied.
Primary dressings. — If surgical or operative sterilization (de-
bridement) of a wound is well done, the essential of the fir.st dress-
A. E. F. — HOSPITAL, CENTERS. 1787
ing is simply protection. A diy sterile dressing, amply large, and
surely fixed in place, to assure the greatest possible protection,
therefore, comi^letely satisfies this condition. The possible adyan-
tage in a wet dressing is in preyenting scabbing and in furnishing
a dressing less painful in its remoyal. but to hold this adyantage the
dressing must remain wet until it is changed, and which is frequently
impossible where the wounded are often two or more days in trans-
portation.
Packing a wound should neyer be done. AMien gauze is packed
deeply and firmly in a wound it has been done for one or two rea-
sons: (a) To arrest bleeding, this should be accomplished entirely
by ligation ; oozing may be controlled by painting the surface with a
0 per cent solution of iodine, or ether, (b) To keep the deeper parts
of the wound open to drainage, this should be accomplished through
the technic of the operatiye procedure, long incisions and relief of
all fascia and other tissue tension. Packed gauze is not a drain but
a cork.
The Carrel use of Dakin solution is practically impossible in an
eyacuation hospital which is sending back its wounded as quickly as
they are able to stand transportation. Moreoyer. following debride-
ment it is not indicated. When both are employed one or the other
was incorrectly chosen. The Carrel-Dakin method has a definite in-
dication in the presence of increasing local infection not amenable
to operatiye procedure. In such condition, like water on a fire, it
lessens the yirulent activity and giyes needed time to nature and the
surgeon.
War surgery has brought the surgeon to a fuller realization than
eyei- before that ultimate insults depend largely on the thorough-
ness and technic employed in the postoperative dressings and care.
Restoration of function, rapid cleaning and healing of the .wound,
avoidance of secondarj'^ or mixed infection, depend fully 80 per
cent on the trained aftercare and the wound dressing, which should
be performed with all the technical skill and care of detail of a
sterile operation.
Chest cases. — Operate all but those with no rib fractures or not
marked pneumothorax or hemothorax. Close after operations all
but skin. If a drainage tube is used it should not be too long, should
be sealed in the wound and connected with bottle apparatus.
Operate at the beginning with local anesthetic, and if patient is
distressed finish the operation under gas oxygen. Usually post
axillary line, 6-inch interspace. Operate earlier the better, unless
there is deep shock.
In latter case do not he.sitate to reoperate and drain if the needle
shows re-collection of fluid with any chance of infection, remember-
ing a single syringe full of reported sterile fluid does not proye a
sterile pleural cavity.
To those who belonged to surgical teams sent to eyacuation hospi-
tals for work several points for improvement suggested themselves:
(a) The organization ])roper 6f the hospital should be restricted
as much as possi])le to facilitate rapid change of location.
(h) The surgical work should be entirely done by attached teams,
the number of which can be constantly changed to meet require-
ments. These teams should carry their own equipment of instru-
ments and consist of a sufficient nuuiber of officers, nurses, and men
1788 REPORT OF THE SURGEON GENERAL OF THE ARMY.
to run two or three tcables (and so be developina; material for new
teams), and also have one man and one nurse to spare for constant
supervision of the postoperative cases.
(e) These teams should not be looked upon by the reg-ular orp:an-
ization as outsiders and necessaiT nuisances, but given every facility
for their best work and personal comfort.
(d) Special shock teams should also be attached, and gas teams
if gassed cases are to be expected.
(e) The triage officer or officers should belong to the regular or-
ganization, be most carefully selected as holding the most important
place, and should forward frequent critical reports to the chief sur-
geon of the work of the various teams. These reports should be
acted upon.
(/) Greater coordination from the front and back should be es-
tablished, either by the inspection of consultants visiting the front
hospitals and then the bases to which these patients are evacuated,
to carrv back a statement of the conditions as found at the front:
and bring forward i-eports of results obtained, or by sending from
time to time members of these teams back with their patients, to
meet and learn from the base criticisms. In another place in this
report is a summary of operations of this team while with evacu-
ation hospitals.
Resuscitation. — The cooperation of the medical and surgical serv-
ices of a military hospital is nowhere better exemplified than in the
study and treatment of patients suffering from surgical shock. The
phenomena involved in the individual case are found in the province
of the internist, and the procedure necessary in treatment may well
be applied by him.
In a brief account of the resuscitation work of the medical service
of Base Hospital Xo. 31, no attempt will be made to review the
various theories of the cause of shock, the factor concerned, the
phenomena exhibited, nor detailed descriptions of methods of trans-
fusion advised by the medical research committee.
Ward " X " for convalescent patients at all times furnished suffi-
cient material for selection of donors. Slightly gassed cases and
cases convalescing from minor medical and surgical conditions were
the material of choice.
"Wlien the extent and significance of the procedure were explained,
heart cooperation was almost invariably found, the service being
entirely voluntary. Many of the boys were eager to act as donors,
following the transfusion with intense interest and subsequently
showing almost pathetic concern for the progress of the recipient.
Several boys volunteered as donors the second time, and one who
remained in ward " X " over a period of several weeks gave himself
for transfusion three times. To many donors an official note of com-
mendation was given by the commanding officer of the hospital.
This was highly prized, and in one instance upon the return of the
donor to his organization the note of commendation was officially
read before the whole battalion by its commanding officer.
At all times a list of donors properly gi^ouped was kept on file with
the transfusion set, and an effort was made at least to keep one group,
four donors, within easy call of the ward " X " office, in order to
avoid delay in case emergency should arise.
A. E. F. — HOSPITAL CENTERS. 1789
Squads of from 6 to 12 robust boys were sent for grouping every
two or three days in order to keep on hand sufficient number of group
fours. Most frequently group fours were used, thus saving the time
which would be necessary in determining the group to which the
recipient belonged. ^Vlien there were no group fours in waiting the
recipient Avas typed and a donor of the corresponding group was
used.
In general, the grouping was done by the staff of the hospital
laboratory, though from time to time emergenc}' demanded that
the work be done by the resuscitation officers. At all times the
resuscitation officei^ were available for consultation concerning shock
€ases and transfusion. This service was freely employed and
operated to the good of both medical and surgical services. All
transfusions were done by the resuscitation officer or by their advice
and direction, though other officers became perfectly familiar with
the simple technic and did transfusion well.
The care of the transfusion apparatus was under the direct super-
vision of the transfusion officers. This was shown to be necessary
because the success of transfusion depends to a large extent upon the
condition of the apparatus, particularly the needles. The officer
sharpened his needles himself before using and kept them in alcohol,
ready for use.
The greatest difficulty encountered was an occasional clotting of
blood as it was drawn from the donor, in at least three cases the
coagulation taking place before reaching the receiving bottle. In
a few instances coagulation took place in the bottle, due to the
fact that the sodium citrate solution was not sufficiently strong.
It was necessary to cut down on the vein of the recipient, only
when the patient's veins were in a state of collapse due to low pres-
sure and exsanguination. It was never necessary to cut down on
the vein of the donor, though hemorrhage into the tissues about the
needle occasionally necessitated use of a second vein.
The total number of transfusions made was about 50. Of these,
five were in medical cases, the remainder surgical. Of the five
medical cases, three were pneumonia in desperate condition, tem-
porarily improved, but ultimately died. The remaining two were
typhoids who were in desperate condition because of intestinal hem-
orrhage.
Xumber one was temporarily improved, no further hemorrhage
taking place, but ultimately died because of other complications.
Number two, during his typhoid, had pneumonia, empyema with
drainage, double otitis media, and severe hemorrhage. Transfusion
caused a decided change in his condition, without further hem-
orrhage and he later was able to be evacuated. It is believed that
transfusion saved his life.
The surgical cases which were transfused may be classified in two
main groups, viz, (1) those suffering from shock due to wounds and
secondary hemorrhage, (2) those in shock accompanying toxemia
of infection. Cases falling in giT)up one require little comment; the
beneficial results of transfusion were remarkable.
The cases of group two may be classified in three classes: (a)
those suffering from severe infected wounds, (h) those having gas
gangrene, and (c) those having wounds of any type of infection
accompanied by streptococcus septicaemia.
1790 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Class (a) cases made marked improvement with repeated trans-
fusions. Class (b) cases showed less marked improvement, repeated
transfusions were moi^e frequently necessary, and the ultimate out-
come was more often in doubt. Class (c) cases showed no permanent
improvement though at times a temporary benefit was observed.
SURGICAL PROBLEMS.
Professional problems which have arisen in the operation of Base
Hospital 31 are discussed briefly in the answers to a questionnaire
of the American Eed Cross Research Society.
General surgery. — Abdominal cases should not be transported from
the front until the patient is in good condition, temperature down,
bowels moving, and nourishment being taken without discomfort;
a minimum of six days.
Cases with through and through chest wounds, uncomplicated b}^
a massive haenio-thorax, diaphragm injury, or fractured rib. travel
well early.
The types of cases most injured by travel are abdominal, compli-
cated chest, fractured femur, shock and hemorrhage, and extensive
cranio-cerebral injuries.
The condition of wounds arriving at the base was best when plain
gauze had been used as dressing. They were not in good conditioji
when dressed with vaseline gauze. No opinion can be given of com-
parative value in the use of dichloraime-T. Carrel-Dkain. dipp, or
flavine. Rubber-tube drainage is very satisfactory in badly infected
wounds, but prevented the possibility of delayed priuiary closure in
clean wounds.
Gas gangrene. — Ligation of main artery of a limb, tight liandages,
tight packing of a wound, insufficient debridement, and low vitality
from shock and hemorrhage, singly or in combination, are predis-
posing causes of gas gangrene. The combination frequently seen of
insufficient debridement, tight packing of a wound, Avith tight
bandaging, has been a marked predisposing cause in cases admitted
to this hospital.
Local operations should be done where the gas infection or gas
gangrene is confined to a muscle or muscle group and the circulation
of the extremity is good. Amputation should be done where the gas
infection has spread beyond nmscle groups, where the circulation has
been badly damaged, and in cases where it is associated with ex-
tensive muscle injury and comminuted fractures of the large bones.
In all cases developing secondary to a good primarj^ operation, and
in cases where the patient's resistance is very low from shock or
liemorrhage, amputation is usually necessary.
Our opinion of the value of antigas sera is undecided. We feel
that it may have a prophylactic value. It is never justifiable to base
the decision between local operation and amputation on the bacterio-
logical findings alone.
The temperature in gas infection is usually moderate, except in
cases with an associated streptococcic infection. The pulse is xQvy
rapid, almost invariably, with low tension.
Gas gangrene seldom attacks tissue other than muscle, with the
exception of the liver. The collection of blood in tissues, haemo-
toma of hsemo-thorax, is frequently infected.
A. E. F. HOSPITAL CENTERS. 1791
Dehnde7n.ent. — A gcod debridement sliould include the removal
of any visible skin, free incision in anatomical lines, thorough re-
moval of all devitalized tissue, removal of all foreign bodies and
blood clots, and free incision of fascia so as to leave the wound free
from tension, the removal of muscle or muscle groups which have
lost their blood supply on account of injury or operation, absolute
hsemostasis. a careful regard to the avoidance of injury to both blood
vessels and nerves. The entire operation should be done in plain
view, counterincisions or incision made if necessary.
Violation of all the above points has been noticed in cases received
in this hospital. The most common serious error seemed to be in-
sufficient excision of the depths of the wound, faulty ha^mostasis
necessitating in the mind of the operator tight packing of the wound
with gauze and a tight bandage.
Tetanus. — -We have had one case of tetanus. This case recovered.
There are no contraindications to the giving of a second dose of
antitetanic serum if an anaphylactic individual is properly desen-
sitized.
Have not seen local tetanus, and we have had no cases of late
tetanus. We have isolated the tetanus organism late in a number
of wounds. "We ascribe our absence of late tetanus to the reported
use of serum before operation or manipulation.
Delayed primary closure of iroumls. — Xo opinion can be based
on the few cases of delayed primary closure of wounds done in this
hospital. There has been no loss of life or limb.
Preoperative eases. — ^All through-and-through machine-giin or
riflle-bullet wounds, uncomplicated by fracture or blood-vessel in-
jury of sufficient extent to produce tension from a haemotoma,
require no operation unless infection develops. Nerve lesion alone
is not sufficient indication for immediate operation in these cases.
Cases received preoperative under conditions stated above have
done exceedingly well. Cases received preoperative with wounds
of the scalp, face, and neck, through-and-through wounds of the
liands and feet, even with fracture, and all superficial wounds
including those of the gutter type at this base have done well. Pene-
trating shell-fragment wounds of the thigh, buttocks, calf, thorax,
shoulder, and subscapula region received preoperative have done
badl}'. Types of cases as listed above as having done well are suitable
for preoperative evacuation. The advantages of a preoperative
train is that during a rush, a larger number of cases, properly
selected, can be placed in the hands of a gi'eater number of com-
petent surgeons early.
Ch-est sur</ery. — Che.st cases with an open thorax, a massive
haemo-thorax, those complicated by diaphragm injury or comminuted
fracture of a rib, and those having a large piece of shell fragment
in the lung or pleural cavity should be operated in the front area.
Indications for oj)eration at the base include all the above condi-
tions when received as preoperative at the base; all cases when
high-explosive shell fragments within the lung or pleural cavity on
account of the extremely high probability of secondary infection,
notwithstanding that these cases have been received in good condi-
tion and may have a moderate haemo-thorax. All cases showing
infection of the retained blood in the pleural cavity, empyema, and
local lung abscesses should be operated. It should be definitely
1792 KEPOET OF THE SURGEON GENERAL OF THE ARMY.
understood at the bases that because a case arrives preoperative,
in good condition, it does not mean that those forward had decided
this patient should not be subsequently operated; their decision
restinc^ solely on the advisability of iminediate operation or trans-
portation to the base. The anesthetic of choice at this base hospital
is nitrous oxide and oxygen combined with local blocking. The
operative technique should include free incision, allowing visible
exploration, careful toilet of the pleural cavity, removing all blood
clots: complete hiemostasis and removal of all rib fragments by
resection. In addition to the usual surgical care, the patient should
be under the careful observation of a good internist.
Secondary hemorrhage. — Secondary hemorrhage occurs in cases
of prolonged wound sepsis. Predisposing causes of secondary
hemorrhage are faulty debridement, insufficient drainage, and im-
proper ligation.
The general treatment of secondary hemorrhage consists of imme-
diate vessel ligation, free incision for drainage, immediate trans-
fusion, if much blood has been lost, and a thorough chemical steriliza-
tion of the wound.
Knee joints. — In through-and-through machine-gun or rifle wounds
of a knee joint without extensive fracture, and in the absence of
marked tension from hemorrhage into the joint, results are better, in
our opinion, with nonoperative treatment. If there is marked tension
from hemorrhage, the blood should be asperated and the joint not
opened if the fluid is sterile.
If proper debridement has been done, and if the wounds are not
complicated by muscle injury, we believe in complete closure. If
there is an associated muscle wound, closure of the capsule and fascia
only. If infection is present, the incision should be left entirely
open.
It is our opinion that shattering of the head of the tibia involving
the joint is more serious than that of the condyles of the femur.
Knee injury involving the joint and popliteal artery, which would
necessitate ligation of the popliteal, demands immediate amputation.
Infection of the knee joint, with streptococcus hsemoliticus, associated
with comminuted fracture of either bone entering the joint, generally
demands immediate amputation.
More error has been in knee-joint injury, with infection, in con-
servation than in amputation.
In all cases arriving at this hospital with excision of the patella,
the knee joint has been infected and functional results have been very
bad. It is our opinion that all joints should be immobilized during
the acute stage following the injury. Where the function of the
joint can probably be saved antiseptic treatment is contraindicated.
Antiseptics. — In conditions where the character of the wound shows
progressive infection, assistance from outside to aid tissue reaction
would be soon called for, and in these cases the addition of active
chemical sterilization of a field would seem a sounder principle than
plain sterility.
List of antiseptics in order of their availability at the base include
tincture of iodine solution, Dakin solution, dichloramine-T, and lysol.
Anesthetics. — We value the nurse as an anesthetist very highly,
both for her efficiency and because her use conserves a medical officer;
for the same reason we would still more recommend an adequately
A. E. F. HOSPITAL CENTERS. 1793
trained corps man for an anesthetist, for his use not only conserves
a medical officer but also a nurse, and his physical endurance is
greater.
Regional local anesthesia is very satisfactory in operation about
the face and head, including brain wounds. It should not be
attempted for extensive debridement. We consider that spinal anes-
thesia has a very limited field, if any, in war surgery.
Gas and oxygen, with or without local blocking, is the anesthesia
of choice in nearly all cases of general anesthesia, and is especially
indicated in all secondary operations where the patient's resistance
is lowered from infection in thoracic operations.
The use of gas and oxygen as a general anesthetic in the class of
cases enumerated above has given better results at this base than
could have been expected with other anesthetics.
We have employed a modified De Page mixture, with a lower
percentage of chlorc form for anesthesia in a fair number of cases
in this hospital. It has been very saving in time and has been
entirely sufficient for short operations, and seems acceptable for use
by a novice without danger under proper supervision.
Fluids. — We have not used sodium bicarbonate solution and have
seldom used saline solution in the treatment of shock and hemor-
rhages. Intravenous sy.line infections give better results for im-
mediate effect than the giving of water by mouth or rectum, or sub-
cutaneously.
We prefer saline solution to giun-salt solution. Our limited
experience with gum-salt solution has been disappointing. Blood
transfusion in our experience is infinitely superior to the use of
giun-salt of saline solutions in the treatment of shock or hemor-
rhage.
The ill effects we have noted in the use of gum-salt solution have
been failure to react, occasional chills, and in' a number of cases
fallen blood pressure.
Blood transfusion. — We prefer the citrate method of blood trans-
fusion.
We have had no reactions in cases properly grouped.
In prolonged infections blood transfusion usually is followed by
temporarj' ajjpreciable benefits. In an occasional case it has seemed
life-saving.
Abundant voluntary material is easih' obtained from convalescent
patients Avhon the purpose of the procedure is explained to them.
Our only difficulty encountered was occasional coagulation of blood,
discovered to be due to the use of insufficient amount of citrate so-
lution.
Ainputafions. — In the cases coming to this hospital, amputated
by the guillotine method and those done here on account of in-
fection or gas gangrene, the results of this operation have seemed
to us superior to any other method.
The medio-tarsal amputation seems seldom, if ever, justifiable.
The Symes amputation is usually unsatisfactory, the lower third
amputation appeals more unsatisfactory; amputation about the
micldle of the leg gives better results.
The rule that the stump of the lower extremities shall have no
terminal scar is not good. We do not feel that it is correct that
1794 REPORT OF THE SURGEON GENERAL OF THE ARMY.
the stump of upi)er extreniities sliould always have a terminal
scar.
Amputations through the knee joint are not recommended.
We see no advantage in the conical shape of the bone stump.
In o])eratirg near the knee joint the amputation should be done
below the insertion of the patellar tendon or above the expansion of
the condyles of the humerus. Amputations through the elbow joint
are seldom, if ever, justifiable.
Head in juries. — -La* eration of the scalp should be explored surgi-
cally vvithout exception for fracture even if fluoroscopic report is
negative.
All high-explosive shell fragments, bone fragments, and any other
foreign material should be removed from the brain, if possible, by a
technique Avhich does the least possible damage to uninjured brain
tissue.
The magnet does not seem to be a useful instrument in extracting
foreign bodies.
Surgery in a hase hospital. — When Base Hospital 31 started op-
erations as a semievacuation liospital all ( ases were divided into four
general classes after operation,, as follows :
{a) Cases ready for duty in from 10 days to 2 weeks.
{h) Cases not ready for duty in from 10 days to -2 weeks.
{c) Cases immediately evacuable.
{d) Cases not able to stand travel and so nonevacuable.
As a result of this classification only two sets of patients were
retained in the hospital, all others being evacuated at the first oppor-
tunity. Class A, oi" cases ready for duty within two weeks were held
that they might return to their command with least possible wastage
of time. Class D. or cases too ill to permit of transportation, were
retained until their condition permitted proper disposition.
Historical sketch' of Jahoratories, Base Hospitals 31 and 32. —
United States Army hospital unit G was organized in Syracuse,
N. Y., in June, 1917. from the Syracuse Univei-sity Medical College.
The unit mobilized at Fort McPherson. Ga . December 22. 1917.
After a period of training here the unit sailed for France, February
26, 1918. On March 13. 1918, unit G reached Contrexeville and was
immediately attached to United States Army Base Hospital No. 31.
United States Army hospital unit R was organized at Fairfield,
Iowa, was mobilized December 11, 1917, at Fairfield, Iowa, and was
ordered to Fort McPherson, Ga., December 15, 1917. After a period
of training the unit w^ent to Camp Merritt, N. Y.. Febniary 1, 1917,
and embarked for Europe. February 14, 1918. The unit arrived at
Contrexeville. France. March 14. 1918, and was immediately at-
tached to ]5ase Hospital Xo. 32.
Base Hospital No. 32 was organized at Indianapolis, Ind., during
the summer of 1917. The unit was mobilized at Fort Benjamin
Harrison September 1, 1917. On December 4, 1917, it embarked for
France, arriving there and reaching its destination at Contrexeville
December 26. 1917. The first convoy of patients was received March
23. 1918. On April 8, 15 days later, the central laboratory was
organized.
Base Hospital No. 31 was organized at Youngstown, Ohio, in the
spring of 1917. It was mobilized September 5, 1917, in Youngstown,
Ohio, and proceded to the ambulance camp at Allentown, Pa., arriv-
A. E. F. — HOSPITAL CENTERS. 1795
ing there September 8, 1917. On November 22, 1917, it was ordered
to Camp Mills, Long Island, remaining here until December 15, 1917,
when it embarked for overseas duty. The unit arrived in France De-
cember 27, 1917, and six days later, on January 1, 1918, reached its
station, Contrexeville, Vosges.
Upon arrival at Contrexeville a laboratory was established which
was prepared to do gross and microscopic pathology, bacteriology,
and clinical pathology.
Patients were first admitted to Base Hospital Xo. 31 on March 23,
1918.
The central laboratory for the two base hospitals was organized
April 8, 1918.
On April 8, 1918, the director of laboratories and infectious dis-
eases, American Expeditionary Forces, recommended the pooling of
the laboratory equipment of Base Hospitals Xos. 31 and 32 and the
formation of a central laboratory. He also recommended the forma-
tion of a number of smaller subsidiary laboratories in the wards of
the two hospitals for the handling of clinical pathology.
Seven rooms of the second floor of the Hotel Harmond were selected
as the location of the central laboratorj^ Six subsidiary laboratories
were established.
Ilistorij of Base Hospital No. ^^.— Pursuant to S. O. 21, E. D., the
mobilization of the unit at Fort Porter, Buffalo, N. Y., was ordered.
At 9 a. m., August 21, 1917, the entire unit was called into active
service.
On August 26, 1917, the nurses arrived at the post and were sworn
in the reserve corps, and on the following day were sent by special
train to Ellis Island. Xew York City, there to await transportation to
France.
On August 27, 1917, the entire equipment was forwarded to the
port of embarkation, Xew York City.
On November 20, 1917, all members of the unit were told that on
the following day no one would be allowed to leave the post. So
secret was the whole maneuver that only a few relatives were at the
station, and we wore off — off on the second lap of our journev. Novem-
ber 21, 1917.
The following morning, by 10 a. m., all were safely aboard the
Carpathia.
Because of the very severe weather, many of our life rafts were
smashed to kindling wood or washed overboard, and also because of
this weather our escort did not meet us until just a feAv hours before
our arrival at Liverpool, England, December 8, 1917, where, the fol-
lowing day, we disembarked. It was without regrets that we. some
months later, learned that she had added her tonnage to the roll
being piled up by the Hun submarine.
From there vre marched to the Morn Hill rest camp, and arrived
thoroughly and completely drenched.
On December 12, 1917, we arrived at Southampton, and in the
e\oning embarked upon the Nirvana, a former East Indian tramp
cattle boat, for passage across the Channel. On the evening of
December 13, 1917, a second attempt at crossing was made, and on the
morning of December 14 we docked at Lc Havre, France.
The Nirvana had aboard about 250 horses, AVe left her without
regrets.
142367— 19— vor, 2 52
1796 REPORT OF THE SURGEON GENERAL OF THE ARMY.
At Le Havre we spent two clays and nights. At 4 a. m. we left the
camp and marched through the slushy snow to the station, where we
began our trip across France.
At 4 o'clock on the afternoon of December 19, 1917, we reached
our destination, Vittel (Vosges).
The rigors of the trij), with the cold weather, proved too much
for some. Many had contracted severe colds and were suffering from
influenza. Fortunately, the infection was a mild type and, while
widespread, was not particularly virulent, and there were no fatal-
ities.
Early in January, Base Hospital No. 31, Indianapolis, Ind., and
Base Hospital No. 32, Youngstown, Ohio, arrived at Centrexeville, a
small town some 5 kilometers from Vittel, and, like it, a famous
watering resort. A few days later orders were received consolidating
all four units, and it was henceforth known as the Vittel hospital
center. The commanding officer of Base Hospital No. 23 became
headquarters, hospital center, Vittel.
On March 13, 1918, Base Hospital No. 23 was augmented by the
arrival at V^ittel of hospital unit B, consisting of 12 officers, 20
nurses, and 47 enlisted men.
Hospital unit B was organized in Westchester County, N. Y.,
under the auspices of the Westchester County Chaptei* of the Ameri-
can Red Cross, which defrayed all expenses of organization and pro-
vided the complete equipment for a hospital of 250 beds.
It was at first thought that the unit would continue to function as
an independent organization subject to withdrawal at any time, but
orders were received directing that unit B be absorbed in Base
Hospital No. 23.
The first real rush of patients occurred during the latter part of
May and early June and was a direct result of the Chateau-
Thierry drive. Patients were rushed by hospital trains to these
hospitals direct from the fields of action. Many of these joatients
were gas casualties, though there were plenty of injured requiring
operations and dressings.
With the advance of the summer and the continuance of hostilities,
it was found necessary to increase the hospital capacity. Rooms
which had heretofore been thought indispensable for administration
needs were evacuated and cots installed; additional beds, where pos-
sible, were placed in already overfull rooms; lines of cots w'ere
placed in the long corridors; still other cots, folded, were held in
readiness to place in the various hotel lobbies ; wooden barracks were
erected in which to feed personnel and ambulatory patients, and
rooms thus released from dining-room purposes were converted into
large wards. By such means our capacity became 2,586, with an
emergency extension of several hundred more.
All during our hospital life in France there had been more or less
influenza everywhere prevalent. It greeted us upon arrival and
intermittently was present in our midst ever after. Until the fall
of 1918 most cases had been of that comparatively mild type known
as three-day fever. Our experience proved this appellation to be
a misnomer. However, while some cases were more severe than this
term would imply, there were no fatalities in the command. In
September an epidemic of a more virulent type swept through the
armies, and the following few weeks brought hundreds of patients
A. E. F. — HOSPITAL CENTERS. 1797
to our hospitals, and there were many deaths, probably fewer,
though, than in the cantonments at home, where every facility for
treatment was available. No organization escaped the ravages of
this disease, and the personnel of Base Hospital 23 proved no
exception.
The start in September of the St. Mihiel drive, which for all time
will reflect an everlasting glory on the doughboy in France, came
when the influenza epidemic was at its height. The combination of
the two filled our hospital and taxed not only its already swollen
capacity but that alike of officers, nurses, and men. Daily train loads
fresh from the front came rumbling in bringing their frightful battle
toll. Many of the cases so admitted came direct from the fields,
where first aid only had been applied. Immediate operations in
many cases were imperative to save lives and limbs. Operating
rooms ran day and night. Our medical personnel was insufficient
with so many away on detached service.
For a few weeks our identity as a base hospital was lost, and we
became in reality an evacuation hosi^ital. All patients, as soon as
their condition would possibly permit, were evacuated to the hos-
pitals farther in the rear in order to provide room for the con-
stantly increasing casualties coming from the front. The greatest
praise is due the entire command for the manner in which the work
was handled and for the spirit displayed in coping with the situation.
The completion of this offensive marked also the last great rush
of patients we were to recei\e, and gradually our census resumed
its normal proportions.
On February 0, 1919, the last of the few remainin,<r patients were
evacuated to hospital center Bazoilles and a telegram foi-warded lieaa-
(juaiters that Base Hospital 23 had ceased functioning as a hospital^
and on February 13, 1919, the records of this hospital were forwarded
to the sick and wounded office |of the chief surgeon and the registrar
received a clearance.
Ill'itoncal sl'efch of pathological lahoratoi-y.- — The history of the
''laboratory, hospital center, A. P. O. 73'2 " is complicated' by two
factors. Fach of the Red Cross base hospital units possessed and
operated independently a laboratory of its own; and these laboratory
organizations differed in methods and ideas as well as in both (juan-
tity and quality of per-onnel. Contrexeville. where Base Hospitals 31
and 32 Avere located, is distant a matter of 3 miles from Vittel where
Base Hospitals 23 and 3G, as well as center headquarters, were located.
Therefore, even Avhen all the laboratory activities were brought under
the jurisdiction of our laboratory officer attached to headquarters
staff", it was found necessar}^ to establish two central laboratories, or
more accurately, two branches as quasi-independent cstalilishments
held together by a common supervising laboratory officer and by a
common supply system.
It was also possible to effect something of a division of labor be-
tween the two laboratories, Contrexeville, for instance, doing most
of the tissue work, and all of the Wassermans, while the blood
chcmistrv was done exclusively at Vittel.
Vittel hranch. — Base Hospital No. 36 was organized and eipiipped
under the auspicies of the Red Cross at Detroit. Mich., and mobilized
in that citv on August 23, 1917. It sailed from the United States
1798 REPORT OF THE SUEGEOX GENERAL OF THE ARMY.
on October 27 and reached its permanent station. Vittel. France, on
November 17, 1917.
In res])onse to an emergency one of the hospital buildings was
opened for patients three Aveeks after arrival and five days later
tlio pathological laboratory simultaneously established in another
buihlino- received its first specimens.
Base Hospital No. 23 was organized and equipped, under the Red
Cross at Buffalo, jST. Y., and was mobilized at Fort Porter. N. Y.,
August 20, 1917, where military training was begun. The unit sailed
for France from Xew York on November 21. arriving at Vittel, De-
cember 15. A number of the large hotels were taken over for hospital
purposes, three fair-sized rooms on the ground floor of the Hotel
Continental being assigned to the laboratory.
Hospital unit B was organized under the Red Cro'^s in Westchester
County, X. Y. It was mobilized on December 11. 1917. at Fort
MePherson, Atlanta, Ga.. sailed from Hoboken. February 16. 1918,
and arrived at Vittel, March 13. where its organization was dissolved
and merged with that of Base Hosj^ital Xo. 23.
In the spring of 1918 it was decided to centralize and consolidate
as far as possible the laboratories of the various base-hospital units
situated in a single hospital center.
The quarters finally selected were on the second floor of one of
the buildings of Base Hospital No. 36. and consisted of a suite of
eight fairly well-lighted rooms, supplied with running water and
electricity.
As an autopsy room that in the basement of the Nouvel Hotel,
which had formerly served Base Hospital No. 23, was taken over.
Autopsies were done in practically all cases of death. This
service was exceedingly heavy, during the influenza-pneumonia,
and active period at the front, averaging .5 a day for the whole month
of October, and sometimes reached 8 or 9 in 24 hours.
The serology at the Vittel branch was confined to grouping volun-
teered donors for blood transfusions, a considerable number of each
group being kept ready for emergency transfusions.
No Wassermans were done, the Contrexeville branch taking care
of this work for the whole center.
On January 20, 1919, Base Hospital No. 36 having officially been
closed, the laboratory was transferred to one of the Base Hospital
No. 23 buildings (Hotel Continental), into the quarters originally
occupied hy the laboratory of that hospital before consolidation.
On February 1 the patients of Base Hospital No. 23 Avere evacu-
ated and the entire Vittel branch of the hospital center (including
the laboratory) practically ceased to functionate.
Histo7y of Base Hospital Xo. 32^. — The formation of a base hos-
pital to offer its services to the United States Government and to be
known as an Indianapolis unit was organized in Indianapolis in
-June, 1917, under the direction of the American Red Cross.
The enlisted personnel and officers of Base Hospital No. 32 were
mobilized at Fort Benjamin Harrison. Inch, September 1, 1917, with
a strength of 150 enlisted men and 25 officers.
The unit entrained at Fort Benjamin Harrison for Hoboken, N. J.,
the night of December 1, 1917, and arrived at the port of embarka-
tion the morning of December 3, 1917, going on the seized German
ship George Washington immediately thereafter. The boat sailed
A. E. F. — HOSPITAL CENTERS. 1799'
for Fi-ance the night of December 4, 1917, and arrived in the bay
at Brest. France, at noon, December 20, 1917. At the time of the
embarkation the unit was joined at Hoboken by 60 female nurses,
who had been recruited mainh^ from Indiana and trained at Ellis
Island. N. Y. The unit landed at Brest the morning of December
24, 1917, and entrained that evening for Contrexeville (Vosges),
France, arriving at that point earlv in the morning of December 26,
1917.
The buildings obtained for use by Base Hospital 32 were: Cosmo-
politaine Hotel, Grand Hotel de Paris, Hotel Providence Annex,
Hotel Royal, and Hotel de la Providence, known respectively as
hospitals A, B, C, D, and E. Hospital A, the largest of all, was
designated as the major surgical hospital and hospital B contained,
the minor surgical cases. Hospitals C, D, and E cared for the medi-
cal cases. The Hotels Moderne and Jeanne Pierre were leased as
homes for the nurses. The Villas Parisot and Salisbury were taken
as quarters for the officers. A glass pavilion, known as Source Le Cler,
and an old theater served as barracks for the enlisted men. Various
other buildings were used as warehouses, etc., and the town power
plant was operated by the enlisted men.
The unit came prepared to care for 500 patients, but this capacity
was officially increased to 1,900 as the war progressed.
Because of the need of more hospital workers Base Hospital 32 was
joined by hospital unit R March 13, 1918.
The first patients were received March 23, 1918. They were Ameri-
can soldiers and were largely gas cases. From that date until the
middle of the summer the unit received sick and wounded soldiers
of all the allied armies and a few of the enemy. At the time the
American armies became activelv and generall}' engaged at the front
the hospital became strictly an American hospital. Pre\dously a cer-
tain number of beds had been allotted to the Allies. The total number
of patients cared for was 9.698.
On the day of the armistice, November 11, 1918, the hospital was
nearly filled with sick and wounded. Shortly afterwards the unit
received orders to reduce its bed capacity and was officially closed
January 7, 1919. Orders for the organization to leave Contrexeville
for a base port, to depart for the United States, were received Feb-
ruary 18. 1919.
Base Hospital No. 36 arrived in Vittel (Vosges) at 1 a. m., Novem-
; ber 17, 1917. The first days were used in preparing certain buildings
'. for hospitals which were taken over from the French.
1 December 8 — this date Base Hospital 36 began to functionate as a
I base hospital, with a personnel of 26 officers, 165 enlisted men, 71
nurses, and 5 civilians. Two hundred and ninety-eight infectious
{ cases (8 measles, 289 mumps, and 1 chronic gonorrhea) were received
and placed in the first hospital available, Hotel Central, designated
as hospital A.
December 11 — 52 additional cases were admitted to date. All were
mumps.
December 13 — 76 new cases were admitted, consisting chiefly of
mfluenza.
During the month of December 895 American patients and 1
French civilian were received by Base Hospital 36. Of these. 5 died.
1800 REPORT OF THE SURGEON GENERAL OF THE ARMY,
Duriiiir the month of Jannarv "(U American soldiers and 6 French
civilians were received by 3(). Of these, 3. died.
Dnrins: the month (if Fel)ruary 36 received 312 American soldiers,
101 French soldiers, and -4 French civilians. Of these, 2 died.
French patients were first received at this hospital ; hospitals C and
D on February 12.
Durins: the month of March 489 American soldiers, 90 French sol-
diers. 5 French civilians, and 19 Italian soldiers were received by 36.
Of these, 1 died.
During the month of April 90 American soldiers. 1 French soldier,
f.nd 2 French civilians were received, of which 1 died.
During May 444 American soldiers. 205 French soldiers. 7 French
civilians, and 3 Italian soldiers were received by Base Hospital 36,
•of Avhich number 2 died.
During June 396 American soldiers, 340 British soldiers, and 101
French soldiers, 4 French civilians, and 3 Italian soldiers were re-
■ceived. Of these, 5 died. The British patients had been sent, almost
without previous care, straight from the Somme front.
About this time trainloads of wounded arrived on the average of
two a day, and the hospitals were filled to overfloAving. Patients
'were quartered in the corridors: the Red Cross recreation hut and the
Casino were turned into hospital wards. During the whole month
of July, 887 Americans, 538 Frencli soldiers, 5 French civilians, and
2 British soldiers were received. Of these, 5 American soldiers. 1
French soldier, and 1 Italian soldier died.
During the month of August Base Hospital 26 received 617 Ameri-
cans, 4 French soldiers. 4 French civilians, and 1 American civilian.
Of these. 8 died.
During the month of September Base Hospital 36 received 2,389
American soldiers. 14 French soldiers, and 6 French civilians, of
which 16 died.
During the month of October 4.500 American soldiers, 2 French
soldiers, and 5 French civilians were admitted to Base Hospital 36.
During the month of November 944 American soldiers were ad-
mitted to the hospitals of Base Hospital 36, besides 4 French soldiers
and 1 British soldier who were also treated during this period.
From A])ril 7 to Xovember 19, 1918. 982 cases of gas poisoning
were admitted to the hospital. The larger number of these cases were
gassed with dichlorethyl sulphide, the so-called mustard gas. Phos-
gene gas came next in frequency, and then chlorine. An intensive
study was made at hospital E of 230 of these gassed cases with a
special view of determining the advantages and results of graduated
physical exercise of these patients.
Report of gas cases to Dceembei- 1, 1918.
IS'uniber of cases of all kinds admitted to hospital to Dec. 1, 1918 2, .536
Isumber of gas cases '982
Kuiiibor of eas cases given graduated exerci;\i treatment 230
The graduated exercise was route marching under noncommis-
sioned officer. Three classes were established and the men promoted
from one class to a higher one as their progress warranted. Before
and after each exercise the pulse rate was noted and in many cases
1 Or 38.7 per cent
A. E. F. — HOSPITAL CENTERS. 1801
the blood pressure. The length of the march varied from one-fourth
to 2 miles. The 321 gas cases not exercised either passed through the
hospital before the exercises were started or were so lightly gassed
that exercises were not needed.
During the month of December 100 allied patients, including
American, Russian, French, English, and Italian wounded, were
received at Base Hospital 36 from the prison hospital at Trier, Ger-
many. Nine French civilians were treated at the base and 557 Ameri-
can soldiers were cared for in the unit, making a total of 583 patients
received.
B. HOSPITAL CENTER, BAZOILLES-SUR-METJSE (VOSGES), FRANCE, A. P. O.
731, A. E. F.
GENERAL KKVIEW.
Location. — Reference to the map of France will show the lines of
supply of the American Expeditionary Force running east from the
base ports. Bordeaux, La Rochelle. and St. Xazaire. through Tours
and JBorges to St. Dizier, Xeufchateau, and Is-sur-Tille. Of the last
three places mentioned, two, St. Dizier and Is-sur-Tille, are regu-
lating stations, and a third such station is located at Liffol-le-Grand,
5 miles west of Xeufchateau. Through these stations supply of the
troops in and evacuation of ineffectives from the American sector
of the front to the center of France and the base ports were con-
ducted. Xeufchateau is about 40 miles from Toul and Xancy and
the battle line. It is a railroad center of some importance.
Bazoilles-sur-Meuse is a village of about 300 people situated 4
miles southwest of Xeufchateau. A line of the Est Railway and
the River Meuse run through the town. The valley of the Meuse at
this point is rather deep and perhaps three-quarters of a mile wide,
and bounded some distance back from the river by steep, wooded
slopes running several hundred feet upward to level high ground.
The floor of the valley is wider on the east bank and drops more
gradually to the water's edge.
The Bazoilles group of hospitals is built around the village on
both sides of the river. The larger part of the town and two hospital
sections are on the west bank, and five hospital sections on tlie east.
HOSPITAL ACTIVITLES AT BAZOILLES PRIOR TO JULY 1. 191S.
In the early days of the Great AVar the French '* Service de Sante "
operated a military hospital at this point. The chateau and
grounds of a baron, by far the best property in the vicinity, were
leased and a group of semipermanent frame buildings were erected.
The total capacity was about 800 patients. The chateau itself, a
stone building, was not large enough to accommodate any consider-
able number of patients, and has been used for offices and officers'
quarters, at least since the Americans have been in control.
After the United States entered the war American training areas
were established in the district about Xeufchateau. As our troops
increased in numbers the French withdrew, partly at least. The
hospital ceased to be of any use to them and Avas closed. The l)uild-
ings were transferred to our Medical Department, who continued
the leases. The hospital equipment was bought outright.
1802 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The first representatives of our Medical Department, 2 officers and
20 nien of a unit organized at Johns Hopkins Hospital, Baltimore,
arrived at Bazoilles eJuly 5, 1917. The remainder of the organization
joined on Jul}^ 26. All set to work to prepare the buildings for
active operations. The first patients were received on July 31.
Two American divisions, the First and Second, were training in the
district and were served by the hospital for some time. The first
wounded were received on November 1. They came from Field Hos-
pital No. 13, which was attached to the First Division.
Some repairs, alterations, and additions were made to the buildings.
First known as United States Army Base Hospital No. 2, the name
was changed later to Base Hospital No. 18. It was so designated
until the unit was relieved in January, 1919, and sent to a base port
for return to the United States.
Shortly after the opening of the hospital the personnel was reen-
forced by the arrival of hospital unit A with 12 officers, 20 nurses,
and 43 enlisted men. This unit was organized in Philadelphia.
Operations as an independent base hospital continued until July 1,
1918, when it became a part of the Bazoilles hospital center. In the
11 months ending July 30, 1918, over 7,000 patients were admitted.
Stories of the hardships of the first winter in France are still heard.
The weather was severe, buildings poor, and fuel scarce and of infe-
rior quality. The experience was far from enjoyable.
Much excellent professional work was accomplished in spite of
unfavorable conditions. Through this, by reason of being first in the
field and due to the reputation of the mother institution. Base Hos-
pital No. 18 became one of the best known of our units. Many mem-
bers of the American Expeditionary Forces were certain that the
Jolms Hopkins unit was the best hospital in France, and that a tour
of duty overseas was not completely rounded out without at least one
course of treatment in their hospital.
To meet the necessity of providing hospital accommodations for
our rapidly expanding military establishment overseas, the Medical
Department authorities decided to group its base hospital units. This
necessitated an enormous construction program for which sectional
wooden buildings or demountable barracks were to be used. These
were called type A units. Bazoilles was selected as a site for one of
these projects. A group of 6 sections, each accommodating 1,000 pa-
tients, was authorized. Each of the new sections was to have suffi-
cient ground space for a thousand bed tent expansion. The capacity
of the entire group, including Base Hospital No. 18, was to be about
13,000 beds.
The Engineer Corps began construction toward the last of October,
1917. A number of organizations, the names of which appear else-
where, participated in the work.
Progress was very slow. Macadamized roads were built, and the
French railway authorities put in sidings to accommodate hospital
and freight trains. An unloading quay was provided for patients.
The quay has been a great convenience and the metaled roads a
necessity.
The location of a convalescent camp for the service of the Bazoilles
area was considered and finally definitely fixed at Liffol-le-Grand, 4
miles from Bazoilles, the camp to operate as a part of the center.
A. E. F. — HOSPITAL, CENTERS. 1803
Early in August 4 base hospitals, with a total capacity of about
7,000 beds, were in actual operation or ready to operate. Charts X
and XI will show the stead}' increase of bed capacity during the
month and the relation thereto of the numlicr of patients in hospitals
and of admissions to discharges.
The second Battle of the Marne began July 18. Urgent calls from
the chief surgeon for increase of bed capacity were received and re-
sponded to in so far as equipment on hand permitted.
Toward the end of July the number of patients rose to very near
the limit of beds available. There was never any crowding after that
time.
Throughout the operations of the summer and autumn unremitting
efforts were made to evacuate to hospitals farther toward the rear.
This rapid turnover of patients is well shown in Chart XI and be-
comes apparent as early as July. Later, as the fighting more nearly
in our immediate front progressed, all the hospitals of the center were
in reality functioning as evacuation hospitals. Frequently patients
were received, ojjerated upon, and transferred to the rear within 48
hours.
During the last two weeks of August rumors of a great offensive by
the American First Army became prevalent, and it was evident from
unending troo]) movements that something out of the ordinary was
imjoending. The chief surgeon began to manifest an acute interest in
bed capacity and to send out instructions to install everything avail-
able.
^^Tiile the date set for the coming American offensive was sup-
posed to be a profound secret, it was rather generally expected to
occur about September 1. A delay of U\o weeks, however — the Battle
of St. Mihiel began September 12 — ensued, and this was immensely
valuable to us in completing our preparations. Much needed hospital
equipment arrived : also two base hospital units. Base Hospital Xo.
60 on September 15 and Base Hospital Xo. 81 on September 25. This
provided both property and personnel for the operation of the entire
center if the emergency should require it.
Though things did not turn out as anticipated, much work was
done. While at no time in September did the number of patients
reach 4,000, it was due not to the few admissions but to rapid evacua-
tion. It was feared that a large influx of casualties might entirely
overtax the available accommodations, a condition highly undesirable
in a hospital so near the fighting front, and no opportunity to pass
them on was allowed to slip.
During the last half of September the influenza epidemic began
among our troops and it affected in a marked way the admissions and
death rates of this center as, of course, it did those of practically all
other centers. The great majority of deaths reported were caused by
pneumonia, usually a complication or sequel of influenza. The mor-
tality in this and a neighboring center (Vittel-Contrexeville) was well
over 30 per cent.
The Argonne-Meuse offensive began September 26 and severe
fighting continued from that date until the armistice became effective
on Xoveinbor 11. Within three weeks approximately 17,000 sick and
wounded were received and between 11.000 and 12,000 evacuated.
The number of patients in the center rose to over 10,000.
1804 REPOET OF THE SURGEON GENERAL OF THE ARMY.
INIany of the wounded were in bad shape. Conditions were such
in the advanced areas that many did not reach hospitals for four
or five days after receiving their wounds. A fair proportion had
not been operated upon and severe infections were present. The
operating staffs of the various units were pushed to the limit and
in some instances worked for 24 hours or longer without intermis-
sion. Many extensive operations made necessary b}' the severity of
traumatism and untreated infections were performed.
Later in October a marked decline in number of admissions oc-
curred. The definite reasons for this is not certainly known. Doubt-
less the casualties diminished during the final stages of the allied
advance. The Bazoilles center is situated well to the flank of the
direct line of evacuation from the Argonne district — St. Dizier was
the principal regulating station — and this may have lead to evacua-
tion to the large hospital groups located in the intermediate section
in central France. At about this time the Second Armj' was organiz-
ing and it has been asserted that only the conclusion of an armistice
prevented the undertaking of another great forward push to the east
of the Argonne front. It is possible that those cent.ers directly in
the rear of the theater of this proposed offensive, of which Bazoilles
is one, were being held to accommodate the resulting casualties. At
any rate there were few admissions during a period of two weeks or
more just prior to November 11.
After November 11a considerable change took place in the charac-
ter of patients received, naturally, and fewer were received. The
First Army billeted in the surrounding areas furnished a fair num-
ber of sick, and for four months the number constantly in the center
was about 4,000.
Another organization, Base Hospital No. 79, the last base hospital
to arrive (Evacuation Hospital No. 21 came in January, 1919),
reached the center on October 16 and was assigned to section 2.
Equipment had already been installed and crisis expansion tentage
pitched. The arrival of this hospital completed the number for
which accommodations were available.
Since the conclusion of the armistice there has been a continuing
reduction in all hospital activities in the group, as in most of the
advance area.
The construction at Bazoilles represents one way of providing
shelter in the theater of operations in time of war. It consists of
erection of cheap wooden buildings of a uniform type specially
grouped to facilitate efficient administration. The result is a com-
pact layout of one-story buildings, which may be put at any point
desired and extended to accommodate any number of beds. Such
buildings require time for construction, take fire more readily than
the more permanent kind, and may be lacking in sanitary installa-
tion. They are less suitable for cold climates. The matter of cost
must be considered in connection with the length of time they are
to be used, which is necessarily somewhat uncertain.
The other method of supplying shelter is by making use of such
buildings as are already available. In France most of this class have
been hotel buildings like those employed at Vittel, Contrexeville,
Royat, Chatel Guyon, Vichy, and at the Riviera center. Such build-
ings are, as a rule, not well adapted to the purpose. They are five or
six stories high and poorly provided with elevators or practicable
A. E. F. — HOSPITAL CENTERS. 1805
stairways. Kitchens and dining rooms are in the basements or on
the lower floors. It is difficult to get patients' food and supplies to
the upper floors. Toilet fixtures are more frequently bad than good.
There are no very large rooms suitable for wards, but, on the con-
trary, innumerable small ones, with an average capacity of three
beds. They are usually situated in towns or cities, frequently abut
on the streets, and have no yards or grounds. Railway sidings may
be at too great a distance and storehouses not available at convenient
points. Their location and peculiarities of construction and interior
arrangements make administration and control of patients most diffi-
cult and unsatisfactory. Such buildings are practically fireproof
and usually may be had at short notice.
After having had experience in operating hospitals in both classes
of buildings, I wish to say that in my opinion the temporary struc-
tures are very much better in almost every way than the hotels. In
some cases substantial barracks turned over by the French authorities
have been used, and these, I believe, have been more satisfactory than
the hotels.
It is probably that no one type of construction can be utilized to the
exclusion of others. The point I am trying to make here is that even
buildings of poor material, especially made and arranged for hospital
purposes, are very much superior to those of the best material built
for another purpose and merely adapted.
C. HOSPITAL CENTER, LANGRES.
The hospital center at Langres is situated about three-quarters of
a mile to the east of the city and in a valley, through the center of
which runs the Marne Canal and also the Est Railroad. The city
of Langres is built upon the crest and promontory of a ridge run-
ning north and south ; paralleling this ridge and about 4 miles from
it on the Avest there is another ridge, thus a valley is formed. It is
in the eastern portion of this valley at the base of the ridge, on which
the city is placed, that the hospital center is built.
Construction of the center was begun during the early part of the
summer of 1918, but delay in receipt of building material and the
shortage of labor prevented its early completion, so that the center
with all its equipment complete was not a fact until after the sign-
ing of the armistice.
The original plans for this center contemplated four base hospi-
tals and one convalescent camp ; however, buildings for only two base
hospital units — a convalescent camp and for the center administra-
tion— were constructed, all of A type, and located on a rolling ter-
rain which provided fair natural drainage and covered an area of
about 80 acres. To the wooden buildings were added later 36 mar-
quee tents, crisis expansion, to each base hospital, and 72 such tents
to the convalescent camp ; this addition gave a bed capacity of 1,500
to eacli base hospital and 1,000 to the convalescent camp, a total of
4,000 available beds for the center.
The center as such has its beginning on August 15, 1918.
The commanding officer of the center organized his own adminis-
trative force from the commissioned and enlisted personnel assigned
to him and from that of Base Hospital Xo. 53. Inasmuch as instruc-
tions to rapidly prepare 2,000 beds for occupancy had been received,
1806 REPORT OF THE SURGEON GENERAL OF THE ARMY.
all construction work was expedited to the utmost and particular at-
tention o-iven the organization of the quartermaster and medical
sup])ly departments in order to place them upon a working basis.
Within two weeks the 2,000 beds were ready for the nonsurgical cases
which arrived on the first hospital train on September IG, 1918.
From that time on the center was very active. The first filling of
the center with patients was accompanied by some confusion, but
no more than could be expected with the first arrivals. The organi-
zation as planned rapidly adjusted itself and soon was working-
smoothly.
One of the greatest handicaps under which this center operated
was its distance from the detraining point, necessitating the trans-
portation of all patients a distance of more than 2 miles by ambu-
lance and truck over rough narrow roads to the center. At no time
was there sufficient ambulance transportation available and the ma-
jority of all cases received were transported by trucks. This was a
serious defect. At the time of the armistice, plans were under way
providing for a railway track to be built directly into the hospital
area.
During the heavy fighting at St. Mihiel and in the Argonne more
patients were received than could be successfully cared for by the
personnel of one base hospital. Base Hospital No. 53 Avas practically
operating two base hospitals with a reduced personnel up to Septem-
ber 25, when Evacuation Hospital No. 18 arrived at the center for
a temporary stay and, immediately under the direction of Base Hos-
pital No. 53, took over the second base hospital equipment and the
wards. On October 26, 1918, Base Hospital No. 88 arrived. Evacua-
tion Hospital No. 18 having departed the same date. The center
was now operating as planned — the two base hospitals were now
functioning; also the convalescent camp. It was originally planned
that the convalescent camp should accommodate 2,000 beds; this
number was reduced later to 1,000. A laundry was included in the
plans for the center, but, as it was not in operation up to the time
of the signing of the armistice, the satisfactory practice of sending
laundry to Rimaucourt by truck was retained, and the plan for the
center laundry was therefore abandoned.
From the outset and up to the signing of the armistice the pro-
curement of the quartermaster supplies, other than food, in sufficient
quantity was extremely difficult, but the medical supplies were avail-
able in abundant quantities at the depots. There was at times a tem-
porary shortage in our own depot, due to the lack of motor transpor-
tation with which to bring supplies from the large medical supply
depots.
The problem of the installation of the steam-heating plants for
the operating pavilions was a difficult one to solve, shortage of
cement and nonreceipt of fixtures delaying its completion until
January, 1919.
About this time instructions were received for Base Hospital No.
53 to assume control and operate both base hospitals. Base Hospital
No. 88 being ordered to Savenay and departing on January 13, 1919.
On January 10 hospital unit I arrived, and was incorporated into
the personnel of Base Hospital No. 53 : accordingly, it ceased to exist
as a sej)arate unit, and has assisted with the additional work of the
larger organization.
A. E. F. — HOSPITAL CENTERS. 1807
On January 22 the convalescent camp was discontinued and its
personnel absorbed by Base Hospital Xo. 53. As the central admin-
istrative staff "was no longer necessary, it was discontinued and offi-
cially ceased to exist on that date — January 22, 1919.
HISTORY OF CONVALESCENT CAMP, HOSPITAL CENTER, A. P. O. 714.
The convalescent camp at the hospital center, A. P. O. 714, Lan-
gres, Haute-Marne, France, was located on a rolling plateau to the
east of Base Hospital Xo. 53 and Base Hospital No. 88, and utilized
approximately 20 acres of land prveiously used for farming pur-
poses. The drainage was quite good and the chosen area well adapted
for the purposes intended.
As originally planned, it was arranged to care for about 2,000 con-
valescents. This number was subsequently decreased to about 1,000.
The shelter was provided in Marquee tents, in wards of 3 tents each,
and at the signing of the armistice 69 tents were in operation.
These tents were of a superior type, but not especially desirable for
a convalescent camp by reason of their dark, gloomy interior, as they
were coiistructed for tropical use and, in the dark, cloudy weather of
this portion of France, exercise rather a depressing influence upon
the occupants.
The i^ersonnel, supply departments, kitchens, and dining rooms
were cared for in 17 buildings of the portable wooden A barracks
The men were fed on the cafeteria plan in individual mess kits and
ate in wood barracks. Food supplies were ample and were secured
from the center supply officer. Electric light was furnished by the
hospital plants. Water of good potable quality came from the cen-
tral water plant, operated bj- the Engineer Corps of the Army. The
filtration and sterilization being performed at the central plant. The
heating of the buildings and tents was done by small French stoves
and was not entirely satisfactory. It was necessary to construct
stone paths connecting the various parts of the camp, as mud was a
factor always to be combated. The excreta was removed in G. I.
cans to a central point and carried to the hospital destructors by a
closed steel excreta truck. A portion was removed and dumped on
fields, under the direction of the United States Army Sanitary
School in Langres.
The reconstruction plans of rapid unhospitalization of patients
contemplated dividing the men into several grades, according to
strength, that they might engage in graduated exercises, hikes, games,
and amusements. The Red Cross constructed a large hut to the east
of the camp area and herein the men were regularly exercised and
drilled. Amusements in the form of motion pictures, athletic exhi-
bitions, and athletic games were held in this excellent building. Some
sort of entertainment was provided nightly.
During January, 1919, under orders from the chief surgeon, Amer-
ican Expeditionary Forces, the canvass was taken down, and on
January 22, 1919, the camp officially passed out of existence.
The wooden barracks were taken over by Base Hospital No. 53 for
the care and housing of its personnel.
1808 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
MEDICAL SUPPLY DEPOT, HO.SPITAL CENTER, A. I'. O. 714, LANGKES.
This department of the hospital center was organized primarilj^ as
the medical supply depot of Base Hospital No. 53 during the latter
part of August, 1918.
Some difficulty was experienced in obtaining supplies, principally
because of the delay in receiving shipments bj?^ rail. Su^Dplies were
received from the base depots at Cosne, Gievres, Dijon, and Is-Sur-
Tille. Motor-truck transportation was utilized as much as possible
in obtaining supplies from the two latter depots. The initial equip-
ment for a thousand-bed base hospital was shipped directly from New
York to Base Hospital No. 53. This shipment was very tardy in
arriving and occasioned much confusion and many mistakes, as it in-
cluded approximately 75 carloads and arrived in small lots, covering
a period of over two months.
d. HOSPITAL CENTER, ALLERr, SAONE ET LOIRE, FRANCE.
Geograj)hical location. — The hospital center at Allerey, Depart-
ment of Saone et Loire, is located in the southeastern part of France,
on the P. L. M. Eailroad, about 75 miles from the Swiss border.
The village of Allerey itself has no direct connections with the larger
cities, but it is conveniently near to Chagny, Chalon. and Dijon,
where connections with the main lines can be made to any part of
the country. It also has the advantage of being situated on the
direct highwaj^s to Nevers and Dijon. The Saone River, one of the
chief waterways of France, runs close to the camp and afforded a
waterway, which, upon several occasions, has been made use of in
the transportation of fuel and other materials.
CJiiiuite. — Climatic conditions were not at all what might be
wished for in the care of the sick and wounded. The summer was
warm, but the spring, fall, and winter brought an abundance of
rain and damp weather together with cold of a penetrating nature.
The report from the weatlier bureau showed an average rainfall
of 840 mm. The temperature ranged from 1.5° C. to 18.91° C. with
an average of 10.52° C. for 10 years.
Terrain, — The hospital site covered an area of 172.3 acres which
was made up of farm land and some swamp land. The east end
was covered with trees and a thick underbrush. The soil was found
to be of clay, covered by a porous layer of loam, which allowed the
water to soak through to the clay where it remained. Proper drain-
age became a problem from the beginning of the construction. The
hospital site was low. one of the lowest parts of France. Before
drainage ditches were dug the entire site was often under several
inches of water. Almost the entire surrounding country was used
for agricultural purposes.
Roads. — Temporaiy roads were laid out and graded by the Engi-
neers, but it was impossible to make them of a permanent nature.
At first cinders were used as surfacing material, but with the con-
stant stream of heavy loads roads were soon cut to pieces and often
were impassable. Later, as material arrived, many carloads of
crushed rock were distributed over the roads. A steam roller was
operated in an attempt to obtain a hard surface, but the heavy
traffic soon forced the rock into the soft ground. In contrast to the
roads within the camp were the original French roads which bor-
A. E. F. — HOSPITAL CENTERS. 1809
derecl the camp on the south and east. These roads withstood the
heavy traffic with only occasional repairing.
Construction. — On February 16, 1918, the work of laying out the
site of the hospital was begun. Labor was a big problem, for the
country was destitute of able men. Old men, boys, and those unfit
for further military service comprised the working force, and horses
and ox teams were the only available means of transportation. The
type of buildings selected for the center are known as the Cavanair
and Mora jam, being of the knock-down variety, and of European
construction. They are built by securing together uniform sections
made up of double thickness of three-fourth-inch tongued and
grooved lumber, nailed and cleated. allowing an intervening air
space. These sections formed walls, floors, roofs, and ceilings. Par-
titions were constructed with 2 by 4-inch studding and paper wall
board. Dimensions of all buildings were uniform as to width, being
6 meters, and varied in length from 10 meters, for the smallest
building, to 50 meters for the wards. This type of building could
be constructed very rapidly but in many instances settling took
place so that cracks and openings occurred.
In the latter part of February, 1918. the sections arrived in such
quantities that the freight house at Allerey station was soon filled
and 109 cars were unloaded at St. Loup, a neighboring village. By
the 23d of March only 10 buildings had been erected. Only the slow-
moving ox teams could force their way through the mud. Company
C of the 26th Engineers arrived on May 19, and from that day the
hospital grew rapidly.
Plan of center. — The center was composed of 13 sections and a
cemetery; 10 of the sections to provide for one hospital each, 1
section for the quartermaster depot and motor park, 1 for the con-
valescent camp, and 1. secluded from the rest, to be used for the
psychiatric unit. Each hospital unit was identical with its neigh-
bor with but few exceptions, such as the location of latrines and the
placing of crisis expansion tents in the rear of the wards. These
tents were of French manufacture and known as the Marquee type,
dimensions 17 by 35 feet. Three tents were connected end to end,
placed in the rear, forming part of the respective wards. The dimen-
sions admitted of two rows of hospital beds, leaving a passageway
through the center. This increased the bed capacity of a ward by
50 beds, though this number was necessarily reduced to permit the
installation of stoves. It was found necessary to use wooden blocks
under the legs to prevent them from sinking through the tarpaulin
floors into the soft ground. Thirty-six tents were placed in each
unit, 12 series of 3 tents each, increasing the capacity of the section
by 600 bods, which at times were all occupied.
North of sections 7 and 8 was established the convalescent camp.
Tliis camp consisted of some 20 buildings and 150 tents, capable
of handlir:g 5,000 men at one time.
Equipment. — The original plans called for a high-tension line
from Chaion for the purpose of conveying electric current for light
and power, but it was necessary to install six emergency light and
power stations, each serving two sections of the center. The first
plant began operating June 26, 1918. This plant was located be-
tween sections 1 and 2 and supplied these two sections with current.
1810 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Stoves were requisitioned for as early as July, 1918. However,
these did not arrive in sufficient number until after the coldest
weather had been experienced. By the middle of December stoves
had arrived in sufficient number to allow two to each ward and one
to each tandem tent. Fuel was on hand at all times, several thou-
sand tons being stored against possible dehws in delivery. Con-
siderable shrinkage occurred upon the introduction of heat into the
buildings, leaving large cracks, which let in the wind and cold.
Water supjyly {permanent). — Water was pumped from three wells,
located in the flats at the east end of the reservation to a 100,000-
gallon reservoir on a hill at the west end of the camp, furnishing
sufficient pressuie to supply all sections. All patients and personnel
were supplied by the Lyster-bag system.
/Sewage sy stein. — A sewage system for liquid waste material, re-
lieved the necessity of trucking to a dump and of using surface
drainage. The incinerators and destructors located in each unit and
the central disposal plant handled the solid waste material.
Transportation. — One of the greatest handicaps experienced in
this center was the lack of transportation, both steam and motor.
Trucks were few in number, and the small number of ambulances
made it difficult for the center to obtain supplies from the neigh-
boring markets. It was often found necessary to keep the ambu-
lances and trucks running day and night.
The plan, as outlined by the chief surgeon's office, was that the
commanding officer of the center was to have control of all matters
outside the jurisdiction of the commanding officer of the individual
hospitals. The hospitals themselves were to operate independently.
Equipment which had been accumulated by Base Hospital No.
26 to supply a 1,000-bed hospital had not arrived up to the middle
of Jul.y, when the first convoy of patients were received, and it was
necessary to canvass the surrounding country for surgical appliances,
dressings, and medical supplies of all kinds, together with mess
equipment, for the incoming patients. All of these preparations
were made on short notice; officers were dispatched to the nearby
towns, and others sent to the medical supply depots. Although these
supplies were received only the day before the first convoy arrived,
everything was in readiness for the receiving, housing, and treatment
of some 400 patients. At this time quartermaster supplies were re-
ceived from Dijon by truck and after much telephoning and tele-
graphing and some personal trips to supply divisions, supplies of
all kinds were received in carload lots, so that after the first acute
shortage the center was regularly supplied.
During the life of the center the commanding officer was required,
with only the personnel of three hospitals, to equip and maintain
three additional hospitals, known as provisional hospitals and named,
respectively, 26-A,.25-A, 49-A. All of this immense amount of
work of distributing personnel, supplies, and equipment was carried
on under the supervision of the commanding officer of the center,
who at all times met every request from the chief surgeon's office for
additional bed space. During November it was necessary to take
over the Red Cross recreation huts in order to care for the great
influx of patients. At this time the center had more than 18,000
f)atients and was equipped to care for 20,000. Additional hospitals
soon arrived and took over the provisional hospitals, which had been
A. E. r. — HOSPITAL CENTERS. 1811
organized to meet the emergency caused by the heavy casualties at
the front.
The original suggestion from the chief surgeon's oflSce that all hos-
pitals operate independently could not be carried out, because of
frequent requests from that office for expansion.
EECEIVING AND EVACUATING SEB\^CE.
As the first convoy did not arrive until July 23, this work was not
very strenuous. Distribution of patients to hospitals from incoming
convoys, and also superintendence of outgoing convoys to replace-
ment depots was in charge of an officer.
As the physical condition of all men going to duty is very impor-
tant, and as it was necessary to return men to the line as quickly
as their condition would permit, a careful check of all patients leav-
ing this center was made. The records of the men, together with
their equipment, were made as complete as possible. Fit men were
encouraged to reutrn to duty in the shortest possible time. Those re-
quiring additional hospitalization or treatment were given every
opportunity to fit themselves for front-line duty. Before the con-
valescent camp was organized, patients were evacuated from the in-
dividual hospital direct. During the first two months the supplies
at this center for equipping the men fit for duty were scarce, so that
only men returning to front-line duty or leaving the center were
given full equipment. Patients at fii-st were evacuated to the con-
valescent camp in their hospital clothes; that is, pajamas and shoes.
There they were given their full equipment. It was necessary in
some cases to send men forward without complete records or full
equipment, but in no instance did any man suffer because of lack of
clothing, etc.
As soon as sufficient clothing and equipage arrived, individual hos-
pitals were required to supply each man with the necessary equip-
ment before sending him to the convalescent camp. Convoys evacu-
ated from individual hospitals to the convalescent camp were accom-
panied by a nominal roll. This roll contained the name, serial num-
ber, rank, organization, and tentative classification of the patient
which was made by the ward surgeon. Chiefs of the services, to-
account of the number of patients awaiting evacuation to the con-
to certify that all patients had been thoroughly examined, were free
from venereal and infectious disease: that the}' had been properly
equipped, and that they were accompanied by complete records.
An abstract of the individual morning hospital report was made
for the use of the receiving and evacuating officer of this center.
This abstract contained the total number of patients in the hospital,
together with the number of vacant beds. It also had a detailed
account of the number of patients awaiting evacuation to the con-
valescent camp and other data of value to the receiving and evacu-
ating service. When patients were foimd to accumulate in any hos-
pital becau'^e of the inaction of the disability board, the receiving
and evacuating officer directed that such boards speed up their work
so that the evacuation be not delayed.
Onl}'^ A, B, and C cases fit for duty were evacuated to convalescent
camp. Class D cases were sent to base ports for evacuation to the
United States. After the signing of the armistice the chief surgeon's
142367— 19— VOL 2 53
1812 REPORT OF THE SURGEON GENERAL OF THE ARMY.
office required that all men who would not be class A within a period
of two or three months should be evacuated from the American Ex-
peditionary' Forces. With this end in view all B and C patients
fit for duty, but who would not be in class A in two months' time,
were sent to St. Aignan to be organized into companies and sent
home. B and C cases requiring future hospitalization, but who
would be well of their condition in approximately two months, and
battle casualties who would become class A in two months were
evacuated to the hospitals in the Eiviera district. D cases were
evacuated from the center onlj' under the direction of the chief
surgeon's office, and then only by hospital train. Men of this classi-
fication were sent direct to base ports, where they were evacuated
overseas.
Divisional evacuations were made direct to the headquarters of the
(li \ ision concerned. All men were carefully examined for vermin
and w'ere completely equipped, except pack, before going to these
areas. Because of the many patients who had to depart from this
center during the night, and because of the uncertainty of the arrival
of French trains, an evacuating center for the hospital group was
started as an adjunct to Base Hospital 70. Patients who were to
depart from this center between 10 p. m. and 7 a. m., were sent to Base
Hospital 70 immediately after the evening meal.
Before a convoy left a hospital of this center for the convalescent
camp, the ward surgeon examined the patients and made a tentative
classification. The patients were next examined by the chief of the
service together with the registrar. Upon arrival at the convalescent
camp, all patients were marched before the commanding officer of
this institution, when their equipment and records were inspected and
all patients grouped according to the tentative classification made by
the ward surgeon. Men fit for full duty were separated from those
who were able to do only light duty, and those fit for light duty were
separated from cases who could do no duty. All patients were then
passed through the medical hut of the convalescent camp for physical
examination. In any instance where the classification which had
been previously made by the hospitals, was in question, the patients
Avere reboarded. This reboarding was done by a permanent board
which was in session at stated intervals at the convalescent camp.
All A men who were fit for full duty were then assembled according
to the regulating station to which they were to be sent.
A train containing as many as 600 patients, walking and litter,
could be evacuated in three hours. Details of enlisted men were sent
from each hospital under the command of a noncommissioned officer.
This was hard, tedious work, but all men performed well, and no
accidents or rough treatment were encountered. During the time
that influenza was epidemic, and during the handling of contagious
or infectious diseases all personnel were required to wear masks.
MOTOR TKANSPOETATION.
The beginning of the motor transportation dates back to the early
part of June, when Base Hospital 26 arrived. The equipment con-
sisted of a motorcycle with a side car. The only cars in the center
were assigned to the Engineers at that time. Because previous
weather conditions had hindered the construction, they were in con-
A. E. F. — HOSPITAL CEXTERS. 1813
stant use throughout the day and could be obtained for other neces-
sary hauling only after 6 o'clock in the evening.
Early in Jul}^ men from Base Hospital 26 were sent to the motor
reception park at Bordeau to bring two 3-ton Packard trucks from
the center. Shortly afterwards one 2-ton Garford truck was brought
from La Havre. These few vehicles were insufficient, but they greatly
relieved the situation. By working these both day and night most of
the necessary transportation was accomplished. Two 2-ton Fierce-
Arrow trucks were received from Bordeau and a few weeks later
seven G. M. C. ambulances arrived, three from Bordeaux and four
from Brest. Previous to the arrival of the ambulances it had been
necessary to carry by litter squads all patients from the trains to the
various hospitals.
RED CEOSS.
The medical supply situation was acute at this time, and surgical
dressings were in great demand. On July 20 a carload of such dress-
ings was coupled to a fast passenger train and brought as far as
Dijon, from where it was hauled to Allerey by truck. The same situa-
tion was experienced again in October. At this time there was ob-
tained for the center 10,000 blankets, 19,000 sheets, 600 suits of
pajamas, 1,000 operating gowns, 1,000 helmets, 1,000 pairs of bed
socks, 2,000 yards of Dakin tubing, and 2 cars of surgical dressings.
About the middle of October there was an enormous influx of pa-
tients, which taxed the capacity of the center, and the Red Cross huts
were cleared and turned over to be used as wards. This condition
existed until November 25, when the huts were again placed at the
disposal of the workers, and places of recreation were again furnished
to the men. The Red Cross also maintained a corps of searchers in
the center, whose work took in the locating of relatives and friends
at home and the finding of those who had been lost in the American
Expeditionary Forces. If a man was known to have been missing,
these searchers, by an efficient system, were able to ascertain within
a few days what must have become of the man in question.
NURSES.
During the months of September, October, and November, which
covered the most trying period of work in the hospital center, the
nurses from Base Hospitals 25, 26, 49, and 56, cared for the thou-
sands of patients in the hospitals. The work was trying in the ex-
treme, and these girls were by necessity called upon to work from 12
to 16 hours a day. They had come from training in Army canton-
ments in the United States where, by regulation, 1 nurse cared for
jio more than 10 patients. Here some of the wards to which tents
Were attached contained as high as 120 patients. Two, and rarely
ever more than three nurses were available for duty on such a floor.
Some units averaged as high as 25 nurses off duty because of sick-
iuss at one time.
: From time to time nurses were sent to the front for duty on operat-
ing and shock teams. Base Hospital 26 sent four such teams,
two nurses on each of two of the teams and three on each of tho
other two teams. Base Hospitals 25 and 49 had but one nurse each
away on this type of duty. Base Hospital 56 sent six nurses to the
front for duty, three on a team.
1814 EEPOET OF THE SUEGEON GENEEAL OF THE AEMY.
CAMP SANITATION,
When the first unit arrived at Allerey, there were no sanitary ap-
pliances available, with the exception of a few galvanized-iron
latrine pails.
A large number of civilian laborers were employed by the contrac-1
tors. These men were from the southern European countries andi
had no idea of cleanliness and sanitation. They defecated on the
ground at any place, without covering their deposits. The only
latrines in use at this time was an old abandoned well back of section
1, which was used by the Engineers, and a few latrine pails used in
outhouses by the female j^ersonnel of the contractor's office. Strad-
dle trenches and latrines were immediately constructed for the civil-
ians and pails put in place. Laborers would not use these. In
many instances it became necessary to place guards at several places
about the camp to prevent the soiling of the ground.
The only water supply available was that from two wells situated
in section 2. At first the water had to be transported by trucks from
the near-by wells. Analysis of the water from these wells, and also
from the wells inside the camp, showed the water to be very impure,
so that all water was treated in lyster bags. Two temporary iron
tanks were put in place on a wooden scaffolding, about 20 feet from
the ground in section 2, and water was pumped into these from the
wells in section 2. Pipes were laid on the surface of the ground from
these tanks to sections 1 and 2 ; the water first being used only for
cooking, etc. Frequent examinations of this water were made. It
was always found necessary to chlorinate it before it could be used
for drinking purposes.
As the personnel of the camp increased, it became necessary to con-
struct septic tanks. Three of these tanks were made by digging pits
in the clay. The average dimension of these pits were 5 by 10 by 9
feet deep. These were connected one to the other by a large pipe,
so that the liquid matter that came out of the third tank was practi-
cally clear and odorless. After the first convoy of patients arrived,
patients came in very rapidly and the tanks were soon filled.
A permanent water supply for the center was finally derived from
three dug wells situated on the flats about 1 mile from camp. Water
was pumped from these wells to a reservoir situated on a high piece
of ground to the west of the camp. This tank was constructed to
hold 100.000 gallons of water, and was to serve as a reserve for fire
fighting as well as other purposes. Samples of water from these
wells proved the water to be in good condition, and for a time it was
used without chlorination. Because of the peculiar consistence of the
soil, the water main soon developed leaks, and great contamination
of the water followed immediately, so that it again became necessary
to treat the water in Lyster bags before drinking.
Milk for the center was obtained from the farmers in the neigh-
borhood, but an inspection of the dairies demonstrated the necessity
of pasteurization of all milk, which order was issued and enforced in
all units before the milk was used.
French hospital trains, when they unloaded in this center, were
cleaned ancl disinfected before being sent back. The entire train was
swept first and scrubbed, and if any of the patients were gas cases
a saturated solution of bicarbonate of soda was used. The walls,
A. E. F. — HOSPITAL, CENTERS. 1815
ceilings, and other parts of the cars were sprayed with a 5 per cent
sohition of formaline, and all blankets were exchanged for others
that had been sterilized.
This sterilizing was done by means of a portable field sterilizer.
Wastage became a problem which was at first hard to solve. Cooks
and ward masters were prone to serve more food than the patients
could eat; resulting in a large wastage. This was partially due to
inexperienced kitchen police, and other attendants that were neces-
sary to staff the large mess kitchen in each unit. Frequent inspec-
tions, together with disciplinary action, soon corrected this condi-
tion.
Infectious and contagious diseases occurred in this center in only a
few instances and not until about the second week of October, when
influenza and pneumonia became epidemic. Most of the. cases in this
center were among patients who had been sent here from hospitals
in the forward area, but later developing among patients and per-
sonnel stationed here. On November 4 the greatest number of in-
fluenza cases, 1.002, were under treatment here. On that date the
total number of patients in the center was 16,363. On this date 15
cases developed in the center, while 45 cases were admitted from
hospitals outside of the center; 86 being the greatest number of ad-
missions in any one day. This epidemic gi^adually subsided until
January 1, 1919, when there were a total of 100 cases among 8,542
patients. Pneumonia, in many instances, developed from influenza,
so that this disease became epidemic at the same time that influenza
was prevalent. On November 8 there were 291 cases of pneumonia
undergoing treatment. On October 30, 22 cases were admitted; 13
of which developed in this center, this being the largest number of
cases reported in any one day. A great many deaths were due to
pneumonia, while no deaths were reported from influenza.
The arrival of Base Hospital 25 at AUerey found the Engineers
still at work, and the home for the unit in section 1 uncompleted.
Orders were received by the unit to be prepared for taking patients,
and everybody hustled to comply.
There were no shelves, desks, chairs, tables, latrine seats, ditches
(except the main big drains), and but few tools to work with.
These difficulties were gradually overcome, and, in the surgical de-
partment, there appeared tables, chairs, desks, a cemented floor in
the operating room, etc., crude but serviceable. Dressings were
requisitioned, and since there were no nurses, French women were
hired to prepare them.
Until late in October there was but one tap for water in the oper-
ating pavilion, and not until November were any of the washstands
installed. In the meantime an improvised washing arrangement was
made by having a stand with three large containers with faucets for
water, and these conveyed water to basins placed over holes in the
stands.
The instrument, dressings, and medicine cabinets were all impro-
\ i<ed by enlisted men and served admirably. Except for one surgical
cabinet none of the Eed Cross cabinets were ever received. The same
may be said of the X-ray and other outfits. Supplies of dressings,
drugs, etc., were scarce, and it Avas not until in November that such
supplies were delivered in such quantities as to properly handle an
emergency.
1816 REPOET OF THE SURGEOK GEiSTERAL OF THE ARMY.
Ether Avas the anesthetic of necessity and choice, as fittings for
the few gas tanks were unobtainable. Ethyl chloride was used for
short anestliosia, and many cases were done under local.
After the first convoy of cases (July 30, 1918), which were chiefly
ambulatory, this hospital was given practically only litter cases. At
no time after these began to arrive was it practicable to keep the
cases separate as to the type of wounds, so that every ward, especially
during the rush, presented ever}^ kind of case the war furnished.
There were practically no serious outbreaks of infectious or con-
tagious diseases, only a ward or two being quarantined for diph-
theria. There were 10 cases of pneumonia, with a mortalit}'^ of 50
per cent ; 5 cases of diphtheria, 1 of measles, and 2 of scarlet fever.
No cases of tetanus developed in this hospital.
On July 30, 1918, the first patients were received, of which 158
were medica'l. These were all ambulatory, being mosth^ mild gas
cases and psychoneurosis, with some gastro-intestinal disturbances.
In September the real epidemic of influenza began, the first con-
siderable number of cases being received on September 9, 1918. Dur-
ing this month there were received in all 193 cases of influenza and
51 of other acute respiratory infections, which should probably be
grouped with them. The pneumonia cases climbed up to 37 tins
month, and the first deaths from this cause occurred. The total num-
ber of new medical cases was 449.
October saw the influenza and pneumonia epidemic at its height.
This hospital handled 258 influenzas, 114 other respiratory infec-
tions; in all there were 144 pneumonia cases, with 45 deaths. The'
total of the medical cases for the month was 1,170. In this month
the first cases of diphtheria appeared, 6 being found, mostl}^ in gasseda
patients. ,
From the beginning of the influenza and pneumonia epidemics,
sheet cubicles and masks were used and the wards quarantined. By
far the greater number of cases of pneumonia were of the broncho-,
pneumonia type with the streptococcus as the predominant organism
The most severe cases were broncho-pneumonias following influenza,
or secondary to severe gas inhalations, especially of mustard gas.
At first, type determination was impossible, because of lack of fa-
cilities, but later the type 4 organism was found to be the most com-^
mon of the pneumococcus group.
In the earh' portion of the epidemic there were very few cases com-
plicated by empyema : in fact, this complication was very rare as
compared with the epidemic at Camp Sherman, Ohio, last winter.
Toward the last it became more common. The nonhemolytic strep-
tococcus and sometimes the streptococcus hemolyticus was found.
Several of the severe gas cases, and especially those with pneu-
monia, formed good culture ground for the diphtheria bacillus and
were the starting place of the diphtheria epidemic which followed.
Most of the earlv diphtherias originated in the gas wards or in the
pneumonia ward where the gas cases were transferred when pneu-
monia developed. (See "Diphtheria at a hospital center.") In
these wards, too, the epidemic got its start among the medical de-
tachment as two clinical cases developed in the men working in the
gas wards. Two carriers were also found in the men working in
the pneumonia ward. All patients with diphtheria were at once
transferred to Base Hospital 56 and the ward from which they
A. E. F. — HOSPITAL CENTERS. 1817
came placed under quarantine, which was held very rigid. Masks
and cubicles were used.
Gas cases. — Xumericallv, gas cases were the most numerous, but
most of them were so slight and well advanced toward recovery by
the time they reached us as to be very uninteresting medically. A
fair number, however, had a persistent bronchitis which was very
deceptive and extremely difficult to differentiate from pulmonary
tuberculosis, as it was characterized by continued evening tempera-
ture, loss of weight, loss of strength, cough and expectoration, and
all the physical findings of an active tuberculosis. The history and
negative sputum tests was about all we could use for differentiation.
The severe mustard burns of the surface and especially of the mu-
cous membranes of the eyes, nose, and throat and larynx were very
distressing, and in most of the post-mortems showed marked necro-
sis of the mucous membrane. These cases usually died of pneumonia.
Typhoid and paratyphoid. — These diseases were few, but rather
severe, largely as the result of travel. Of the six cases in the hos-
pital, three died, one from hemorrhage, one from perforation which
was operated on, and one from marked septicemia.
Pulmonary tuberculosa. — The scarcity of these patients speaks
well for the weeding-out process in the States. Only nine cases
could be proven by the sputum examination, and one of these was a
British soldier.
Surgical work upon battle casualties at Base Hospital 26 began
July 23, 1918. . On that date 398 patients were admitted, of which
327 were surgical. This convoy came from the Chateau-Thierr}'"
region, and almost all had been operated on, so that only 12 primary
operations had to be performed.
The second convoy, which came July 30, was transferred from
overcrowded and overworked evacuation hospitals. A certain num-
ber of the patients were sent back without operation; many were of
the type of surgical cases which require the greatest amount of atten-
tion. Four operating-room tables were arranged and two surgical
teams worked at the same time. During the ensuing 2J: hours about
75 cases were dobrided in the forward hospitals so few debridements
were necessary here.
The hospital was originally intended to accommodate 1,000 pa-
tients, but the influx of battle casualties and sick was so great that
the crisis expansion had to be resorted to. and the marquee type of
hospital tent was erected in the rear of the wards. In this way the
more serious cases could be treated in the wards and the overflow
taken care of in the tents.
The largest number of surgical cases under treatment at one time
was 1,191, on October 21, 1918, The number of surgical cases
treated up to November 30 was 3,050. The total number of deaths
due to surgical conditions was 33, resulting in a mortality of little
in excess of 1 per cent. In considering this mortality it is to be
remembered that for a short time this hospital was functioning
almost as an evacuation hospital, although at a considerable distance
from the front.
Patients on the early convoys arrived at the hospital in very good
condition. Most of them had had only one dressing at an evacua-
tion hospital before they arrived here. One was able to draw con-
clusions as to the methods of treatment applied early to wounds.
1818 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Wounds that had been dressed with dry gauze, lightly packed, ar-
rived at this hospital in very good condition; also wounds only cov-
ered with a protective layer of dry gauze did very well, but Avere
jnore likely to be infected than those which had been lightly packed.
Wounds to which rubber tubes had been introduced did badly, un-
less some irrigating solution, such as Dakin's, was constantly applied
during the time the patient was in transit. Wounds lightly packed
with gauze soaked in Dakin. solution behaved about the same as those
packed with dry gauze. Those dressed with vaseline and gauze
were more likely ix) become infected than those packed with dry
gauze, but the subsequent dressing was much less painful. It was
usually found advantageous to perform the first dressing under light
anesthesia.
Very few cases arrived at the hospital with gaseous gangrene.
Ligations of large vessels predisposed enormously to infection with
the gas bacillus. Tight bandages also seemed to predispose, and
such packing as actually interfered with blood supply of the wound
was often a predisposing factor. Aside from these cases, most of
our cases of gas gangrene could be laid to inadequate debridement.
In the treatment of gas gangrene it was our custom when definite
groups were infected and were accessible to excise all the muscle
groups which showed the least signs of infection. In instances
where the infection was diffused, although some muscle groups were
only slightly infected — as indicated by their color and slow reaction
to stimulation — amputation was done. The clinical expression of a
wound is the only criterion of value in the diagnosis of gas gangrene.
It was found that the mere presence of the Welch bacillus in a
wound would not at all indicate a Welch bacillus infection.
There was but one case of tetanus in Base Hospital 26 — a late case,
in which only one prophylactic dose of antitetanic serum had been
given. This patient had been wounded in the hand. The wound
had been debrided, but an eclat of about one-fourth by one-half
inch in size was retained. The first evidence of clinical tentanus
developed in this patient about two weeks after his admission to
this hospital and about three weeks after his injury. Treatment
commenced with the administration of antitetanic serum over a
period of six days, during which time 98,000 units of antitoxin were
given, 50,000 intravenously, 18,000 intraspinously, and 30,000 sub-
cutaneously. This patient recovered entirely and was symptom
free at the end of two weeks.
Before wounds were sutured cultures were made and, if these re-
vealed the presence of hemolytic streptococcus, the wound was not
closed until after this organism had disappeared. In cases wherein
there had been clinical evidence of a streptococcus infection, even
though the infection had entirely disappeared as far as could be
determined by bacteriological examination, the wound was not
closed. Many failures occurred before this point was called to our
attention.
There were seven instances of very severe secondary hemorrhages.
Practically all of these cases could be laid to improper debridement
and retention of foreign bodies. In nearly all cases the hemorrhage
was due to a sloughing of a vessel wall, either from infection in its
immediate vicinity or to actual pressure from a retained foreign
body. It was found extremely dangerous to temporize. Ligation
A. E. F. — HOSPITAL, CENTERS. 1819
should be performed as soon as possible. Wlien an occasion arose to
transfuse blood only the citrate method was used. Transfusion was
used only for the anemia following hemorrhage.
The following ligations are recorded : Subclavian artery, 1 ; femo-
ral artery, 3 ; axillary, 1 ; popliteal, 1 : posterior tibial artery, 3 ; bra-
chial artery, 1. Following these ligations it became necessary to do
two amputations. One, of the arm, following the ligation of the sub-
clavian artery; the other, of the leg, following the ligation of the
popliteal arter3^
It does not seem out of place to mention some of the problems
which have been most difficult of solution. The first, and the one of
paramount importance, is that of infection, following wounds, more
especially of bones and joints. "Wounds of the soft parts alone, which
had been thoroughly debrided, readily overcame infection when care-
fully treated by one of several methods. The wounds were second-
arily sutured and resulted in healing in all but a small percentage of
cases.
It is already too late when a patient reaches a base hospital for any
treatment to be a factor in the prevention of bone and joint infection.
Whether or not infection is going to take place is determined before
the patient leaves the evacuation hospital, and it is the surgeon at the
base who has the greatest opportunity for estimating the thorough-
ness of the work done in the evacuation hospital. Of course, when
too great an interval elapses between the injury and the time of
operation, nothing will prevent infection in wounds produced by
shell fragments.
Infection of bone does not make itself at once apparent and the
patient passes out of the hands of the first operator with a normal
temperature and with the wound showing no signs of inflammation.
This fact has been responsible for a certain degree of conservatism in
the debridement of shattered bones. In most evacuation hospitals it
seems to have been the custom to remove only those fragments which
had been completely detached from the periosteum.
There is much to support the view of those who believe that all
small fragments should be removed at the primary operation with an
excision by chisel or curette of the ends of the injured and discolored
bone. Through the latter procedure the blood clots, which have be-
come organized in the interstices of the bone in the traumatized area,
are removed. These areas are favorite sites for the development of
bacteria which are invariably carried into the wound with shell
fragments.
It is apparent that there is one practical and serious objection
to the debridement of bone, which is the possibility of nonunion when
too much bone has been removed, HoAvever. a gap of considerable
distance will fill in if the periosteum remains and, in case of failure,
a secondary operation is preferable to prolonged sepsis.
Probably the greatest advance which has l3een made has been in
the treatment of the recently injured joints. AVhen a careful de-
bridement was made and the joint immediately closed, primary heal-
ing is the rule.
Cases of severely infected knee joint are the m.ost difficult to man-
age when the cartilages and articular surfaces of the bone are in-
volved. It is better to do a resection while the condition of the pa-
1820 REPOET OF THE SURGEON GENERAL OF THE ARMY.
tient permits. Otherwise he may be overcome by the prolonged
sepsis and then even an amputation is useless.
The two orthopedic wards accommodated an average ^f 120 cases.
Many types of bone injuries were encountered, those most difficult of
treatment being comminuted compound fractures of the femur, which
was almost invariably infected. Such infection associated with a
greater or lesser amount of osteitis and osteomyelitis.
In the medical service the first item of interest is pneumonia. One
hundred and twelve cases of this disease had been completed in Base
Hospital 26 December 1, 1918, with a mortality of 45.3 per cent. Of
those who died 50 per cent had been evacuated as influenza cases
from evacuation hospitals further forward and brought in on hos-
pital trains as influenza, the pneumonia being discovered within 24
hours after admission to the base. This evacuation occurred princi-
pally during the latter half of September and the month of October,
when fighting on the American front was severe, and evacuation was
forced, at times three and four hospital trains coming into the center
daily. In many instances, 24 hours were required for the trip from
the front. Base Hospital Xo. 26 received man^i' of the very ill and
a considerable number of the most severely wounded.
A point of difficulty throughout was to determine the presence of
a complicating empyema, as physicah signs were often misleading,
and a few experiences taught the necessity of the early use of the
exploratory needle. By doing this a number of purulent effusions
were found early and the outlook for the ease of empyema complicat-
ing pneumonia improved.
With the appearance of diphtheria in October, a few cases were
found, which diphtheria bacilli were found in the throats of pneu-
monia patients, but only one clinical case of diphtheria complicating
pneumonia occurred.
A unique complication of pneumonia was the occurrence in one
case of infection within the sheath of both recti muscles by dip-
lococcus pneumoniae, with the formation of abcesses s^'mmetrically
placed in the abdominal wall below the umbilicus. The frequent oc-
currence of Zenker's degeneration in the recti muscles, as seen in
pneumonia cases at autopsy, gave the clue.
The relationship between the inhalation of deleterious gases and
diphtheritic infection provided an interesting study; the recently
gassed man was highly susceptible. It was important to take nose
and throat cultures from gassed cases every three days. A gassed
man showing symptoms of respiratory obstruction increasing after
the third or fourth day required particular watching in this respect, i
as heavy and extensive tracheobronchial diphtheritic membranes were |
prone to occur.
In October and November a diphtheria epidemic occurred in the
hospital center. Base Hospital No. 26 having a number of cases. -
These occurred in both the medical and surgical services. An un-
usual number of so-called carriers were found during this epidemic,
and these, with the positive clinical cases, were promptly evacuated
to another hospital.
Eleven cases of amebic dysentery were found clinically. Eighteen
cases of dysentery with every clinical feature of the bacillary type
were admitted, but in not a case could dysentery bacilli be isolated,
although careful attempts were made. It seemed probable that the
A. E. F. — HOSPITAL. CENTERS. 1821
bacilli had disappeared from the stool before admission. Xo develop-
ment of this disease occurred in the hospital.
Patients suffering from absorption of deleterious gases by inhala-
tion or surface contact, although classed as wounded patients, were
treated on the medical service.
The majorit}'- of the number of gassed cases had been affected by
the so-called mustard gas. The mustard burns were treated like
any chemical burns. One point of interest was the appearance of
new burned areas, largely of the first degree, although sometimes
of the second degree, as long as two weeks after the primary Ijurn.
These burns were more slow to heal than thermal burns in civil life-
Following phosgene inhalation, the evidence of bronchitis was
not marked, but disability was manifested by shortness of breath on
exertion and rapid pulse in many cases. The so-called effort syn-
drome was more common in these than in any other group of cases.
There were 467 patients admitted to the hospital with a diagnosis
of gas absorption of deleterious inhalation. 247 by surface contact,
and 141 with a combination of the two conditions.
Another interesting type of case was conjunctivitis (chemical)
due to absorption of deleterious mustard gas. Such cases were
treated according to instructions from the chief surgeon. In all,
184 cases of acute conjunctivitis were treated, 80 per cent of which
resulted from gas. In only two of the gassed cases did corneal
ulcers develop. Of 18 corneal ulcers on record, 16 were due to
traumatism.
BECEIVING WAKD.
When the first convoy came to this center. Base Hospitals 25
and 26 were the two hospitals here, and only Base Hospital 26 was
functioning. Three hundred and ninety-eight cases were received;
at least half of these were litter cases. The problem of handling
these cases was entirely new. and after this first convoy was taken
care of a system of handling patients was gradually evolved.
"When the first convoy was admitted the data for the register
card was taken by the registrar's department after the patient went
to the ward. This was found to be very difficult. So it was decided
to do this in the receiving ward. A special mimeographed sheet
was made with spaces for the data following the exact order of
Form 52 or register card.
After the patient was racked (there being racks for 64 patients on
the diagnosis tag, the ward number to which he was assigned; and
when he was not to be bathed a cross (X) was marked under the
ward number. The officer was accompanied by an enlisted man with
a small chart of the available beds in each ward. These were checked
off as each patient was given his ward assignment.
After being seen by the receiving officer, the required information
Avas pro]:»erlv filled in on the data sheets. It was found that six
men could fill in this data as fast as the ward assignments could
be made.
After the patient was assigned to his ward, he was carried out from
the receiving ward, stopping first to get a suit of pajamas. His field
medical card was taken from him and the ward number which was
marked on the card was written on a piece of paper and inserted in
1822 REPORT OF THE SURGEON GENERAL OF THE ARMY.
the pocket of the pajama coat. If the patient was to have a bath the
ward number would stand alone, but if the case were serious or the
patient was not in need of a bath, the ward assignment would be
followed by a cross (X).
The patient was then taken to the bathhouse. At first there were
no facilities at all and all water had to be carried. A number of
bath tables were constructed. These were made of wood, 7 by 3 feet,
about the height of a standing man's waist, and slanting from head
to foot. A cross piece at the top raised the patient's head about 2
inches. They were covered with roofing paper. These drained into
a trough which, in turn, drained into the ditch through a grease
trap on the outside. These tables were used for all litter patients,
even those with fractures. The most severelj^ injured cases were
bathed on the litter on top of the^e tables, but most of them could
be transferred from litter to table. Water was carried into the
bathhouse and heated on a field range. Later water was piped in
and a shower was built for walking cases.
Contagious dise-ases. — Considering the crowded condition of the
wards, especially during the crisis expansion, the incidence of in-
fectious diseases, aside from influenza and pneumonia, was surpris-
ingly low.
Diphtheria at one time, apparent^, was assuming the proportions
of an epidemic, but subsequent events led to the conclusion, that it
was in reality more an epidemic of cult'uring than an actual epidemic
of the disease. The first case of diphtheria occurred on the 1st of
November. Between this date and January 10, a total of 25 cases
developed in the hospital. During this time 121 carriers were de-
tected. On the detection of a case of diphtheria the patient was
immediately transferred to Base Hospital 56, the ward quarantined,
and all patients in the ward had cultures taken of the nose and throat.
If carriers were found they were transferred to Base Hospital 56
and the ward again recultured. Quarantine was not raised until
three negative cultures were obtained. In the wholesale culturing
which was carried on many cases of carriers were found, the offending
organism in most cases being the Hoffman bacillus.
The experience with diphtheria at this hospital differed from that
at other units in the center in that pra:ctically all the cases arose in
the surgical wards and could be traced to two carriers among the
attendants. The gassed cases, which seemed to show a particular
susceptibility in some localities, escaped, not a case or carrier devel-
oping in the gas ward.
One case of laryngeal diphtheria developed in the case of sep-
ticemia and pansinusitis, which was not discovered until 12 hours
before death. Being in a quarantined ward, he had been cultured
twice with negative results, and the day before death had a negative
Schick. There were no symptoms or signs of diphtheria until the
morning of his death, when a membrane could be seen just behind
and below the right tonsil. At autopsy there was found a dense
membrane lining the larj^nx, trachea, and extending down into the
finest bronchicles completely plugging some of the latter. On other
similar cases in the center showed the same insidious nature, higli
virulence and rapid progress of Klebs Loeffler infection in the pres-
ence of a general streptococcic infection.
A. E. F. — HOSPITAL CENTEKS. 1823
Pneumonia. — The first case of pneumonia occurred on August 27.
Following this, after a lapse of eight days, there was a steady in-
crease in cases up to Xovember 6, when the high mark (71 cases) was
recorded. After November 10 there was a very rapid decline in the
number of cases, only 11 being recorded from that date up to Janu-
ary 10, lOlD. At the outset a separate ward was assigned for pneu-
monia cases, and in this ward from August 27 to January 10 there
were treated 88 cases.
The onset was gradual in most of the cases, a large percentage
being secondary to influenza. From 4 to 10 days after the onset of
influenza symptoms there was noted a slight rise of temperature,
dyspnea, increased cough, and a marked tendency to cyanosis. The
pulse was usually low in proportion to the temperature, and while
the patients looked extremely ill and toxic, they rarely complained of
feeling badly. Pain in the chest was complained of only in those
having excessive cough. The temperature was rarely high, except
in fatal cases, 48 to 72 hours before death.
After a considerable number of cases were treated, less and less
dependence was placed on the physical findings in the chest, diag-
nosis being based on the general toxic state of the patient, dyspnea,
cyanosis, low blood pressure, leucopenia, cought, and insomnia.
The general low pulse-temperature proportion seemed to indicate
a streptococcic rather than a pneumococcic infection. In many
instances, however, both organisms were cultivated from the same
case, it not being unusual to find the pneumococci in the sinus pus
and hemolytic streptococci in the heart's blood at autops}'.
The association of sinus infection was a very common one, 49
cases (63 per cent) manifesting sinus symptoms. Of 22 autopsies
on pneumonia cases only 3 (13.6 per cent) had normal sinuses. In
all the cases having sinus infection more than one sinus was involved.
By far the greatest number of the cases came in on the trains
from the front with a diagnosis of influenza. By the time they
reached here many had frank signs of pneumonia, or developed them
within 48 hours. There is no question but that the strenuousness of
24 to 48 hours on a crowded train, with irregular meals and insuffi-
cient rest and sleep, lowers a patient's resistance materially and
renders him much more susceptible to the ubiquitous organisms.
Inftuenza. — On August 26, 1918, Base Hospital 49 received its first
train of patients. Among these were found eight cases of influenza.
By September 10 the number of cases of influenza had reached 52.
From September 10 to September 19 there were few additions to
this number, but a few days later by September 22, there were 110
cases.
The rise in number was then rapid until by October 6 there were
242 cases, the largest number at any time. From that time until
the present there has been a gradual decline, both in the number of
cases and in the severity of symptoms.
The largest number of pneumonias secondary to influenza was
reached in Xovember.
No attempt was made to differentiate between influenza and
three-day fever, both being considered one and the same. A total
of 459 cases of influenza occurred in all wards from August 27 to
January 10, with no deaths in uncomplicated cases.
1824 KEPOKT OF THE SUKGEOJST GENERAL OF THE ARMY.
Gassed cases. — On September 11, ward 18 was set aside for the'
exclush'B care of cases of pis poisoninir. This ward had a bed]
capacity of 64, and was sufficient until the early part of October.
Ward 16 was also assigned for gas and heart cases. Between Sep-
tember 11 and November 30, 200 cases due to gassing were treated
in these two wards. There were quite a number besides these, which,
on account of gunshot wounds, were cared for in the surgical wards.
The time ela])sing between the gassing and the entrance into the
hospital varied between 18 hours and 7 days. The average time was
two days. As a result most of the acute symptoms had subsided and
this report will deal mostly with the late developments and the
sequelae. There were four classes of patients: First, a number in
which the onh' historj^ was that of a feeling of dryness and burning
in the throat and the detection of the odor of a gas. At the time of
entrance into the hospital, 48 hours later, there were no physical signs
of gas irritation. These comprised, roughh' 20 per cent of the cases.
Class 2, cases of gas inhalation, mustard or phosgene, or a mixture of
gases. Some of these were of extreme severity. Class 3, cases due
also to contact with mustard gas. Practically all of the cases of
mustard gas inhalation belonged to this group. All cases of con-
junctivitis due to mustard gas are also included. Class 4, those in
which the symptoms were mainly due to the ingestion of food or
water contaminated by mustard gas.
Symptomatology : Class 1. — The symptoms of this class were varied
and could not be explained upon the basis of absorption of deleterious
gas. The main complaints were of dizziness, weakness, pains in vari-
ous parts of the body, especially in the precordium ; and dj^spnoea and
palpitation upon slight exertion. Judging from the history of these
cases principally, we concluded that most, if not all, of the symptoms
were due to a psychoneurosis engendered by the weird and mystical
tales which they had heard concerning the effects of gas. Many of
the men were constitutionall}' unstable and others were below normal
on account of exposure and fatigue. By far the largest number of
these were raw recruits. Many of our effort syndrome cases came
from this group.
Cla-^s 2. — Inhalation of deleterious gas. We were unable to dis-
tinguish in all cases between those due to mustard gas and those due
to phosgene and allied gases. In general those due to mustard gas
showed a much more marked involvement of the upper respirator}''
tract as well as the lung involvement. In the phosgene cases the lung
condition seemed the most prominent. In most cases there had been
the inhalation of a mixture of gases so that no distinction was made
as to etiology, but the cases were treated upon the bases of symp-
tomatology' and physical findings.
The chief symptoms were :
1. Sensation of constriction about the chest and dyspurea, coming
on within four to six hours after gassing and lasting three to four
days.
2. Extreme weakness usually followed the primar}^ nausea and
vomiting and gradually disappeared during convalescence.
3. Cough, constant, tracheal in type, sometimes nonproductive,
often, if associated with edema, very profuse and watery. During
the first 24 to 48 hours the patient often coughed up a bloody or blood-
streaked sputum, the cough in the mustard-gas cases, especially, lasted
A. E. F. — HOSPITAIi CENTERS. 1825
for three to four weeks, and in some it was present after five
months.
4. Aphonia, varying from a moderate huskineps of the voice to
complete aphonia. In all of the cases under observation it was due to
mustard gas. An interesting feature was that it frequently did not
come on for three or four days after the gassing and always persisted
for from 10 days to 3 weeks. Laryngescopic examination showed
edema of the vocal cords and in the severe cases superficial ulceration
with false membrane formation.
5. Painful deglutition, dryness, and a burning sensation in nose
and mouth. This occurred only in the first four or five days and in
cases showing a severe phar3^ngitis.
6. Procordial pain : Many cases complained of severe pain in the
chest, sometimes on the right side and sometimes on the left, in the
early stages. But in nearly 75 per cent after the first four or five
days there was a complaint of severe, lancinating pains through the
precordium. This was aggravated by exercise, but often it occurred
at night while at rest.
Cluss 3. Mustard-gas hums. — All burns treated by us were super-
ficial. In the earl}^ stage there was an erythematous area which
quickly went on to vesicle formation. The vesicle often increased in
size for three or four days after its formation and even the erythema-
tous area surrounding would increase. Ruptui'e of the vesicle left a
raw surface. A number of times it was noted that these superficial
ulcerations increased in size for a few da^-s. The healing was usually
slow and left a brown pigmentation. -
Conjunctivitis was a very common condition. It was due to chemi-
cal irritation, no secondary infections occurring in any cases under
observation. In only one case was there ulceration of the cornea.
The worst feature of these cases was the severe photophobia. This
condition often persisted for several weeks after signs of the con-
junctivitis had disappeared.
Class h. — Ingestion of contaminated food or water. Approxi-
mately 10 per cent showed symptoms due to this, but all were in
cases which had either burns or respirator}' symptoms besides. In
the early stages the symptoms were those of an acute gastritis,
crampy pains in umbilical and epigastric regions, nausea, and diar-
rhea. Later hyperchlorhydria developed and the patients com-
plained of heartburn, eruption of sour watery fluid, and pain and
burning sensation in epigastrium relieved by soda bicarbonate.
SUKGICAL SERVICE.
In the beginning it was intended that there should be a distinct
segregation of surgical cases. Wards were divided into one for
active infections, two for inactive but open, healthy progressing
wounds, one for fractures and joint injuries, and two for clean sur-
gical cases. With the rapid loss of officers sent to other duties and
the great number of incoming wounded men, it became apparent that
all ideas of segregation must be given up; in fact, a great number
of surgical cases were spread here and there throughout the hospital,
wherever a bed could be found.
It was not until November that it was possible to establish a
Carrel-Dakin ward. In this ward the majority of the severe cases
were grouped and every effort made to follow the method of treat-
1826 REPORT OF THE SURGEON GENERAL OF THE ARMY.
ment with scrupulous care. Apparatus was hard to obtain. For a
while the intermittent instillation by syringe was the best that could
be done. Later a dozen and a half of graduated bottles were ob-
tained. Rubber tubing supplied when Carrel-Dakin tubing was
requested was of the soft, flimsy, black variety, practically useless
for getting accurate results. This hospital has never been able to
get proper Carrel-Dakin tubing on requisition. That which was
used was salvaged from the dressings of incoming wounded patients.
This had been boiled and reboiled a number of times.
At no time could Forms 55K be obtained, and only since late in
December was it possible to obtain paper from the medical supply.
Such forms were made by memeograph on paper purchased at Verdun.
One form was filled out for each operation and given to the registrar,
after a copy was made on the field medical card. Shortage of paper
and forms has made it most difficult to care for the histories properly.
In addition to this, there were no blank field medical cards on hand
at any time, and the thin, flimsy, memeographed folds of paper have
been easily made worthless by much handling. No envelopes for the
protection of these records were obtainable. For these reasons such
records have necessarily been poor.
Base Hospital 56 was designated as the contagious hospital of the
center. From the verj- inception, due to the great shortage of bed
space, it was found necessary to care for several types of diseases
in one ward ; thus there were cases of mumps, measles, scarlet fever,
meningitis, and diphtheria, in a single ward. The usual methods
of isolating each type of a disease into a group, and cubicling each
bed with proper use of disinfectants and masks, was employed.
Although the bed space was quite limited, so that there were as high
as 48 patients in the ward at one time, the efficiency of the methods
will be grasped from the fact that there were but two cross infec-
tions: a convalescent measles patient contracted scarlet fever, and an
erysipelas patient, diptheria.
The total number of typhoid patients, as determined by cultural
methods, was four, with two deaths; the first death was subsequent
to a pneumonia during convalescence, as the autopsy showed healed
typhoid lesions only; the second was uncomplicated and due to the
disease itself. Six patients ran the course of a mild typhoid,
although several examinations of blood, urine, and feces did not
show the presence of the typhoid bacillus. Two cases of para-
typhoid-A were in the hospital ; both ran the usual course. So far
as could be determined they had been vaccinated against typhoid and
paratyphoid; this history could not be obtained from the two
patients that died.
NEXmOPSYCHIATEIC SERVICE.
In this unit there was no ward devoted to the care and treatment
of neurological or psychiatric cases. The work of the neurologist
has consisted of examination of patients in the surgical or medical
service where consultation has been requested. Such patients, when
mental, were transferred to Base Hospital 49, or Base Hospital 25,
for treatment and classification.
From September 22 to January 15, 1919, about 700 patients were
examined, including the neuropsychiatric cases of the Base Hospital
56-A.
A. E. F. — HOSPITAL CENTERS. 1827
SANITATION.
On taking over section 8, there were 400 patients distributed in
eight wards. There was water supply in only the receiving ward,
the kitchen, and four of the wards. There were no sewers, no lights,
no heating apparatus. Lyster bags were used for drinking water.
The roads constructed by the Engineers were already breaking doAvn
in spite of the previous good weather and absence of heavy traffic.
There was no incinerator or destructor, no sterilizer or drying shed.
The drainage ditches were constructed with insufficient fall, so tliat
they Avould not drain. The culverts under the roads were soon
crushed in by the heavy trucks, causing additional damming back
in the ditches. "When the space occupiecl by this unit had been just
about repaired, it was all again destroyed during the laying of
water and sewer pipes. The incinerator, when finally obtained,
cracked badly and had to be repeatedly patched. In spite of this
the accumulated rubbish of many weeks was successfully disposed
of, and later the feces also, although no sawdust was available for
mixing purjDOses, The most serious defects encountered were the
shortage of latrine pails for wards crowded with 70 to 75 patients,
shortage of cleansing utensils, stagnant water in the ditches, the
marshy condition of the ground on which the hospital was con-
structed, and the very excessive overcrowding,
BASE HOSPITAL NO. 70.
Base Hospital No. 70 left St. Nazaire, and arrived at Allerey,
September 22 at 10.30 a. m. It was assigned to section 9, which at
that time was occupied by the convalescent camp.
When the unit arrived from St. Nazaire, man}^ of the officers and
men of the detachment were sick with influenza, so that when the
flood of patients came, they were received and treated b}^ a weak
and inadequate personnel. In addition, during the time of the
greatest emergency; i. e., until the middle of November, this hos-
pital had no Nurse Corps of its own. It had available only those
that could be spared by other units so that at no time did the num-
ber of nurses exceed 20.
The large debridements with compound fracture of the long
bones were interesting. Wlien the Dakin technique was carried
out properly, pus was kept down to a very small amount, the edges
of the wound looked healthy and the temperature rose little above
normal. When improper or neglected, the wound soon filled with
pus. the temperature rose and the patient complained of pain. In-
fections traveled along muscle sheaths, forming new pockets and
tracks which had to be later opened and drained, some several
times. X-ray plates also proved very valuable in locating foreign
bodies missed by the fluoroscope of the evacuation hospital ; and also
showed many fragments of dead or detached bone splinters. The
wounds as received from the evacuation hospital seemed a little too
extensively debrided, and not sufficiently Dakinized.
Wound cultures and smears, as laid down by the chief surgeon,
American Expeditionary Forces, was practiced. It proved a good
guide to secondary closure. A number of cases on culture showed
the B. icelchii without clinical symptoms of gas gangrene, no rise
142367— 19— VOL 2 54
828 REPORT OF THE SURGEON GENERAL OF THE ARMY.
in temperature, a bright red healthy appearing wound surface, no
crepitus, and no edema.
Much coukl be written about the secondary' closures; these closed
earl}', 10 to 15 days after debridement, were the most successful.
It was early demonstrated that after loosening the skin, preparatory
to closure, the subcutaneous space must be perfectly dry, and com-
plete hemostasis obtained. Otherwise a slow developing secondary
hemorrhage took place and a clot formed which ruined entirely
the closure. The wound would break down in two or three days.
Another lesson learned, was that too great tension in a closure
means devitalization, and that the stitches would cut out early and
the wound break down. This was especially true of the forearm
or leg, where there were two closures of the same wound, entrance
and exit.
Before the female nurses reported for duty a sergeant proved
most valuable as an operating-room nurse. Three enlisted men
were trained as anaesthetists, giving well both ether and chloro-
form. The latter proved an ideal anaesthetic when given very liglitly,
as in obstetrics, for secondary closures. These took but a short time ;
the patient was easily anaesthetized and perfectly controlled. Chloro-
form anaesthesia shortened the time per operation very materially,
and many more closures could be handled in the same given time, as
compared to ether anaesthesia. It also lessened the incident of post-
operative pulmonary complications at a time when influenza and
pneumonia were at their height.
MEDICAL SERVICE. _
On October 4, 1918, the first patients, 510 in number, were received
at this hospital. Of these, 283 were medical cases, consisting largely
of influenzas and diarrhoeas. Many of these cases admitted as am-
bulatory patients were discovered to be active pneumonias on their
entrance to the receiving ward. Others developed into frank pneu-
monias soon after their arrival.
The lack of sufficient personnel made it necessary to have one ward
surgeon take care of as many as three or even four wards, with an
average of 64 patients in each. The paper work was also difficult
because of the lack of proper blank fonns.
Infuenza. — The influenza cases were isolated in the wards by
cubicles and masks. Ward masters and nurses were also masked.
The cases were kept isolated in these wards until the temperature
was normal, for at least seven days. They were then moved to a
convalescent influenza ward.
Pneumonias. — As soon as a case of pneumonia was diagnosed the
patient was transferred to the pneumonia ward and there isolated
in a way similar to the influenza cases. During the emergency a large
number of cases of this type were treated.
Gas cases. — Inhalation and contact of mustard gas fonned the
largest number of these cases. The patients were isolated in sepa-
rate wards until the symptoms of bronchial irritation disappeared.
In severe inhalation cases with cough, herein, one-twelfth grain at
one-hour-interA^als for three doses, was used, occasionally augmented
by small doses of morphine. The distressing cough was most marked
A. E. F. HOSPITAL. CEXTERS. 1829
it night. A small percentage of these cases developed broncho-
pneumonia.
Diphtheria started in the hospital, on the surgical side with an
isolated case, and spread with no apparent sequence in different
parts of the unit. In all there were 25 cases of this disease and one
ot them died. A quarantine officer was appointed at the hospital.
This officer's duties consisted of, first, examining the throats of the
sntire pei-sonnel daily ; second, the isolation of all suspicious tlu'oats
in a ward set aside especially for this purpose; third, culturing ad-
missions to this ward and patients in quarantined wards; fourth,
establishing and maintaining an absolute quarantine on wards from
which a positive culture was obtained; fifth, administering Schick
tests to all contacts, and reading same so as to standardize this test.
As soon as a patient showed a suspicious throat or developed any
ymptoms whatever of an acute infection he was placed immediately
in the isolation ward and kept cubicled until negative cultures were
obtained.
BASE HOSPITAL 70-A — (LATER KNOWN AS PROVISIONAL HOSPITAL NO. 6).
On October 1, 6 officers and 40 men were detached from Base
Hospital 70 to organize new unit 70-A. This personnel was soon in-
creased by additions from other hospitals to a total of 12 officers
and 87 coVps men. This organization took the place of Evacuation
Hospital Xo. 22, and at once went to work. One thousand cots were
replaced by beds.
The first patients arrived on October 9, when 181 came in one hour
and were received and taken care of by candlelights. October 10 600
niore were received. The tap water giving out, they had to be liathed
Tiith water carried by hand from the distant wells. The maximum
number of patients cared for at one time was 1,432 on November 14.
In November the convalescent camp was so congested by inadequate
e\ ucuations that 70-A devised the following plan for relief. Patients
ready for the convalescent camp were transferred to convalescent
Fards, where one evacuation officer equipped them, and he was re-
sponsible for the inspection, nominal rolls, etc. In this way the ward
surgeons were relieved of the paper work and the wards relieved of
ilie congestion due to the presence of convalescent patients. In these
Convalescent wards the patients were held in immediate full equip-
ment and preparation for evacuation to convalescent camp in any
number called for.
BASE HOSPITAL NO. 97.
An order of the Adjutant (leneraPs Office. War Department, dated
June 25, 1918, authorized the organization of Base Hospital No. 97
in the Southern Department, Camp Newton D. Baker, El Paso, Tex.
On August 14. 1018. the unit, consisting of 4 officers and 200 enlisted
men, moved to Camp Fort Bliss, Tex.
The first case of influenza in this command developed September
2<i, 1918. By September 30, 1918, 15 enlisted men were sick in hos-
pital. The rapid progress of the disease in the El Paso district taxed
flie facilities of United States Army Base Hospital, Fort Bliss, Tex.,
to the uttermost, and on October 3, 1918, that hospital called upon
this unit for assistance.
1830 EEPORT OF THE SURGEOlSr GENERAL OF THE ARMY.
October 3, 1918: Forty enlisted men sent to base hospital, Fort
Bliss, for emergency duty on account of influenza epidemic ; 28 men
of this command sick in hospital.
Movement overseas: At G p. m., October 19, 1918, received orders
from the commanding general El Paso district to entrain for the
East at noon the next day. The organization, consisting of 15 officers
and 192 enlisted men, "left Camp Fort Bliss, Tex., promptly on
schedule and arrived at Camp Mills, Long Island, N. Y., at 3 p. m.
Left Camp Mills and embarked on the S. S. Balmoral Castle October
27. Arrived at Liverpool, England, November 8 and left that port
November 9 for Southampton. Left Southampton November 10 and
arrived at La Havre, France, November 11, the day the armistice vpas
signed. At La Havre awaiting orders until November 28, when the
organization entrained for Allerey, France, arriving November 30.
Upon arrival the commanding officer of the center assigned this unit
to section 4, which had been operated by Base Hospital No. 56 as an
auxiliary to their hospital. No patients, however, were taken over
by Base iHospital No. 97. On December 10, 1918, this organization was
again moved to section 6, which had been used as an adjunct to Base
Hospital No. 70, This transfer included the taking over of 748
patients, most of whom were convalescent. On December 28, 1918,
the commanding officer of the center ordered that section 6, then oc-
cupied by Base Hospital No. 97, be converted into an evacuation
center.
Base Hospital No. 97 operated as a hospital from December 10 to
28, 1918, only. The patients received from Base Hospital No. 70
were in advanced stages of convalescence and with the exception of
about 60 on the surgical side, who required dressings, and about an
equal number of medical side, who were suffering from minor ail-
ments, these patients required no treatment.
EVACUATION HOSPITAL NO. 19.
Evacuation Hospital No. 19 was organized at Fort Riley, Kans.
On June 17 1 officer and 235 enlisted men left Fort Riley, Kans., for
Camp Dix, N. J., embarking September 2, arriving at Scotland Sep-
tember 12, 1918. The unit arrived at Allerey September 19.
Evacuation Hospital No. 19 was assigned to take over section No. 7,
then occupied by Base Hospital No. 25-A, with 302 patients, of whom
110 were surgical and 192 medical cases. The section had a bed
capacity of 1,400 patients. The process of transfer was completed on
September 21. 1918, On this elate 39 patients were received, and
within the following week 300 more. By degrees our wards con-
tinued to fill to their full capacity of 1.400 patients, which, about the
middle of October, was increased to 1,700, necessitating the use of the
Eed Cross hut and the nurses' quarters,
CONVAI.ESCENT CAMP.
From the very beginning of the organization of the center the
urgent need of a convalescent center was recognized. The purpose of
this institution was to provide and make fit for front-line duty all
those patients discharged from the several base hospitals. Men who
were neither well enough to withstand the acid -test of active service.
[ A. E. F. — HOSPITAL CENTERS. 1831
nor ill enough to require the attention and treatment exacted by those
confined in the ward, were the legitimate subjects for this camp.
On June 26, 1918, the neucleus of a convalescent camp came into
being by a verbal order from the commanding officer of the center.
In the latter part of June the convalescent camp was moved from
section No. 2 to section No. 9, where provision was made to accom-
modate approximately 1,000 patients. On July 31, 1918, the first
convoy, numbering 11 officers and 116 enlisted men, arrived.
On August 19, 1918, the convalescent camp moved to the convales-
cent camp section.
The first tents were ready for convalescent patients on September
19, 1918.
Patients were classified into four groups — ^A, B, C, and D, respec-
tively. Generally class D patients were never sent to the convalescent
camp, but were examined by a medical board to be returned to the
United States as physically unfit for further duty ; however, when a
patient's condition was such that a month's rest would restore him to
another physical class, such a patient was sent to the convalescent
camp as class D.
Class A patients are those patients who are physically fit, but who
only require the need of a few days' rest before returning to their
units.
Class B cases comprise those who are physically able to perform
light duty and who become fit for front-line duty within a variable
period of from two to four weeks.
Class C patients are those who in all probability become class B,
and then class A within one to three months' time.
Class D are generally physically unfit for further duty.
Venereal detachment. — On October 6, 1918, an officer was as-
signed to take charge of and treat venereal patients. This infirmary
treated venereal patients not only from the entire hospital center,
which varied in strength from 17,000 to approximately 20,000, but
also treated such patients that came from other organizations.
On October 6, 1918, the first 50 patients reported for treatment.
The number of patients gradually increased, until 432 patients were
received and treated. From October 6, 1918, to January 4, 1919, 211
cases of syphilis, 209 cases of gonorrhea, and 11 cases of chancroid
were treated. Among these were 17 cases with double infections of
syphilis and gonorrhea.
Men coming into the convalescent camp have usually been in the
hospital for such a long period of time that they become lax and
indifferent, with but little or no energy to act or respond to the com-
mands of the instructor. This lack of interest and low ebb of enthu-
siasm changed when the novel system of O'Grady was introduced.
When the camp mbved to the convalescent camp section, a drill field
of approximately 25 acres was graded and leveled for all troop for-
mation, A drill stand, known as the nest, was erected for the
physical instructor, who presented the training drills according to
OHirady. The O'Grady system originated in the British service; it
iToduced such a remarkable effect upon the English " Tomm}'," caus-
ing him to be alert, attentive, and full of aggression. The system
rings about a perfect coordination of mind and muscles without
ausing monotony or loss of interest to the men, but rather acts as a
imulant, enlivening them with increased energy.
1832 EEPOET OF THE SURGEON GENER^yL, OF THE ARMY.
FUNCTIONS OF A CONVALESCENT CAMP.
Purjyose. — The function of a convalescent camp is to return the
soldier to the front line in fif^htin^ trim. In doiiig this it also re-
lieves the hospital of all soldiers who are intended for future service
after convalescence and continues their treatment to the end, simpli-
fies the problem of transportation, and aids in findino- soldiers who
are missing. Many admissions may be absolutely normal from a
physical standpoint, but men who have lost their aggressive spirit.
It is the first function of the camp to return men with this spirit
renewed.
Class if cat i&n. — The first important point in the success of the
routine depends upon the accuracy of the classification from a
ph3^sical standpoint. The soldier must not be made to do more than
he can do with energ^^ and enthusiasm. Once properly classified, the
true spirit of enthusiasm and competition can be rapidly pushed
forward.
Diagnosis. — With a long stay in hospital, a large number of pa-
tients develop a lack of independence with a loss of plwsical and
nervous energy, flabbiness of muscle, a lack of control, and a lessened
incentive to duty.
At the i^resent time 40 per cent of the admissions are gas cases.
Externally, these patients may present the physical appearance of
healthy soldiers. Their chief incapacity is indicated b}' cough and
expectoration of moderate extent, with or without eft'ort syndrome
added, without fever or signs of serious inflammation in the chest.
It is proposed that the lung condition shall receive special attention
by postural drainage as soon as complete diagnosis is made. The
patient will be instructed and drilled in carrying out of j^ulmonary
toilet by posture, so that his lung secretion may remain below the
cough and expectoration level. Bj- securing early . and thorough
drainage in these mild cough and expectoration cases, it is hoped
to reduce them more rapidly and more thoroughly to the no-expecto-
ration state.
For the treatment of war neurosis, the patient is employed in
trades or mechanics and other camp duties, in line with training in
civil life, and is followed by a system of calisthenics. Laggers and
shirkers must be disciplined. A mild discipline is a long march with-
out music.
Reclassification is carried out once a week. Ninety-five per cent
of the cases move up regularly to the exercise grades. If the con-
valescent period is longer than six weeks, the patient is returned to
a disability board for reconsideration.
At 2 p. m. on the day preceding the evacuation for the front the
troops are reviewed by the commanding officer, and each soldier is
given an opportunity at inspection to report any reason wlw he
should not be evacuated. Evacuation is usually week end. in con*
formit}" with weekly reports of medical officers of the section. Con|
ducting officers accompany troops to their destination. A disabilit]!
board is appointed from the center, which meets as often as necessaryl
Ninetj'-five per cent of the men are returned in fighting trim. Tlie
activities of the convalescent camp make the soldier fit and stout-
hearted.
A. E. F. — HOSPITAL. CENTERS. 1833
On August 4, 1918, the convalescent camp had but 127 patients;
14 days hiter the number increased to 1,014. On August 19, 1918, the
first evacuation of 192 men from the convalescent camp took place.
On October 24, 1918, there were 3,720 patients in the camp. On
November 17, 1918, 1,684 patients were evacuated for front-line duty,
the largest number of men to be evacuated at any one time since the
beginning of this camp. Up to and including this date 4,660 men
had been returned to duty.
On November 19, 1918, the base hospitals in the center evacuated
to the convalescent camp 1,753 patients. In two days 3,437 men were
cared for and all records and necessary' data completed. On Decem-
ber 7, 1918, there were 5,374 patients in the camp. The high-water
mark was reached December 9, 1918, when the number of convalescent
patients totaled 6,004.
On January 25, 1919, 149 tents were taken down, assorted, and
properly packed, ready for shipment. Everj^thing in readiness,
awaiting orders to formally close and evacuate the convalescent camp,
which took place on January 31, 1919.
PATHOLOGY OF (MUSTARD) GAS INHALATION.
(From the Base Laboratory, Hospital Center, Allerey, Saone et Loire, France.)
Of the 37 cases included in this study, 35, according to the field
medical cards, were due to mustard gas, 1 to mustard gas and phos-
gene, and 1 to pliosgene alone. In 34 cases the action of the gas on
the respiratory tract was the main factor in causing death. Two
died as a result of extensive skin burns and one of cellulitis of the
face and neck following burns in this region. It is evident that,
though the skin and eyes suffer from contact with this agent, and
though death may result from injury in these areas, inhalation and
the resulting pathology in the respiratory tract is the important
factor in cases which reached this center.
The effects seen here are due, first, to the intense irritation and
escharotic action of the gas; second, to secondary infection which
promptly occurs. As seen in the autopsy room, more or less of the
entire mucosa over this region is covered by a fibrino-purulent exu-
date, a false membrane, from dirty gray to yellowish or greenish-
yellow in color, depending somewhat on the amount of suppuration
and blood pigments present. In many cases it covers the entire area
from the tip of the epiglottis downward.
The appearance of this membrane, both grossly and microscopic-
ally, is very similar to that usually seen in cliphtheria. In addition,
the clinical features are not unlike those in the laryngeal type of this
disease, hoarseness, temperature, and frequently a relatively rapid
pulse. Also, throat cultures often showed that many of them har-
bored the typical organisms. As a result, it not infrequently hap-
pened that perplexity arose in the differential diagnosis.
In nearly all cases tlie larynx is attacked. Here the false mem-
brane extends down into all the irregularities of this region. When
the membrane is removed a deeply injected hemorrhagic surface is
revealed, usually showing shallow ulcerations.
In the trachea and larger bronchi there is the same sort of mem-
brane with the injection, hemorrhage and ulceration of the under-
lying tissues.
1834 REPOKT OF THE SURGEON GENERAL, OF THE ARMY.
The lungs are usually very voluminous, due to a marked empysema,
largely vesicular, but occasionally interstitial or bullous. Subpleural
hemorrhages are frequent. There may or may not be a pleurisy,
depending upon the extent of the secondary infection present.
In the older and more advanced cases, necrosis is frequently present
in the consolidated ai;eas, and this becomes the more prominent fea-
ture. The necrosis gives rise to abscess cavities, the larger of which
have ragged, irregular walls and are filled with thin, grayish, granu-
lar, purulent, and necrotic material.
In the upper respiratory tract the membranous exudate lining the
lumen is exactly similar to that seen in diphtheria, consisting of
masses of fibrin mixed with occasional leucocytes, cellular debris and
plasma.
NECEOPSY STUDIES AT A HOSPITAL CENTEK.
[From the base laboratory, hospital center, AUerey, Saone et Loire, France.]
During the period included between July 23, 1918, when the first
convoy of patients arrived at this center, and January 1, 1919, there
are recorded a total of 429 deaths. The number of autopsies per-
formed during this period was 358.
The highest death rate occurred during the month of October, when
245, or considerably more than one-half of the total number of deaths
occurred. During this month there averaged 8 deaths per day, with
3 deaths as the minimum and 14 deaths as the maximum. Of these,
the majority were due to respiratory diseases. Indeed, the total num-
ber of nonwounded among the 356 cases that came to autopsy
was 214,
The most frequent autopsy finding was empyema and pleurisy.
This occurred in 63.2 per cent of the series. The degree of pleurisy
varied from a few cubic centimeters of sero-fibrinous exudate to
several liters of thick pus. Keal thick creamy pus was of rare occur-
rence, being present in only about 20 of the cases. The remaining
30 cases classified as empyema were characterized more by a thin,
only slightly turbid, serous exudate, containing large fibrino-purulent
masses. A number of the true empyemas were associated with gun-
shot wounds of the chest.
The terms " chronic " and " acute " are often misnomers. "We term
lesions with fibrous adhesions as chronic. A case came to autopsy
which demonstrated how quickly these adhesions may arise. A man
was wounded by a piece of shrapnel in the chest, and was sent to the
hospital with a diagnosis of a foreign body in the lung, as revealed
by the X ray. In the hospital X ray confirmed the diagnosis until
about a day before death, which was 22 days after the injury. An
X ray taken at this time in a changed position of the patient showed
the bullet movable in the pleural cavity. At autopsy there was found
a localized empj^ema in the pus, of which was present a small piece
of shrapnel. The adhesions walling off this empyema were exceed-
ingly strong, and along the entire margin of the abscess cavity there
were dense, hyalinized, grayish-white, connective tissue adhesions,
3 mm. in thickness, which abruptly thinned out over the uninvolved
portions of the lung and pleura. The involved portion of the pleural
cavity occupied about two-thirds of the space on that side ; the rest
was entirely normal. The other pleural cavity was also free from
A. E. F. — HOSPITAL, CEXTEKS. 1835
lesions. Here, then, was a lesion with dense fibrous connective tissue
formation, 3 mm. in thickness, which formed during the short period
of 23 days.
The next most frequent finding was pneumonia. (Chart 2, fig. A.)
This condition was present in 218. or 61.2 per cent, of the cases. The
intensity of the involvement varied from almost miliary areas of
consolidation around the bronchioles to that of complete hepatization
of entire lobes on one or both sides. Broncho-pneumonias were most
common, constituting more than three-fourths of the cases. These at
times were so massive and confluent that they resembled true lobar
pneumonias. Some of the cases diagnosed at autopsy as lobar pneu-
monia, which later proved to be streptococcic culturally, were most
probably of this type.
Cultures and smears from the lungs were taken fi-equently. The
cultures were made by seering thoroughly the cut surface and then,
with a glass pipette having a^rather large opening, a small quantity
of macerated pulp mixed with expressed fluid was drawn up and in-
oculated into appropriate media. The maceration was accomplished
by working the end of the pipette up and down into the parenchyma
through the sterilized surface.
The frank characteristic lobar pneumonias in the gray hepatization,
or early resolution stage, as found ordinarily, were very uncommon.
Not more than 20 such cases were encountered. The others classified
under lobar pneumxOnias were atypical. An entire lobe or even an
entire lung was often involved, but this involvement was irregular.
The organ, the solid and heavy, was not large, and the cut surfaces
were very mottled, showing grayish, brownish, or dark red areas of
hemorrhage and edema, with small portions that would still float in
water. Areas of necrosis with abscess formation were quite frequent.
One type of pneumonia was encountered that was diUerent from
all ordinary pneumonias. In this type the involvement was either
of an entire lobe or only portions of one or several lobes. The in-
volved areas were firm, heavy, and had a rubbery resiliency. The cut
surfaces were dark red or dark brown in color, often showing a mot-
tling with miliary or submiliary yellowish areas. Sometimes there
was a fine grayish lacework visible through the reddish parenchyma
that suggested thickened alveolar walls. These areas seemed to be
most prominent along the bronchial branches. Culturally this type
of pneumonia gave invariably a streptococcus, either hemolytic or
nonhemolytic.
Influenza is not a finding at autopsy ; but under this heading are
simplv discussed the lesions found at necropsy in 87 cases in which
the diagnosis of influenza was present on the field medical card, as
the cause of the patient's admission to hospitalization. Probably
some of these cases were wrongly diagnosed ; perhaps others died as
a result of complications of influenza in which the proper initial
diagnosis was not entered.
Of the 87 cases (Chart 2, fig. B) so diagnosed, 86.2 per cent showed
complicating pneumonias. These pneumonias were not greatly dis-
similar to other pneumonias with the exception of a few details.
First, the percentage of lobar and interstitial types are higher in
this group than in the total pneumonias. This may be accounted for
by the fact that in these cases the pneumonias played a more impor-
1836 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
tant role in the causation of death than in the others, since in the
total pneumonias manj' of them were only terminal conditions,
secondary to severe wounds, typhoid fever, etc. The percentage of
identified pneumococcus pneumonias is also higher.
Typhoid fever. — In this series, eight cases of typhoid fcA'er were
encountered. Only one or two were diagnosed clinically. The lesions
in the intestines were characteristic, but extensive ulcerations in the
colon were more frequently encountered than is the usual experience.
In most of the cases, the B. typhosus was recovered from the spleen,
gall bladder, and the heart's blood. A few cases failed to give any
bacteriological evidences of the disease though the gross lesions were
definitely diagnostic.
The clinical diagnosis of typhoid and paratyphoid fever proved
quite a problem. In many cases at the center which were clinically
typhoid, no corroborative laboratory evidences could be obtained.
One of the laboratory staff obtained interesting results by using
Drej^er's quantitative agglutination.
Diphtheria. — The mortality from diphtheria was very disappoint-
ing. Several cases dying of diphtheria came to autopsy wholly un-
diagnosed clinically. All cases were of the laryngeal type, a condi-
tion rather unusual for adults.
E. JUSTICE HOSPITAL GROUP.
The Justice Hospital group was organized primarily for the pur-
pose of taking care of the wounded in the St. Mihiel drive, Septem-
ber, 1918. The hospitals were situated in the village of La Justice,i
adjacent to the town of Toul, in the Province of ]\Ieurthe-et-Moselle,
France.
Certain base hospitals, which will be enumerated, were ordered to
this point, and a hospital center of 15,000 beds organized August 27,
1918.
The buildings occupied were French casernes turned over by the
French Government for the purpose.
The following instructions and information were received from the
chief surgeon. First Army :
{a) That in approximately 14 days the St. Mihiel offensive would
be started.
(6) That is was estimated conservatively that there would be
20,000 American casualties the first day, and of this number about
60 per cent would probably be handled bj^ the Justice Hospital gi'oup.
(<?) That there were now at the Justice Hospital group Evacua-
tion Hospitals Xos. 3 and 14, Base Hospital No. 45, and Red Cross
Hospital Xo. 114; that Nos. 3 and 14 were almost completely
equipped.
The following day the commanding officer arrived at Toul and
found the following situation :
{a) Evacuation Hospital No. 3 was well equipped with surgical
instruments and supplies. Personnel sufficient and well trained.
About 1,000 beds ready for occupancy.
(&) Evacuation Hospital No. 14 was about 60 per cent equippedJ
Personnel untrained. This hospital had never functioned before^
The surgical staff had had no experience in war surgery. The com^
A.. E. F. — HOSPITAL, CENTERS. 1837
manding officer had recently arrived in the American Expeditionary
Forces.
(c) Base Hospital Xo. 45 had been in Toul for six days.
The rejuvenation of this hospital was one of the most remarkable
pieces of medical history of the war. By virtue of the high-class
personnel, officers, nurses, and men, complete equipment, which was
secured later, and the spirit of cooperation and loyalty to their hos-
pital commander, this hospital had, by October 15, 1918. become one
of the most serviceable in the American Expeditionary Forces.
Base Hospital Xo. 51 arrived about 10 days before the St. ^Mihiel
offensive. They were vntrained, had no equipment, and there was a
lack of cooperation betveen the personnel and commanding officer
of this hospital.
Red Cross Hospital Xo. 114 was found to consist of 1 medical
officer, 6 Bed Cross medical officers, and about 35 Red Cross nurses
and nurses' aids. Later this hospital was equipped by the Red Cross,
and operated rather successfullv as Red Cross j\lilitary Hospital
Xo. 114.
From August 27 to September 12, on which day the St. ;Mihiel
drive began, it was almost impossible to secure medical and surgical
supplies. The Army supply depots were apparently almost de-
pleted. There was an embargo at Is-sur-Tille on all shipments
except food and ammunition. Trucks were almost impossible to
secure. With this situation the prospects were not bright for the
immediate future, but by begging from the Red Cross, buying out all
available supplies in Xancy, and by securing through G-4, general
headquarters, a certain number of trucks, supplies in limited quan-
tities were hauled from the Advance Medical Supply Depot Xo. 1
at Is-Sur-Tille, a distance of about 100 miles.
On September 12, 13, and 14, about 11,000 patients were passed
through this center, and it is believed, considering conditions existing
at this time, that the results were about as satisfactory as could be
expected.
It was expected by the chief surgeon's office at Tours, by the
deputy chief surgeon, G-4, general headquarters, and by the chief
surgeon, First Army, that a number of dirty casernes without water,
toilets, baths, telephones, or lights, would be ready in two weeks to
handle many thousand of acute battle casualties, but no provision
had been made, owing to the suddenness of the emergency, for a
headquarters staff to handle this problem.
There was no available supply of food for diets. Xo fuel, and
little transportation. A statement of the critical situation and a
request for the proper personnel to constitute a most necessary staff
was made by courier direct to the chief surgeon, American Expedi-
tionary Forces, Services of Supply, and owing to the great need of
speed and action it was necessary to send this request direct. A
copy of the letter was sent to the chief surgeon, First Army. Within
48 hours the chief surgeon's office at Tours had ordered the necessarj^
officers to assist the commanding officer in organizing and preparing
approximately 10.000 beds in two weeks. The complete support and
prompt action in ordering this personnel saved the day.
1838 REPORT OF THE SURGEON GENERAL OF THE ARMY.
F. iMESVES HOSPITAL CENTER.
Part I.
Location and site. — Mesves hospital center is situated on a slight
table-land, midway between the villages of Mesves and Bulcy, in the
Department of Nievre. The elevation slopes southwest toward the
Loire River, about 3 kilometers distant, and north toward the bottom
lands of JSIazou Creek, about one-half kilometer away. The historic
town of La Charite lies 8 kilometers south on the main Paris road,
while the interesting city of Nevers may be found 35 kilometers
south of Mesves on the same road. The Paris, Lyon & Mediterranean
Railroad forms the western boundarj' of the center, with the Mesves-
Bulcy station, which handles the transportation of the center, top-
ping the apex of the triangular site northwest toward Mesves. The
center is bisected by a highway leading from the Paris road to the
town of Bulcy, while a second road from the town of Mesves bounds
it on the north, and joins the former.
At the time of occupation by the American Expeditionary Forces
this tract of land, comprising 150 hectares, was leased in small parcels
from many individual proprietors. When construction was first
commenced wheat was just beginning to sprout in some of these
patches, while in others the native peasant women tended their white
cattle, which browsed quietly over the fields.
. Construction men soon found to their sorrow and dismay that just
below the surface, sometimes only 6 inches or less, there was that
typical soft, clayey white rock, which is so abundant in this region,
and of so little benefit. It was soon discovered that, while the center
was built on a slope which would ordinarily have afforded ample
drainage, owing to the impermeability of this subsoil, all of the rain-
fall remained on the surface, mixed with the clay there, and formed
a most tenacious, bottomless liquid glue.
General pi'oject. — The original plan of Mesves hospital center em-
bodied 10 base hospital units, each to have a capacity of 1,000 beds,
with an additional space reserved for a crisis expansion of tents,
which would accommodate 1,000 beds more. Each unit was de-
signed to be a complete hospital within itself, and by this first plan
consisted of 55 buildings, apportioned to administration, receiving,
and evacuation ; base houses for patients, nurses, and officers ; recrea-
tion hall ; morgue ; X ray and operating ; clinic ; patients' kitchen and
dining halls; quartermaster and medical supply storehouses; 20 ward
buildings: officers' and nurses' quarters; personnel quarters and ablu-
tion building; garage; faeces destructor; disinfector; latrines; fuel
houses: and an incinerator. In the first plan all units ran parallel
to the Paris, Lyon & Mediterranean Railroad, but the railroad would
not put in a head-on switch off their main line, which necessitated a
complete relaying out, and a loss of about three weeks' time. Turn-
ing the axis of the plan to the extent of 45° allowed the railroad to be
built into the units as they were later located. On May 1 instruc-
tions were received to investigate and make preliminarj^ survey and
report on the practicability and possibility of locating 10 additional
vinits in connection with the orignal first 10 already begun. Definite
plans were received on July 24, making Mesves Hospital a contem-
plated city of a population of over 55,000. Work of construction
A. E. F. HOSPITAL CENTERS. 1839
was reduced considerably through the new plan, owing to the fact
that the wards Mere half as many in number, although twice the size
of the earlier ones, while the crisis-expansion building was entirely
eliminated, and the medical supply and quartermaster warehouses
combined into one building, as well as the dining halls and kitchen
of the patients' mess. Operating rooms, clinic, disinfector buildings,
and the recreation halls were to be built in alternate units only.
Following the enlargement of the hospital proper came plans foi"
a convalescent camp, comprising two complete units, allowing for
tents, for the most part, to house the patients.
Labor. — Most of the early labor was Spanish, collected from the
border towns and in Spain by agencies operated by France, the
United States, and the contractors themselves. For a short while
most of these foreigners had to be quartered or billeted in old vacant
houses in Mesves, and some little disorder resulted. Later they were
all moved onto the field and placed in the wooden barracks hastily
erected for them. Each laborer, on arrival, was given a number and
told to forget his name. Other labor troubles at this time were can-
teen accommodations, lack of sufficient bread, and limited sleeping
accommodations. Several serious strikes were averted only by plain,
strong-arm politics.
By June 1 the American personnel numbered 84, including a de-
tachment of the 26th Engineers and casuals from many other or-
ganizations. This detachment of the 26th immediately proved to be
a life-saver to the constructions. These young Americans, enlisted
from the shops, oil-well fields, railroads, and mines of the States,
took firm hold of these utilities and kept them producing 24 hours
a day.
On October 26, 776 Chinese laborers came chattering and jabbering
into the center, completing a parallel organization to the Tower of
Babel with its confusion of tongues.
Transportation. — Means of transportation continued from first to
last as an obstacle in the attempt toward a smoothly running pi-o-
gram. First there were merely the two-wheeled dump carts with
slow farm horses, and slower drivers, the only thing available at
that time. Then a truck organization began to grow from 4 Diattos
on April 4 to 35-ton Mack dump trucks on August 23. On that date
orders were received which removed practically all available trucks,
taking them to the front, and leaving 7 serviceable but nevertheless
questionable trucks to carry on the work, with a demand that grew
every day. As high as 150 carloads of material were received on
certain days, and the removal of any trucks at that critical time
greatly upset all work and plans which were in progress. Arrange-
ments were finally completed with the French Government for the
loan of 50 horses from the cavalry field at Avinor. The few remain-
ing trucks were sent after Decauville track and equipment, which
was secured from the Xevers cut-off, with the hope that a system of
narrow-gauge railroad would help to relieve some of the relay trans-
portation within the job. The installation of this last, although
jjushed by plenty of labor, could not be accomplished immediately,
but eventually much of the sand, concrete block, brick, and cement
was handled by the dinky engines and Koppel cars, leaving the
trucks available for bringing in material from other locations.
1840 REPOET OF THE SURGEON GENERAL OF THE ARMY.
Materials. — AVhen the actual work of building the center started
there was at hand some labor, a few tools, and plenty of open ground,
but as for material there were the parts of 10 demountable barracks.
The contractors were to furnish all material possible, and it is ad-
mitted that plenty of ordei-s had been placed, but the real difficulty
was in persuading the French railroads that there was such a place
as Mesves-Bulcy. Material in large quantities began to arrive about
May 1, and later in the month in such trainloads that da}^ and night
shifts had to be organized, for cars were ordered to be unloaded
within 24 hours after arrival. Floors and walls were completed in
four of the units before time was received to fabricate trusses for
the roofs. ]Many of the unsupported end walls of the construction
buildings were blown down and had to be rebuilt, thus causing un-
necessary delay. Patients arrived in units 1 and 5 before the roofs
^^'ere completed. During July it became extremely difficult to obtain
shipments of hollow tile. A subcontract was let to the firm of Picot
& Gaudin for the manufacture of some million and a half concrete
blocks with a plant installed on the job. Shifts worked day and
night, turning out something like 800 blocks per hour. Concrete
sewer pipe was likewise difficult to secure. After much trouble in
finding iron molds for the purpose, a plant was started in conjunc-
tion with the block plant which averaged about 135 meters of vari-
ous diameters of pijDe per day. Not until late in the fall was it
possible to secure IG-inch pipe by rail, and not until then were the
mains in many of the units connected for use.
C ommencement of construction details. — General orders were to
build a hospital, and build it rapidly. One set of plans was on hand,
very little office equipment, and no instruments. About ]\Iarch 1,
the contractor managed to ship in a questionable transit of foreign
make, a 10-meter steel tape, and a French military engineer to sur-
vey. Base lines were established, and units laid out according to
the first scheme; and foundations placed for 10 Swiss demountable
barracks. Then came the change in plan, and all this work had to
be done over.
Layinof of the standard-gauge railroad was about the first work,
after setting up the demountable barracks. This started with the
long task of excavating a deep cut, and having only hand tools at
that time, work progressed very slowly. Grading for the Devauville
Railroad, running to the stone quarry, was finished April 18, after
much difficulty in locating a grade not greater than 1..5 per cent.
Vt^ater and sewerage sj/stems. — Tlie actual work on the water system
was not seriously pushed until about July 1. Eight-inch pipe for the
main leading to the pumping station at the Loire River was not all
received until September 27. The reason for this delay was the fact
that pipe of this caliber had to be awaited from the tjnited States.
Heavy pipe fittings for the pumping station were recjuisitioned in
May.* These materials were secured at Ponte Musson on September
20, and transported by truck to the center, but, when received here, it
was found that no machine work had been done on them, and there
was several weeks further delaj'. since there was only one large
milling machine within the center which could handle this size of
castings.
The sewerage system of the center consists of 16, 12, 10, and 8 inch
mains, with branch lines of 4 and 6 inch pipe. Sewerage is emptied
A. E. F. HOSPITAL CENTERS. 1841
into a clarification tank, which is constructed of reinforced concrete,
and located on tlie banks of the Loire, about 2 miles from the site
of the center. The total len^h of the pipe used in the sj'stem vrithin
the grounds is approximately the same as in the water system, that
is. 28 miles. The construction of the sewerace system was decidedly
slow, owing to the inability to secure suitable pipe, and it was late
in November before many of the units within the first half of the
hospital were supplied witli sewerage connections. On December 1,
none of the units comprising the second half had any connections.
Medical Department activities. — The construction work which was
begim on Mesves hospital center on February 7. 1918, progressed
very slowly during the first three months of the year, and on May
10, upon being inspected by an officer representing the office of the
chief surgeon, the opinion was expressed by him at that time that
patients could not possibh' be received and cared for in less than
one year from that date.
Further augmentation of personnel. — The ^ledical Department
strength was augmented on July 18. by the arrival of Sanitary Squad
No. 2. which had been just detached from the 2Tth Division, and
consisted of 1 officer and 26 men. On July 23 Hospital Train Xo.
35 arrived, comprising 2 officers and 31 men. On July 26 Base Hos-
pital Xo. 44. which had been assigned to Pougues-les-Eaux. arrived.
First patients to arnve. — The first patients to arrive within the
center were 29 convalescent men. forwarded from Base Hospital Xo.
27. Angiers. on July 19. These men were assigned to a convalescent
camp which had been formed within the center, in compliance with
telegraphic instructions received from the office of the chief surgeon
July 17. and were placed in Marquese tents, located in the west sec-
tion, which were erected for the crisis expansion in TTnit Xo. 1, and
what was later to be Base Hospital Xo. 67. The camp had increased
by the last of July to approximately 3.50 men. all of whom had been
received up to that time from Base Hospitals Xos. 27 and 101. at
Angiers and St. Xazaire. respectively.
First hattle casualties to arrive. — The first sick patients to be re-
ceived arrived at 5 p. m. on August 1. conveyed by United States
Hospital Train Xo. 65, and numbering 400 surgical cases. The
buildings and equipment of Unit Xo. 1 were in fairly ready condition
to receive this number of cases, and the personnel, consisting of sev-
eral sanitary squads and other casual men. unloaded this train and
placed the patients in bed, giving them nourishment, without addi-
tional assistance. Xumerous ^ledical Department soldiers Avere at
the time of arrival of this train engaged in assisting Engineer troops
in roofing the buildings which were to receive a part of the convoy.
These men were hurriedly called down from the buildings, and,
laying aside their carpenter's tools, secured litters and culinary uten-
sils and immediately became ward attendants instead of carpenters,
a- they had been a few minutes before. An hour after the arrival
of this train Base Hospital Xo. 67 arrived, and were immediately
a -signed to Unit Xo. 1 and the patients which had just been put to
bt'(l in the unit. On the following day 600 additional wounded men
arrived and were placed in other wards in the same unit, which were
ready for their reception. Thus, within 24 hours after its arrival,
this hospital had a total of 1,075 patients, largely consisting of
I
1842 KEPOET OF THE SUEGEOlSr GENERAL OF THE AEMY.
■wounded men of the Chateau-Thierry offensive, which was in full
blast during that week. Work of erecting Marquese tents, general
police, and putting the wards and buildings in order was pushed
rapidly, so that within a very few days Base Hospital No. 67, per-
manently housed in Unit No. 1, became a well fixed institution.
Base Hospital No. 50. — On August 7 the personnel of Base Hos
pital No. 50, consisting of 22 officers and 198 men, arrived and wer
assigned to Unit No. 5. Many of the buildings had no roofs an
many floors were yet to be laid, not to mention the absence of nu
merous windows and minor finishing work. The grounds were in
bad condition owing to the debris of building, ditching, and roadi
building, but rapidly improved with hard work on the part of all"
members of the personnel of the organization moving in. No lights
other than candles were available, the water only connected by tem-
porary lines, and sewers could not be used. Also, no bathing facili-
ties were available.
Assignment of patients. — The first assignment of patients to Base
Hospital No. 50 arrived August 15 and numbered 315. These were
followed by 685 additional ones on August 21, and since that time
the receiving and evacuation of patients has continued uninterrupt-
edly. Thus, Base Hospitals Nos. 67 and 50, being the first to arrive
within the center, were the earliest to be completely constructed and
equipped, and it was natural that during the trying days of the rush
during October and November that they should be called upon to
handle the largest number of the most serious cases which arrived
within the center. Base Hospital No. 44, being largely inaccessible
to hospital trains, except when en routed to that place, was largely
used to care for officer-patients and milder surgical cases.
Base Hospital No. 5\.—0n September 6, 1918, Base Hospital No.
54, the third to be stationed within the center, arrived with a per-
sonnel of 34 officers and 199 men. This organization was assigned to
Unit No. 6, which was fairly well completed at the time and was
.ready for occupancy. The first convoy to be assigned to this unit,
numbering 499 wounded men, arrived on September 12, 1918. The
largest number of patients present in any one day within this organi-
zation was 2,288, on October 26, 1918.
Base Hospital No. 86.— On September 19, 1918, Base Hospital No.
86 arrived at this center, with 32 officers and 200 enlisted men of the
Medical Department. This organization was assigned to unit No. 10,
which was at that time about 40 per cent completed. On September
27 they were ready and did receive 264 patients. The largest number
of patients registered within that hospital on any one date was 2,344
patients on October 31, 1918.
Evacuation Hospital No.'Bk- — This organization reported for duty
on September 22, consisting of 28 medical officers and 3 sanitary corps
officers, 1 officer of the quartermaster corps, and 236 enlisted men.
Unit No. 2 being at that time only nbout 50 per cent completed was
selected for assignment of Evacuation Hospital No. 24. Many of
the buildings consisted of only walls and a roof. Practically no
doors and windows were in place. No sewers, water, or light were
installed, and the roads were practically impassable on account of the
deep ditches which were cut for the installation of these utilities.
Supplies of all sorts were limited and equipment was practically im-
possible to obtain. October 1 the first contingent of 355 walking cases
A. E. F. — HOSPITAL CENTERS. 1843
were transfeiietl from another hospital to this organization. On
October IT Unit No. 7. adjoinin": Unit No. '2, antl l)eing well under
way in construction, was assigned to Evacuation Hospital Xo. "24 to
be operated as an annex to that institution. Thus the bed capacity,
Avhich had been ( arried as 2,()r)4 bods, was increased by a single
bound to 4.27."). The nnniber of admissions to this hospital imreased
rapidly as its abilities and supplies grew, and on October 31. 1918,
there were 2..').M) piitients in the hospital. The largest number on
hand at any one timo was 2, .592 on O; tober 30. 1918.
Base IIoHpitdl No. 89. — Four days after the arrival of Evacuation
Hospital Xo. 24, on September 26, about 6 p. m., Base Hospital Xo.
89, consisting of 34 officers and lOG men, arrived at this center. It
was assigned to the grouj) of unfinished buildings, in Unit Xo. 4.
The buildings lacked window panes, frames, and many doors. The
ground had not been broken for the water or sewer supply, nor had
the construction of roads been commenced. Owing to the recent
heavy rains, the unit was very muddy, but presented fairly good
drainage. On October 7, 030 ambulance patients were assigned to the
unit and the following day an additional 831, making it necessary
for the officers and enlisted personnel to evacuate the wards used
by them and to move to the buildings originally designated for that
purpose, although these buildings were far from being complete.
By October 25 electric light had reached the unit, and the water
supply was in a fair state of completion, but the sewers, altliough
for the most part installed in the unit, were not connected, making-
it impossible to use any of the sinks in the wards and other build-
ings. This connection was only completed on Xovember 20. On
Xovember 7, Henri tents were assigned and erected in this unit,
thus bringing up the total to a capacity of 2,190 patients. The cjuota
of patients increased gradually with ordinary evacuations, until
on Xovember 18 a total of 2,186, the maximum number ever handled,
was reached.
Provisional Base Hospital No. 3. — By October 1 the maximum
capacity of the units functionating within the center had been prac-
tically reached, and on that date instructions were received from the
office of the chief surgeon, requesting the preparation of every avail-
able bed that could be used for a wounded man. Unit Xo. 3 was at
that time nothing but walls and roofs, or about 60 per cent complete.
The best solution of the problem appeared to be the formation of a
provisional base hospital. This was accomplished by selecting \'t
officers from hospitals already in operation here, as well as lOenlisted
men from each of these organizations, and the entire enlisted per-
sonnel of Convalescent Camp Xo. 4, recently arrived from the United
States, and placing this group of personnel under the designation of
; Provisional Base Hos]:)ital Xo. 3. October 8, received their first
I admission of 384 slightly ill patients. During the renuiinder of
! October a total of 1,672 ])atients were adiiiitted and 534 patients
. evacuated. During Xovember 2.222 cases were admitted to this
institution and 1.400 evacuated theiefrom. Arrivals and evacuations
of patients continued uninterruptedly throughout December and
until January 15, 1919. By January 12, 1919, the patients within the
center had been evacuated to such an extent that it Avas not deemed
feasible to further prolong the life of this provisional unit, and on
January 15 it officially passed out of existence.
142367— 19— VOL 2 55
1
i
1844 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Provisional Base Hospital No. 8. — On October 15, 1918, it again
became necessary to supply additional bed space for the rapidly
rising- number of patients which were being claily received, and i
became necessary to establish a second provisional base hospital
The buildings in Unit No. S were selected for housing this organiza
tion. As in the case of Unit No. 3, the buildings in this unit con
sisted largely of walls and roofs and were far from completion.
This unit consisted of only 10 wards instead of 20. However, these
wards had a capacity of 112 patients, which made the maximum
capacity of the unit the same. The first cases to come consisted of
325 slightly ill battle casualties which arrived from other hospitals
withinthe center on October 18. After this first arrival daily ad-
missions and evacuations of varying numbers continued uninter-
ruptedly until January 28, when the number of patients within the
center warranted closing up this provisional unit. On February 1
it officially ceased to exist, and all patients remaining were trans-
ferred to Base Hospital No. 89, this center. Since October 15, 2,348
patients were handled, and upon closing this organization was one of
the best equipped and efficiently operating units within the center.
Base Hospital No. 108. — No units arrived within the center until
November 20, 1918. Avhen Base Hospital No. 108 arrived with the
personnel of 19 officers and 159 enlisted men. Medical Department.
This organization was assigned to Unit No. 16. On November 29
500 patients from other hospitals within this center were transferred
to this base hospital. On December 15 Base Hospital No. 108 took
over the completed half of Unit No. 13, which wa.s completed after
the signing of the armistice and which up to this time had been
occupied by a battalion of the 801st Pioneer Infantry. These addi-
tional five wards raised the bed capacity of Base Hospital No. 108 by
500. Admissions and evacuations of patients of this organization
continued steadily once having been started, and this hospital was
one of the last to dispose of all its patients before being ordered to
return to the United States.
Base Hospital No. 72.— On November 27, 1918, Base Hospital No.
72, with personnel of 32 officers and 188 enlisted men, Medical De-
partment, arrived at this center. This organization was assigned to
Unit No. 15. It was decided to use this hospital for handling class
A casuals awaiting evacuation. On February 5 all patients had
been evacuated from this base hospital, and it was reported as avail-
able for preparation to be returned to the United States. On the
following day orders were received containing instructions that this
hospital would immediateh* make the necessary preparations to re-
turn to the United States.
Evacuation Hospital No. 27. — On December 15, 1918, Evacuation
Hos])ital No. 27 arrived and immediately took over Unit No. 7, Avhich
had been operated as an annex to Evacuation Hospital No. 24 since
October l7, 1918. All patients taken over by this organization from
Evacuation Hospital No. 24 were class A men awaiting evacuation.
Evacuation Hospital No, 27 continued to handle this class of cases
throughout their stay in this center. These men were formed into
a provisional regiment under class A line officers and were drilledj
and handled in exactly the same manner as any regiment of troops.!
Evacuation Hospital No. 27 left this center for Prum, German5% on™
Februarv 17, 1919.
A. E. F. HOSPITAL CP^XTERS. 1845
Evacuation Hospital No. 20. — Tliis organization arrived on Janu-
ary 14,^ 1919, for the purpose of takin^r over tlie work of Base Hos-
pital Xo. 44, which was ordered to prepare for return to the United
States. Upon arrival they were located in Unit Xo. 11, at that
time occupied by Base Hospital Xo. 44 and as quickly as possible
took over the patients of that ori;anization. The property of Base
Hospital Xo. 44 was in such an incompleted state that it \-ould not
be taken over by Evacuation Hospital Xo. 29 during its stay here
or up until P>bruary 22, 1919, when it left for Prum, Germany.
AVhile here this organization handled only class A cases awaiting
evacuation, as was the case with Evacuation Hospital Xo. 27. Upon,
leaving their unit this organization turned the set of buildings
back over to Base Hospital Xo. 44, which was also still occupying
them at that time. Xo further organizations arrived in this center
aftei- Evacuation Hospital Xo. 29.
IXFKCTIOlS IJISKASKS.
During the month of Xovember there were present within the
center 945 cases of contagious diseases. Of these the most prevalent
was pneumonia, there being 544 cases of this disease treated. Second
in prevalence was nnunps, showing 171 cases treated, while diph-
theria and dysentery cases showed 115 and 54 cases, respectively.
As (luring the ])revious month the pneumonia cases Avere in the
majority of instances secondary to a type of influenza which was
extremely prevalent at that time and were practically all strepto-
coccis in origin. A marked decrease is noted in the number of
pnemnonia cases treated in Xovember as compared with the pre-
ce(ling month, there being a difference of 186 cases. The total
infectious-disease rate reached its maximum during the early part
of the month, beginning to decline just before the middle and de-
creasing slightly throughout the remainder of the month.
Durintr the month of December there were present within the
center 7-50 cases of contagious diseases, or exactly the same figures
as the number of pneumonia cases treated during October and a
decrease of 215 cases over the preceding month. Of these the most
])revalent was pneumonia, there being 322 cases treated, while
diphtheria and dysentery cases showed 103 and 80, respectively. As
during the previous months the pneumonia cases were in the ma-
jority of instances secondary to a type of influenza which was very
j)revalent at that time and were practically all streptococcis in origin.
A marked decrease is noted in the number of pneumonia cases
treated in December as compared with the jireceding month, there
b(M)ig a difference of 222 cases. The total infectious-disease rate
ivarlied its maximum during the early part of the month, begin-
ning to decline just before the middle and decreasing silghtl}''
throughout the remainder of the month.
During the month of January there were present Avithin the
center 408 cases of contagious diseases of all kinds. This number
lein-esents a decrease of 322 cases over the number during the pre-
ceding month. Of these the most prevalent was pneumonia, there
|)eing 165 cases treated, while typhoid and diphtheria showed 47
f'iises each, and mumps .showed 117 cases. As during the previous
months the pneumonia cases were in the majority of instances sec-
1846 IlEPORT OF THE SURGEOX GENERAL OF THE ARMY.
ondai y to a type of infiiienza whicli Avas very prevalent at that time
and were i)ractieally all stre])toooecis in orijjin. A marked decrease
is noted in the number of cases treated in January as compared
with the preceding month, there being a difference of 157 cases.
The total number of infectious diseases of all kinds readied its
maxinuuu early in the month ancl by January 12 began to decline.
From this date the decrease was abruptly very rapid or in direct
proportion to the number of cases remaining on hand within the
center.
During the month of February there were jiresent within tlie
center 190 cases of contagious diseases of all kind. This number
represents a decrease of 218 cases from the figure of tlie preceding
month. Of the cases present the most j^revalent was mumps, there
being 84 cases treated, while typhoid and diphtheria showed 13 and
15 cases, respectively, and pneumonia 53 cases. A marked decrease
is noted in the number of pneumonia cases treated during February
as compared with the preceding month, there being a difference of,
112 cases. The 4otal number of infectious diseases of all kinds'
reached its maximum on February 3, and after this date declined
slowly and gradually. Of the total cases of all kinds handled dur-
ing the month the infectious diseases represented between 3 per
cent and 5.50 per cent of the whole at all times. The highest per-
centage present was 5.92 per cent on February 8.
Part II.
The medical service. — In a provisional unit one w^ard surgeon could
care for twice or thrice as many patients as in a hospital for the very
ill, and in the convalescent camp the surgeon company commander
could double the latter's case numbers. The convalescent camp pre-
sented the ultimate expression of this type of efficiency. Similar
efficiency in management was also attained when one commanding
officer supervised the activities of two hospitals.
This method of disposition of patients was early put to the test,
for in September the trains with influenza and, unfortunately, often
with pneumonia as well, began to arrive. Two hospitals became
known as preventive pneumonia hospitals, because they largely as-
smned the care of cases of influenza, and to the remaining units, as
they became ready for occupation, were sent cases of diarrhea, and
of a general medical nature. The differentiation was never com-
plete, because at times there were wards for influenza and diarrhea
in all the units, but the essential plan of differentiation outlined
above prevailed. The distinctively influenza hospitals were cubicled
with great care. When a shortage of sheets was imminent news-
papers Avere employed most usefully to replace them.
The usual group of contagious diseases was divided between two
hospitals. Diphtheria, scarlet fever, measles, and mumps were
treated in one hospital, and epidemic meningitis and typhoid were
cared for in another. The exigencies of the local situation regard-
ing personnel, and the overwhelming numbers of pneumonia cases
brought about this division of contagious cases between two units
to a certain extent, but not wholly, for in part it was with design.
This arrangement tended to lessen the danger of cross infections
ancl the outcome appeared to justify the wisdom of it.
A. E. F. HOSPITAL CENTERS. 1847
I The grouping: of other diseases gi'iidiiallv and naturally took
i)lace. Trench feet filled upward of -200 beds* on the medical service
iilone, and thouofh these cases were not all collected in one hospital,
all the cases in any one hospital were c;athered in one ward, whose
ward surgeon showed the crreatest aptitude for their care.
The pneumonia epidemic fortunately differed frcmi that which
occurred in the cantonments in the spring of 1918. Had this not
been so the deaths would have been appalling, because of the lack of
fhe unusual amount of medical attention which the epidemic entailed.
As it was. the comparative rarity of the need of paracentisis of the
chest saved so much time that adequate medical attention could be
given by one physician to an unusually large number of cases. The
day for" the pneumonia patients was saved, however, by the nurses,
because pneumonia hospitals were always supplied with a complete
nursing staff.
Epidemic meningitis was a rare disease. The mortality was rather
high because cases almost in a moribund condition were received
either from train or other hospitals. Two cases died within 5
minutes of the completion of the lumbar puncture, another 30
minutes after entrance to the hospital and l^eforc treatment was be-
gun. One case complicated with severe nephritis and made an almost
miraculous recovery.
(i. HOSl'rrAI> CENTKU, LIMOGES.
As the need for bed capacity Avas being continually reduced, equip-
ment from certain wards was packed and shipped. The bed capacity
of the center on Februarv 1 was 3,810 and on February '28 only 1.180.
On February 28 a total of 23.r)92 patients had been admitted to the
hospitals of this center.
During January the betl capacity of the center was decreased from
6,140 on January" 1 to 3,840 on January 31.
In accordance"^ with instructions to abandon the convalescent camp
all patients and class A casuals were transferred to the hospital cen-
ter on January 3 and the records closed.
During December the bed capacity was decreased from 8,79G on
December 1 to (i.l4() on December 31." Of this total there were 2,150
vacant beds, 1.108 occupied by patients, and 2.322 by class A casuals.
Because of the fact that all "evacuation had been discontinued, many
patients had become well men. but were continued on the records of
the hospitals as patients. On December 4 an order was received to
the effect that all such men should be classed as class A casuals and
held in the hospitals on duty status.
Because of the fact that large numbers of patients were no longer
arriving, the Camp des Eefugees. or Belgian refugee barracks, which
had been operated as an annex of the convalescent camp. Avas vacated
on December 7 and returned to the French authorities.
Because of the demand made by the French military authorities the
administrative labor command "and headquarters men were moved
I from the Caserne de Visitation and on December 2G quartered at the
I Caserne 20 Dragoons.
On December 31 a total of 22,104 patients had been admitted to the
hospitals of this center. The evacuation of patients other than for
1848 KEPOET OF THE SUEGEOX GEXEKAL OF THE ARMY.
em
transfer (o the United States for continued treatment was not au-
tliorizcd during this month.
During November the bed capacity Avas increased from 7.670
NoA-ember 1 to 8,796 on Xovember 30. From November 1 to Nov„..
ber 30 six hospital trains were received, with the result that officer!
were moved from their quarters, bed sacks put in all halls and Re3
Cross huts, and the capacity reported on November 13 as 9,003 beds,
These were divided among the hospitals as follows :
Base Hospital No. 13 (capacity 2.300) 2,323
Base Hospital No. 24 (capacity 1,307) 1,406
Base Hospital No. 23 annex ' 3.50
Base Hospital No. 28 2,949
Convalescent camp 2* 065
On this day the personnel of the organizations was as follows:
Officers. Nurses
Base Hospital No. 1.3
Base Hospital No. 24
Base Hospital No. 2S
Convalescent camp
Enlisted
men.
234
188
46
In order to provide this additional bed space the French school
Ecole d'lnstitutrices, wdiich had been equipped in October with 350
beds, was on November 8 filled with patients and operated as an
annex of Base Hospital No. 24.
The right wing of the Caserne Beaupuy was secured from the
French, and on November 1 was filled with walking patients and
operated as a branch of the convalescent camp.
Because of the continued arrival of patients the Camp des Refugees,
or Belgian relief barracks, consisting of 6 barracks holding about 40
men each, was secured and patients placed in them on November 11.
This was operated as a second annex to the convalescent camp.
As all available space was now in use and it was not known when
more trains would arrive, the matter Avas taken up with the local
French military authorities, with the result that the left wing of the
Caserne Beaupuy, Avhich was supplied with 600 beds, was secured for
10 days. The necessity for its use did not arise and at the expiration
of that time was surrendered.
AA^iile sufficient equipment had been requisitioned, it was impossible
to secure delivery, and it was necessary to borrow 2,000 blankets and
310 beds from the French Government. These were distributed imme-
diately among the emergency camps opened.
On November 30 a total of 19.288 patients had been admitted to the
hospitals of this center. Hospital trains were received during the
month.
On November 19 a verbal order was received from the base surgeon,
Base Section No. 2, to the effect that the evacuation of all patients
was to be discontinued. On this date there were 8,864 patients in a
hospital center designated as a 5,500-bed center.
During October the bed capacity of the center was increased from
5,923 beds on October 1 to 7,670 beds on October 31. In order to do
A. E. F. HOSPITAL, CENTERS. 1849
this it was necessary to increase the bed capacities of the hospitals
as follows:
Base Ho"pital No. 13.
Ba.se Hospital No. 24.
Base ITo^piial No. 2S.
Bel Air Setninan-
Convalescent camp...
This was done by crowding to what appeared to be the extreme
limit. On October 31 a total of 15,798 patients had been admitted to
the hospitals of this center. Hospital trains were received during
the month.
In order to increase the bed capacity at Base Hospital No. 24 the
officers were forced to give up their quarters, and on October 7 seven
rooms were rented at 12 Rue de Loyal and occupied by them.
In order to be prepared for further expansion the French school,
Ecole Normale d'Institutrices (des Filles), was requisitioned and
equipped with 350 beds. The necessity for its use did not arise during
this month.
On July 22, 1918, there were three hospitals in Limoges, as follows:
111 operation :
Base Hospital No. 13.
Base Hospital No. 24.
Under construction :
Base Hospital No. 28.
Bel Air Seminary.
During this period Base Hospital No. 28 received its first patients,
receiving them on July 23, 1918. On August 3, 1918, Base Hospital
No. 28 also took over the operation of Bel Air Seminary, and on
August 7 received its first patients there.
The convalescent camp began operation on September 21, 1918, with
1,000-bed capacity.
Base Hospitals^ Nos. 13 and 24 were in operation at the time of the
organization of the center.
H. :mars hospital center.
As the center is still in active operation this will, of course, in no
sense be a history.
The Engineers started to lay out the work here early in 1918.
Railroad construction to the site was started on February 10, 1918,
and finished in August, 191S, though in use for light trains long
before the ballasting was all in. At the beginning a nai-roAv-gauge
road was established. From then on material began to arrive and
the buildings in No. 1 and No. 4 units were fairly well toward com-
pletion on July 19.
We were directed to get ready to receive wounded at once and it
was immediately reported that Ave would be ready to receive them by
the time the trains could arrive if personnel were sent in in the mean-
time. On July 24 Base Hospital No. GS arrived, followed within a
day or two by No. 48. These two hospitals at once took over Units
No. 4 and No. 1, respectively, and prepared them for action. On
1850 REPORT OF THE SURGEON GENERAT. OF THE ARMY.
AiioiLst 2 the first hospital train arrived and this was followed rap-
idly bv others. A few days later two more hospitals reported — No.
14 and Xo. 85. These organizations took ovei' T^nits Xo. 5 and Xo.
2. res]iectively, and in a few days were also ready to receive patients.
The nnloadinc: or detraining- always attracted attention. A mili-
tary police (ord(m was put around the detraining area for the time
heino- to prevent motor and street tratlic and to keep back the crowd.
Detraining details arrived with their litters. Patients were checked
upon being taken from tlic train and again upon entering the i-e-
teiving wards.
Base Hospital Xo. 62 was next to report, about four weeks later.
Then at intervals of about 15 davs Base Hospitals Xo. 1;>1. Xo 107,
Xo. 123. and Xo. 110. and Evacuation Hospitals Xo. 30 and Xo. 37,
the last four mentioned not arriving nntil after the armistice was
signed, but they were put at once actively to work and have all been
busy up to the time of the departure of practically all of the sick.
The conA^alescent camp was near the center, ])ractically a part of it,
and eventually gi-ew to a size to accommodate 5.500 men. Its pur-
pose Avas to serve as an intermediary between the base hosi)itals and
actiA'e-duty trooi)s. All of the ])atients were eventually sent from
the hosjiitals to the convalescent camp and there y>u\ through a
graduated course of ])hysical instruction until it was estal)lis]ied that
they could stand the vigorous work necessary for front-line troops.
The Avork of this center has embraced every phase of medical and
surgical ])ractice. The original plan contemplated a center of 10
base hospitals, each holding 1,000 beds and with a crisis expansion by
means of tents of 1.000 more beds: in other words, a 20,000-bed center
on extreme expansion. Later this was (hanged to 20 base hospitals
holding 20,000 lieds Avith a crisis expansion of 500 for each hospital,
or a total of 30,000 beds. Then it v\as decided that 5 more hospitals
could be ]5laced here in case of need, whicli would ha^e added 7,500
beds. The convalescent camp Avas prepared for 5.500, making a total
of 43,000.
The greatest numler of beds available at any one time at the cen-
ter Avas 30,000 and we Avere prepared to receiA'e that number of
])atients at the time the armistice Avas signed.
In other Avords, the plan Avas made np at tlie beginning for a city
of approximately 60,000 people. The greatest number of patients
ever in the center at one time Avas about 16.000, Avhich, together AA'ith
the personnel and laborers, made about 23.000 at this station at its
maximum.
I. PERIGUEUX HOSPITAL < ?:NTER.
(reof/raphlcal location. — The Perigueux hospital center is located
in the A^alley of the Isle Eiver, on both I'anks. about 1^ miles aboA-ethe
city of Perignenx. Dordogn.e, France, and about 90 miles east of Bor-
deaux. Perigueux has about 30,000 inhabitants.
Terrain. — A railroad spur Avas early constructed into that part of
the center on the south side of the riA^er. This was, of course, of
great vahie during the construction period and also later when hos[)i-
tal trains arrived. Taa'o tracks Avere built into the grounds, and thus
an entire hospital train could l)e in the center at one time. Owing to
the layout this spur Avas necessarih' parallel to the roAvs of Avards and
A. E. F. HOSPITAL CENTERS. 1851
directly in front of one row of wards in Section No. 2. The problem
of unloading patients comfortably and rapidly was therefore not
difficult.
Emergency hospital. — Before the completion of the hospital proper
one of the wooden buildings of Section Xo. '1 was used as a hospital
by the constructing force for the care of ciyilian emploAees. There
were a number of these constantly in this hospital l)ecause of yery lax
physical examinations before being sent out by the labor bureau. In
September and October there was a slight epidemic of influenza, and
a few died. This infirmary was used l)y the construction force eyen
after the estaldishment of the hospital proj^er. This force at one time
consisted of i(\ nationalities. When Section Xo. 2 was occupied by
Base Hospital Xo. 95 the infirmary was moyed to Jalots.
Occupation of hospital Ifuildirajs. — "With the arriyal of Base Hos-
pital Xo. 84 on September 18. 1918. although there was no equipment^
the slightly sick of the command was cared for in the wards, but it
was not until October 18, when Hospital Train Xo. 62 arriyed, that
the hospital really functioned as such. Patients could haye been re-
ceiyed long l)efore but for the delay in the arriyal of medical sup-
jdies. These had been promptly requisitioned for and shipped, but
the cars were lost en route somewhere and did not arriye for weeks,
and in some cases for months.
,1. nosrrJAL < K.NTKR. PAU. ItASSKS-I'VUKNKES.
Hospital center. Pau. Basses-Pyrenees, first came into existence Sep-
tember 8. 1918. The first d(>signation vras hospital center Biarritz.
This appellation, however, was of short duration for Avhen the com-
manding otlictr arriyed at Tours, headquarters Services of Supply,
and went into conference with the authorities in the chief surgeon's
office, it was disco\ered that Biarritz was likel}' to be placed out of
liounds for the American Expeditionary Forces. This fact was re-
ferred to the general staff, and in a subsequent meeting Biarritz was
closed to the American Expeditionary Forces.
The matter of choosing a new location was delegated to the com-
manding officer, who. on the IHth of September, left Tours for Biar-
ritz principally for the purpose of joining the small detachment of
medical enlisted men ordered to that station for duty at his request,
and to givi> them the information that a new headquarters was to be
established.
On December 30, 1918. a telegram Avas received that hospital center,
Pau. was to be aband(med.
K. IIOSIMTAI. CKNTKI!. NvNIKS.
Ignited States Army hospitn.l center. Xantes. France, was organized
.July 29. 1918. pursuant to autiiority contained in paragraph 11C>,
General Order 130. headcpiarters Services of Supply, American Ex-
peditionary Forces, and began to functionate on that same date.
The original hospital center was composed of three United States
Army base hospitals, to which Avere later added a fourth base hospital
and a convalescent camp: and also a group quai'termaster, medical
supply dejiot. liosj^ital guard, fire department, centi-al laboratory,.
1852 UEPOET OF THE SURGEON GENERAL OF THE ARMY.
American Red Cross hut, Sanitary S(iuad Xo. 39, and Ambulance
Company Xo. 346, the two hitter units arriving in October, 1918.
Tlie site ah-eady occupied by Base Hospitals Nos. 38 and 11 at
Grand Blottereau, a large estate in Doulon, a suburb of Nantes, was
chosen for the site of the hos])ital center.
Base Hospital Xo. 31 was the first of the hospital units to arrive
at Xantes, arriving January 18, 1918, and had located at the Grand
Seminaire, a four-story brick structure which was designed for a
Catholic seminary. This hospital unit had been organized in Janu-
ary, 1918, using the Protestant Episcopal Hospital of Philadelphia
as a parent organization. It was financed l)y the American Red
Cross.
The fii'st convoy of patients was received on April 2, 1918.
Base Hospital Xo. 38 arrived at Xantes on July 11, 1918, and began
active hospital work on July 22. 1918. Tlie unit was organized in
May, 1917, under auspices of the American Red Cross at Jefferson
Medical College, Philadelphia.
The first convoy of patients received was 132 in number, froin the
Soissons front.
Base Hospital Xo. 11 Avas organized by the Chicago Chapter of the
American Red Cross, May 1, 1917.
This unit was called into active service March 4, 1918, trained at
Camp Dodge. Iowa, for weeks. Embarked at Hoboken June 28,
1918: arrived at Xantes, France, July 16, 1918. Active work of the
organization was begun at once after its arrival, and three weeks
after joining the American Expeditionary Forces the hospital was
caring for 750 patients, and shortly its capacity was increased to 1,500
beds.
On October 15, 1918, it reached the height of its activity in caring
for 2.386 patients. The hospital personnel, after mobilization, con-
sisted of 35 officers, 100 nurses, and 203 enlisted men.
Base Hospital Xo. 216 was organized Xoveniber 2, 1918, from hos-
pital units within the hospital center.
The buildings to be occupied by Base Hospital Xo. 216, were
practically completed at the time of its organization and had already
began to be utilized as hospital wards for the excess of patients from
Base Hospital Xo. 38 and Base Hospital Xo. 11. .
At its beginning Base Hospital Xo. 216, handled chiefly medical
cases, the number of surgical cases being small in proportion. After-
wards, the hospital functioned for a time as a camp infirmary to the
hospital center, this provision was made in order that personnel be-
longing to units within tlie center would not have to be dropped from
the rolls and lost to their organizations when admitted to a hospital
for minor illnesses, as had been previously the case. The camp in-
firmary made provision for mildly contagious diseases.
Convalescent Camp Xo. 5, organized at medical officers' training
camp, Fort Riley, Kans.. April 17, 1918, was the last organization
to join the hospital center.
This unit began operating Xovember 7, 1918. The original per-
sonnel consisted of 13 officers and 90 enlisted men. After its arrival
overseas, August 23, 1918, the command was divided and 6 officers
and 45 enlisted men proceeded to Xantes, France.
During the period of its activity the convalescent camp occupied
ground that was low and flat. Owing to continued rainfall and the
A. E. F. HOSPITAL CENTERS. 1853
proximity of the Loire River the difficulties of providing a suita-.
able place for patients became very great. The ground and company
streets tending to become inundated. This disadvantage, together
with the signing of the armistice and the opening convalescent hos-
pitals farther south, undoubtedly led to its early abandonment as
a convalescent camp, January 9, 1919, a little more than two months
after the time of beginning operations.
The duties performed by the hospital center evacuating officer
were as follows :
(a) Receiving all patients arriving at the hospital center, and
by the use of bed reports from the various hospitals, directing them
to the proper hospitals, for admission.
(b) File and rendition of reports showing the number and nature
of cases of patients in the various classes in the hospital center.
(c) Receiving and executing, through the unit evacuating officers,
the regulations and orders relative to the evacuation or final dis-
position of all cases.
Prior to the arrival of a hospital train the evacuating officer was
invariably notified by telegraph or telephone. He then kept in
communication with the local railroad transportation officer as to the
probable hour of the train's arrival and unless already notified by
telegram, it was his endeavor to ascertain the number of patients
to be expected and also, whenever practicable, the nature of their
cases, whether sick, gassed, or wounded, and to get information on
communicable disease cases and the number of litter cases to be trans-
ported.
L. RIVIERA HOSPITAL CENTER.
The Riviera hospital center consists of all the American hospitals
along the northern coast of the Mediterranean between Toulon on
the west and Menton on the east at the Italian border.
Origin. — Its origin was the result of an urgent-felt need for many
hospitals that would give the maximum hours of sunshine and clear
skies, the minimum rainfall, the most even temperatures, and the
most stimulating atmosphere within a practicable distance from the
battle fields in the advanced zone in France and Belgium.
Its purpose is to function as a convalescent hospital group. Its
distance from the scene of active operations is too great, and trans-
portation problems too difficult to warrant sending cases of fresh in-
juries or acute illness directly to this center. All cases are therefore
received by transfer from other hospitals after the patients have so
far recovered as to be able to stand a long journey without detriment
to their health or recovery. Once arrived, the abundant sunshine,
comfortable quarters, agreeable climate, cheerful surroundings have
been strong factors in the early recovery of health and vigor. All
clases of cases have done well. Compared with northern or central
France, the respiratory cases have the most to gain by transfer to
this center, because the sunshine and dry air are more vital to their
recovery.
Location. — Were the whole of Europe canvassed, it is doubtful if
in any part of it could be found a location that would so well approxi-
mate the needs of a vast fighting army for its convalescent wounded
as that strip of coast line extending from Marseille to Menton, called
1854 IIKPOHT OF THE SURGEOX GENERAL OF THE ARMY.
the Cote (TAziuv (beside the blue), or Riviera, al)ont 180 miles in
extent. 50 to 10 miles in depth, fueing the ]MediterraneiUi Sea, and
sheltered by the ^fnritime Alps. That strip of sheltered land em-
braces the Avell-knoAvn winter resorts of Hyeres, St. Raphael, Cannes^
Nice, Ville P'ranche, Beaulien, Monte Carlo. Cap Ferrat, Cap d'Ail,
Cap Martin, and Menton.
Advayitayes. — Its large pi-oportion of sunny days. Compared with
England's, it shows an average for the six months of Avinter and
spring of 97 clear, cloudless days as against 12 for London. The
rainfall is confined to a few days' downpour: the rainy days are only
BO at Nice as against 76 in London, and while the relative humidity
of English winter resorts is 85 to 90 per cent, that of the Riviera is.
only 75 to 80. Its warmth is under that of either ]Maderia or Egypt
and climate more mild than hot : the relative warmth compared with
Paris, London, and other northern places, also Rome, is due to-—
First. The abundant sunshine.
Second. The (general) shelter from northern winds.
Third. The peculiar configuration of the Mediterranean Basin
near the coast. Certain banks obstruct the inflow of deep, cold cur-
rents, the resu.lt ])eing that the water near the shore is about 5° higher
in temi)erature than the air.
Acquisition of hotel properties began in July, 1918, when a board
of officers, consisting of one representatiAe from the chief surgeon'.s
office, one from the rents, requisitions, and claims office, and one
liaison officer from the French, made a detailed inspection of all hotel
properties on the Riviera that were subject to leasing or acquisition.
It should be stated that a considerable numl^er of hotels had already
been taken by the French service or supply and a smaller number by
the British and Belgian services for hospitalization; also the French
Government wished to nuiintain sufficient hotels in operation to care
for the necessary traveling public. The liaison officer showed the
board all properties that were subject to acquisition and at this time
and later was of great assistance to us in securing reasonable prices.
All hotels were obtained by amicable agreement where possible, and
by requisition only in case no amicable agreement could be arrived
at ; and the liotel Avas indispensable to our purposes.
On September 1, 9.000 beds had been secured.
On October 1. 1.000 beds had been secured.
On November 1. 12,000 beds had been secured.
On November 11. as the result of the armistice, requisitions for
hotels representing 6.000 beds were canceled pursuant to instructions;
from the chief surgeon's office.
On January 15, 1919. instructions were received to abandon all
hospitalization at Nice and Menton. except such as was necessary ta
care for the sick of the leave area.
On December 28, 1918. instructions were received to abandon the
hospital at Tamaris-sur-Mer, Var.. also Group No. 2 at St. Raphael
and Agay on January 21, 1919.
The geographical location of hospitals made it advisable to estab-
lish five groups, witlx one hospital in each group for acute medical
and surgical cases and the remainder in each gi'oup for ambulant
cases requiring but little treatment or professional obserAation.
Each group is organized as one hospital for purposes of admission^
transfer and discharge, and general administration. Each separate
A. E. F. HOSPITAJL CENTERS. 1855
building lias its own personnel, with responsible administrative officer
under the group commanding officer.
Railroad fraiiKportation ofp'ci /s. — IJailroad trans})ortation officers
were assigned to Hyeres, Cannes, and Nice on December 15, 1918, for
the purpose of handling all railroad transportation for the personnel,
patients, and supplies for the hospitals situated at these places, as
well as those at Menton, also for the leave areas at Cannes, Nice,
Monaco, and Menton. Men from the different railroad transporta-
tion offices met incoming and outgoing trains and did all that was
possible to assist members of the American Expeditionary Forces
while traveling in tlie Kiviera. Dining war conditions it was diffi-
cult to offer many comforts to those going or coming on trains, but
everj'thing possible was done to see that they secured what accommo-
dations were available. Patients for the different hospitals were all
practically handled on the regular United States hospital trains,
which were without doubt as complete trains as could have been
found. These trains, especially built for our Government, were truly
de luxe and consisted of 16 cars, each car being a finely equipped hos-
pital ward on wheels, supported by springs that allowed neither jolt
nor jar. the whole train nuiking a complete hospital fitted with all
the modern facilities for heating, lighting, ventilating, and comfort-
ing the patients to be carried. They were all well stocked with
surgical and medical eciuipments and the best of subsistence stores.
The personnel of these rapid-moving hospitals consisted of 3 medical
officers, 3 trained female nurses, and 33 male orderlies.
There were 34 trains handled in and out of the Riviera during the
time the center was open, carrying a total of 13.975 patients. These
trains parked at La Bocca, just west of Cannes, where they were
restocked with medical and quartermaster supplies. "When receiving
patients they were spotted to the station at Cannes. Patients from
Menton and Nice were transferred to Cannes for evacuation by train.
The trains for Base Hos])ital Xo. 99 were switched at Toulon and
spotted directly to Hyeres.
M. I'.KAI' DKSKHT HOSPITAL CKNTKl!.
I)eau Desert was selected as a hospital center for the American
F.xj)editionary Forces during the latter part of 1917 and work was
begun in December of that yeaj'. The site is a nearly level tract
of land of ai)proximately 550 acres and shaped something like a
keystone, the two sides of which run northeast and southwest. The
lantl was rented as a whole for the period of the war by the
Fnited States on November 27, 1917. Beau Desert in past years
\'as a well-known '" cours de chasse.'' or hunting field, and in bygone
daj's has seen many a spirited ride to hounds. It was also used for
training horses and for races, and in some of the old buildings Avere
found racing i)rograms dating back manv years, with the names of
well-known horses, so that it is quite evident tluit Beau Desert has
contril)uted to no small extent to French sport. The tract is nearly
due west from Bordeaux and about 5 miles distant. The nearest
village, a very small one, is Pichey, situated a few hundred yards
from the entrance to the reservation, and the town of Nerignac.
which is at the end of the nearest street car line, is about 1^
miles east. The place is well nanuHl and doul)tless from the fact
1856 REPORT OF THE SURGEON GENERAL OF THE /JIMY.
tliat it is almost devoid of trees and is in siunnier time hot and
dry. The climate is in the summer extremely hot and dry and not
at all unpleasant, being very much like that of southern Texas.
During the months of July, August, and Sefjtember there is prac-
tically no rain. The rainfall usually begins about Thanksgiving
and lasts more or less through the winter. The cold weather com-
mences in January, and spring, with a very abundant rainfall, is
usually ushered in early in April. It seldom freezes except at
night during the months of January and February, and it is rare
for the temperature to fall below '25° or 26° F.
Beau Desert was originally selected as the site for 10 base hos-
pitals of 1,00U beds each, with an emergency expansion to 1,500 each,
but enough land was reserved to increase the number of hospitals
to 16. As the war progressed and American participation in it
became greater, it was seen that to provide the necessary bed ca-
pacity in the American Expeditionar}^ Forces it would be neces-
sary to make extraordinary efforts, and during the summer of 1918
final authorization was given to complete the entire IT units.
As the center enlarged, a cemetery was added at the extreme
southeastern portion of the reservation, and land was also requisi-
tioned of approximately 20 hectares to the northeast where a large
convalescent camp of about 4,500 beds was established. Late in the
fall of 1918, 10 more hectares of land were requisitioned to the west
of the convalescent camp, where a farm and garden were estab-
lished. On this farm pigpens were erected, and at one time the
center had more than 100 of these animals. In addition to these ac-
tivities a central salvage and reclamation plant was planned, a
pychiatric hospital was also authorized, and plans Avere made with
the Red Cross to establish a large dairy farm in the vicinity.
The construction plan of Beau Desert called for nearly 1,000
buildings, the laying of miles of railroad track, of many miles of
roads, walks, and sewers, the installation of what was practically a
city water system, fire system, telegra])h and telephone systems, elec-
tric-light service, the construction of mills (lumber and cement), the
opening of gravel pits and sand pits, and the construction of large
warehouses and a large modern steam laundry.
On Octolier 27, 1917, the contract for construction v.as let to an
English contractor, and work was actually commenced in December,
1917. On September 19, 1918, the contract was annulled and after
that was carried on by the United States Army.
At the time of the arrival of the first ISIedical Department units at
Beau Desert on June 22. 1918. Base Hospitals Xos. 22 and 114, but one
unit was comi>leted. Unit No. 3, which was occupied by Base Hospital
No. 114. At that time Unit No. 2. was partially completed and was
soon after that date occupied, while in several other units work was
well under way.
Nine hospital units were eventuall,v completed in addition to the con-
valescent camp, steam laundry, and warehouses, and the total number
of buildings completed up to date has been nearly 600. Twelve miles
of gravel walk and 8 miles of board walk were constructed, while 5
miles of old road were made fit for use and 4 miles for new roads
built. The total amount of railroad trackage to serve the hospital
project is more than 11 miles. There were a few buildings on the
A. E. F. HOSPITAL CENTERS. 1857
place at the time the work Avas started, which served for quarters for
the commanding officer and some of his staff and the P^ngineer
officers, while other buildings served as cement mills, stables, garages,
and motor-repair shops.
Considerable difficulty was experienced during the summer time
due to scarcity of water, the supply being from wells of limited ca-
pacity. It wjis also necessary to chlorinate the water on account of
the presence of colon bacilli. An artesian well 1,500 feet deep was
dug and put in service in the winter of 1919, which insured a liberal
supply of water for all purposes.
Owing to the slight fall in the ground, the sewage system wdiich
was installed would only carry oti' wash and Avaste water and surface
drainage. As a consequence, can latrines Avere used for fecal matter
and urine. This method was objectionable but the only one possible
under the circumstances and in the end proved fairly satisfactory.
As the center inrreased in size, it became more and more evident
that the septic tank was not adequate, and provisions were made to
build two more tanks, which up to date have not been completed.
During the summer months there was a good deal of odor from the
small stream which carried off the waste water, which gave rise to a
number of complaints from the residents of Pichey. but following the
rainy season in November with a more rapid flow and dilution in
the stream these complaints ceased.
The problem for caring for fecal matter was a pressing one from
the start. Since the rate of fall in the sewer pipes was small, it
would have been impossible to care for this matter by the ordinary
means of flushing, inasmuch as the servers Avould have been imme-
diatel}' clogged. The can system had been installed in all hospital
wards and latrines, these cans being emptied by contract with the
French and buried 18 inches below the surface of the ground. Dur-
ing the early months of the hospital center's existence a great deal
of trouble was experienced due to the fact that the contents of the
can was largely urine, and these cans frec|uently overflowed and
slopped upon the ground. This condition was corrected in the fall
after nnich ( orrespondence and effort by connecting all urinals Avith
the sewers. This produced a great improvement in that the contents
of the can thereafter was mostly solid matter, and the cans Avere
not filled as rapidly. At first an attempt was made to burn the feces
in Horsfal incinerators, but there were so few of these incinerators
and the method Avas so unsatisfactory and expensive that the burial
system was again resorted to.
On the Avhole, Avhile the method of feces disposal Avould be looked
upon as unsatisfactory in the United States, considering the difficul-
ties and the lack of proper sewers, it has been fairh' satisfactory and
is probably as good as can be obtained. To sum up the scAver situa-
tion as a whole, as well as the entire drainage system here, we may say
that considering the predictions Avhich Avere freely made that during
the Avet season the system Avould break down and be utterly inade-
quate, it has been more gratifying than otherwise and no catastrophe
has resulted.
The hospital (enter Avas originally planned to acconuuodate 10
hospitals, and before the arrival of any of th(^ organized units this
plan had been modified to include 17 of these 1.000-bed hospitals
1858 REPORT OF THE SURGEON OENERAI. OF THE ARMY.
within tlu' lijiiits of the Beau Descit. To tliis phiii hiter was added
one for a small psychopathic hospital of about 800 beds.
The first two hosi)itals, wdiich arrived simultaneously on June 22,
1918. were Base Hospital No. 22, a Ked Cross unit from ^lilwaukee,
Wis., and Base Hospital Xo. 114, organized at large and mobilized
At Allentown. Pa. The latter hospital was designated as an ortho-
pedic hosi)ital. and was the first and perhaps the most successful of
any of these units. Base Hospital Xo. Ill was assigned to Unit Xo.
8. which was at that time practically completed except for some
minor but really latlier important installati(ms. and liase Hospital
Xo. 22 Avas assigned to Unit Xo. 2. which was at that time very nearly
■completed. The unit occupied by Base Hospital Xo. 114 was pro-
vided with good roads and with board walks and was likewise painted
and beaver boarded throughout, being by far the most complete and
best api)ointed hospital at Beau Desert.
On Xovember 12, the day after the signing of the armistice, in-
cluding the convalescent camp and with but two base hospitals
operating, the center had 12,558 patients. If one stops to consider
what it is for the personnel of a hospital designed to care for 1,000
patients to actually care for and feed over 5,000, it staggers the
imagination. This was simply one of the things which was done
because it had to be done; and that it was not only done but really
done well, and that no patient actually suffered from neglect, is pay-
ing a high tribute to the efficienc}- of these organizations. The other
hospitals arrived either at the time the armistice was signed or
shortly after, and, while they did excellent work after being trained
and installed, the real credit for the record which Beau Desert made
in the war. as far as the medical side is concerned, remains justly
with Base Hospitals Xos. 22 and 114.
Base Hospital Xo. 22. being one of the first 50 hospitals organized
under the Red Cross and later taken into the Federal service, had
been mobilized and equipped since December, 1917, and had had,
moreover, the advantage of a picked lot of officers and enlisted men
all from practically the same locality. Thev had also had the
benefit during the period of their inactivity before coming overseas,
whicli covered several months, of a considerable amount of train-
ing in civil hospitals. Base Hospital Xo. 114, on the other hand,
had been organized at large in a very short time, and had been
mobilized at Allentown about the 1st of April, 1918, coming overseas
in the early part of June. This hospital had had practically no
chance for work in civil hospitals, and the entire period of its stay
in the United States had been devoted to drill and training for
administrative work. As soon as the hospitals were prepared to
take patients, Base Hospital Xo. 22 was designated as a surgical and
general hospital and Base Hospital Xo. 114 was designated to re-
ceive all cases that could properly be called orthopedic, either direct
from the hospital trains, from the other hospitals in the center by
transfer, or from any hospitals in the base section having cases which
in the opinion of the consultants could be better treated at Beau
Desert.
During the months of Xovember and December, wdien the war was
over, four other ])ase hospitals — Base Hospitals Xos. 105, 104, 111,
and 121 — arrived and Avere installed, respectively, in Units Xos. 5,
1, 7, and 4. These base hospitals all functioned within a few weeks
A, E. F. HOSPITAL CENTERS.
1859
after arrival, and. iiotAvitlistaiuliiio- their insufficient organization
and training and the discouragement attending the fact that the war
was over, they all in time did excellent work. One of these hospitals,
Base Hospital No. 100, was designated as a hospital for contagious
diseases, tuberculosis, and venereal diseases, and the wards were
altered to suit the needs of such a hospital. On the 23d of January
Base Hospital No. 22 ceased to function, and was ordered to the
United States, to be mustered out of the service, and Evacuation
Hospital No. 20, newly arrived, but with a few days' experience at
the front, was ordered to take its place. Shortly after the close of
the war the chief surgeon sent information that it was planned to
evacuate a very large number of sick and wounded through Beau
Desert and Bordeaux, and it was therefore necessary to work out
plans for the changing of the function of the hospital center to an
evacuation center. Base Hospitals Nos. 114 and 22, because they had
been here longest and were best qualified from their experience, were
designated as evacuating hospitals and the other four hospitals as
receiving hospitals, and specific regulations were published govern-
ing the methods to be used in evacuating patients. Due to orders of
the War Department and the Expeditionary Forces, which changed
from time to time, these orders were frequently modified, and
finally, in the interests of efficiency. Base Hospital No. 22 alone was
charged with the entire duty of evacuating patients and the hospital
enlarged correspondingly to 2,.500 beds by using the entire tent ex-
pansion and 10 additional wards in Unit No. 6.
I Otdl inniilicr of tnliiiis.sion'^ inn) (H.^iinxifioiix nf imtirnts to Ajiril 1. /'»/.''.
Admitted by convoy 4.5,398
Adniittwl from coiiininiid 1,840
Total.
47,238
Traiisffi-ied to Tiuted States__ 22.88(1
R(4iinie(I t<> duty 12. G99
IMh<1 304
Total.
3."!. 883
Stiiiilur i/f lio>ii)it<il trains rcccircit in tlii.s i(iilc
AuLUist. 1918 3
SeptPiiilxT, 1918 6
()ctol)er. 1918 21
Novemlu'i-. 1918 10
Pfceuibor. 1918 lf>
Total to November 11, 1918, 47.
January. 1919 '>
February. 1919 12
Marcli. 1919 H
Total.
84
X. UniAUCOUHT HOSPITAL CENTER.
1. Located at Rimaucourt. Haute-Marne. France, halfway be-
tween Chaumont and Neuf chateau.
2. Bui7di>ir/s consistcHl of five type A l)ase hospital sections (Swiss
l<ii()ckdown buildings), supplemented by buildings to house the
Miictly center staff. These latter included two office buildings and
oIlKcrs* (juarters of 12 rooms. T barracks to house and feed the quar-
tninaster detachments, 1 bakery capable of baking for 20,000 men,
1 laundrv capable of caring for'a similar number, and an iron ware-
house for quartermaster and medical supplies. As these buildings
were standardized, no description is necessary. It can be stated at
this point that the warehouse was foiuul to be 30 per cent deficient,
and the barracks for central detachments 50 per cent deficient, m
142367— 19— VOL 2 56
1860 REPORT OF THE SURGEOIST GENERAL OF THE ARMY.
capacity to meet the needs of a center of this size. An extra bath-
house for quartermaster personnel should also be numbered among
the deficienLies.
3. Capacity. — The 5 sections could house the necessary personnel— j
175 officers, 500 nurses, and 1,000 enlisted men — and 5,000 sick. Bji
erecting Marquese tents this capacity was more than doubled, so tha*t
on November 11, the date of the armistice, the reported capacity of
the center was 10,338 patients and 1,675 personnel.
4. Authorised expansion {not materialized). — A convalescent
camp of 2,500 capacity and 5 new sections were in the process of erec-
tion on November 11, 1918. Had the armistice not stopped this activ-
ity, this center would have been increased to over 20,000 capacity,
including the limit of crisis tent age expansion on a scale similar to
that actually employed in this center.
No orders existed directing the formation of a central professional
staff. At the time of the armistice the question of assigning center
consultants was being considered. In its very inception, this center
recognized the need of a central professional organization, which
would also serve as a connecting link between the American Expedi-
tionary Forces body of consultants and the various base hospital pro-
fessional staffs. It is believed that this hospital center is responsible
for the growing acceptance of this principle, which was so thoroughly
worked out here that its general acceptance by all centers was only a
question of time.
Upon receiving such an order as the one above quoted, the staff con-
sultant, using the name of the center commander as his authority, di-
rected all base-hospital commanders to require such officers as were
desired to report to him for orders. He arranged to meet these offi-
cers when the arrival of the train was announced by the railway
transport officer, and also arranged for night calls in case the train
was late. (This train arrived at 3 a. m.) The staff consultant and
the evacuation officer then decided how to " spot " the train, and gave
necessary directions to the railway transport officer. (The center had
its own spur of three tracks, and much depended upon intelligent
" spotting," as both sides of the track were lined with base hospitals.)
Train tiiage. — As soon as the train was spotted the staff con-
sultant assigned to each of three or more cars, suitable teams ofj
medical officers to make the triage. These officers by observation and'
consultation of field cards quickly decided upon the'^liospital to which
the pateint belonged and gave him a slip of paper bearing the num-
ber of the hospital to which he was to be sent. Behind these officers
the bearer section with their litters then evacuated the train. This
train triage does not delay an evacuation, but by establishing a deti-
riite system hastens it. No " walking case " should ever be permitted
to walk from the train to his hospital. The trucks are furnished to
take care of these cases, any one of which might be a walking pneu-
monia. Thirty men can crowd into a truck and be rapidly sent to
their hospital. Train triage is not intended to differentiate between
a slight bronchitis and beginning pneumonia, and fatal mistakes are
certain if snap judgment prevails. Train triage serves its purpose
when it " spots " a case as one that should enter the respiratory or
other hospital.
Each commander of base hospital in this center was directed to
keep open two wards for " receiving ward " purposes. All beds in
A. E. F, HOSPITAL, CENTEKS. 1861
these wards were " cubicled," and all persons in these wards wore
face masks. As soon as admissions started the surgeons in these
wards began to perform the " secondary triage,"' sending to the regis-
trar and tlie delousing station all cases ready for final disposition.
The cubicles made cross infection impossible. The sum total of those
registered and delonsed, plus those remaining for final disposition,
represented the total admissions. Final disposition could be delayed
for even 48 hours if necessary-, as the registrar's entry could be made
by the registrar coming to the patients thus concentrated, while the
delousing could await any necessary delay. At this triage, if it was
found, for example, that a man had been entered into the respiratory-
infectious hospital when he should have been entered in the " gas-
case" hospital, the staff consultant was notified and a transfer was
effected by mutual cooperation of the conmianding officers of the
respective hospitals. If the error was discovered earl}', the patient
would not be entered on the original receiving hospital's registry.
If discovered after entry had been made, a formal transfer involved
no great hardship.
Base Hospital Xo. 58 was the hospital for " respiratory infections."
This institution had every bed cubicled. Xo one — not even the com-
numding officer — was authorized to walk in these wards unless
masked. Patients who got out of bed had to wear masks. Doctors,
nurses, orderlies — everyone wore masks. The triage in this hospital
endeavored to separate patients into seriously ill and slighth^ ill,
as well as to separate pneumonias, "flus," dij^htheria, meningitis, etc.
At one time every internist in the center that could be spared was on
duty at this hospital, and as these were overworked the staff consultant
asked for outside aid. Through the American Epeditionary Forces
consultant's good offices 5 extra internists were promptly assigned.
The duties of Base Hospital Xo. 58 with its 100 cubicled beds, Base
Hospital Xo. 238 with its group of specialties, and Base Hospital
No. 64 with its gas cases, and later with its infected wounds, and
still later with all the surgery of the camp, will be explained in the
various reports submitted by base hospital commanders, which will
be appended to this report. The sum total will give a picture of a
smooth-working machine which has proved conclusivel}' to all the
members of this body the following points :
1. In war, a body of exjK'rt consultants under a '"director of
medical services" is ne: essary to nu\ke an army medical organiza-
tion complete. An administrative dej^artment is not alone sufficient.
2. Within hospitals, the chiefs of services will coordinate the work
of these consultants so that their activity may have a direct bearing
upon a patient's welfare, provided these hospitals are not con-
nected with a tenter.
3. If, howevei', the hospital is not an isolated organization, and if
it is a part of a center, there remains between the army consultant
and the various hosi)itals a gap in the center organization that must
be filled bj' a staff of center consultants.
4. That the organization of base hospitals in large numbers in
future wars is not advisable. That a limited number should con-
stantly, in times of peace be held available as the nucelii of hospital
centers of the future. That personnel should be sent to the chief
surgeon of an army unattached to be assigned as re(|uired by com-
manders of centers, which have advanced with the first movement.
1862 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Lar^e niinibers of base hospitals serve no good purpose. They imply I
useless overhead administration, local, instead of central, esprit,
-"iind from 20 to ."iO per cent of wastage in ])rofessional energy. Only
one base hosjiital for each center should therefore be permitted. This
hospital can then expand to any desired size.
a. Centers are advantageous because adniinistratixe gr()U])ing al-
Avoys diminished overhead expense. Professional grou])ing is still
more inipoi'tant liecause the former only saves money while the
latter sa\es money and e; cmomizes professional talent which money
can not buy when the small stock on hand is exhausted.
(■). Centers should always be built in units along the general plan of
arrangement of these centers in France. A geograjihical separation
of units ((/) will permit a physical se])aration of disease gr()Ui)s (h)
will augment fire security and will enable aduiinistrative control to
easily define l)oundaries of responsibility for ]>olice, sanitation, and
discipline.
7. It is highly desiralde that a further j)liysical definition of central
headquarters ])e nuide along professional lines. Administratively, the
center has its own staff, separate quarters, messes, and offices, but
professionally, it was dependent upon the base hospitals present. The
center consultant staff', which was created at Rimaucourt partially
fills this indication, but there was no specially defined building group
for housing specialties that should be under direct central control.
I would therefore adA'ise the building of a center unit, around which
the hospital units would be ground. Without going into the matter
exhaustively, a general outline of the central professional needs would
include: (a) A large central laboratory, (h) a central morgue and
patholcgical rooui with offices, and adjoining the central laboratory,
'(3) a central dental clinic. The quarternuister and medical supply,
laundry, baker3% commissary and storage buildings and the quarters
foi- center detachment personnel should be adjacent to central head-
quarters. The central surgical clinic nuist of necessity be an integral
part of an hosi^ital section. The central G. U. and CA'e, ear, nose, and
throat clinic must also be an integral part of another section. The
X-ray clinic must i-emain a part of the surgical clinic. Duplications
of surgical and other special outfits may be made as required, but
the intent should always be toward concentration of material, pro-
fessional talent and disease groups.
Woi'k accatnpUshed. — A recital of work accomplished, expressed
in terms of patients treated, gives very little idea of this center's ac-
tivity. The average traA'el of 50 miles to get hold of wood to make
coffins for the first dozen deaths, the 100-mile drives in the rain with
medical officers as drivers to get medical supplies, the building of
miles of sidewalks and roads, the digging through solid rock to make
seepage pits, the jilumbing work done by inex]ierienced Avorkers,
directed by medical officers who didn't even know what tools to ask
for, the carpentry work, the guard duty, the loading and unloading
of over 2,000 cars. of freight, the erection of buildings and stoves,
the handling of tons of coal, wood, and commissaries, the disburse-
ment of funds amounting to as much as several million francs a
month, the search for fresh foods, for miles around — all of these
things can never be appreciated except by the brave lads of the
Quartermaster and Medical Corps, wlio. without a murmur of com-
plaint worked not infrequently for 48 hours without sleep or rest.
A. E. F. — HOSPITAL, CENTERS. 1863
Hospital trains nearly always arrived l)etween midnight and morn-
ing and staff consultants and the evacuating officer always met them
and never slept late the next morning. It was all A'er\' fine, and all
the finer hecaiise it was dop.e without ho})e of recognition.
Base Hospital No. 52 (authorized complement. 35 officers, "200
men, 100 nurses), was organized, pursuant to instructions of the Sur-
geon General, United States Army, at Camp Gordon (Atlanta), Ga.,
June, 1918. July 5, 1918, the organization consisting of 31 officers
and i35 men (no luirses) left Cam}) Gordon for service in France.
Arrived at Camp ^Merritt. N. J.. July 7, 1918. At Camp Merritt,
5(j men were received and three were transferred to hos])ital. Sailed
from Brooklyn July 11, 1918 (embarked the day before) on the
trausport KiniiKila. The latter beiug unable to keep up with the
largo convoy in which she was sailing, was at 1 p. m. July 16, 1918,
directed to proceed alone to Halifax to join another convoy. Ar-
rived at Halifax 11 a. m. July 17, and departed with a large convoy,
8 a. m. July 20. Arrived at Liverpool July 31, being convoyed by
a cruiser throughout and destroyers at both ends of the voj'age.
Stopped the night of July 31-August 1 in a British rest camp near
Liverpool and proceeded by rail at 9.10 a. m.. August 1 to Southamp-
ton. Arrived at American rest camp, Southampton. 5 p. m., August
1, and remained until 2 p. m. August 2. Transferred one man sick
to hospital. Southampton. Sailed August 2 from Southampton to
Cherbourg on the transport Ahoarfh. Disembarked at Cherbourg,
7 a. m. August 3. and marched to British rest camp near-by. En-
trained at Cherbourg 9 p. m. August 5 for Himaucourt, Haute-Marne,
at which phu'e the organization arrived for station and duty 7
a. m., August 8, 1918. At Rimaucourt. a hospital center, a group of
five hospitals was under construction, Base Hospital No. 52 occupied
section B of this group, as it was the one of the group most nearly
completed, lacking however when occupied, much essential consli'uc-
tion.
O. VICHY HOSPITAL CENTER.
Base Hospital No. 1 (Bellevue Unit) arrived in Vichy March 12,
1918, together with Auxiliary Hospital Unit D (Louisville, Ky.).
The Medical Department of the United States Army had already
determined to establish a hospital center at Vichy and had secured
from the French Service de Sante 18 hotels, large and small, to be
used as hospitals. These hotels and many others had been used as
military hospitals by the French since the beginning of the war
in 1914, Vichy being a French hospital center until our taking over
all but two of their hospitals. These two remained French military
hospitals throughout the war. One was the face and head hospital,
Auxiliary Military Hospital No. 45. This hospital was located in
the Thermal Palace Hotel. The other French hospital, located in
the Grande Bretangue Hotel, was an orthopedic hospital operated in
connection with the Grande Establishment Thermal et Physiothera-
peutic, where the splendid electrical and other equipment for the
treatment of invalids could be used to great advantage.
Gradually the remaining buildings occupied by the French as
military hospitals were turned over to the Medical Department of
1864 REPORT OF THE SURGEON GEXERAL, OF THE ARMY.
1
)CCU-1
the United States Army for use in this center, and were hiter occu^
pied by the varions units assigned to duty here.
Vichy had man}- advantages as a hospital center, but not without"
some disadvantages. The location, although apparently somewhat
distant from the seat of active operations, was well chosen owing to
favorable railroad connections. Patients were transferred from the
American sectors in some instances within 24 to 36 hours after the
receipt of injuries, and they frequently arrived with their original
first dressings, although a very large proportion of the patients had
passed through evacuation or base hospitals.
Vich}^, being a famous watering resort established for many 3'ears,
is a well-developed small city with a winter population of approxi-
mately 18,000 inhabitants, and capable, owing to its large number
of hotels, of expansion during the season to approximately 80,000.
The streets are well paved and well lighted, which greatly facilitated
the handling of patients arriving in the center on hospital trains at
night, an excellent pure water supply, carried through modern filter
beds, gas and abundant electrical current.
The equipment of Base Hospital No. 1, which was a very complete
and fine one, began to arrive in the latter part of March, and came
to hand a few carloads at a time.
The first patients to arrive were 252 wounded French poilus on
April 9, 1918. before the mess equipment and much of the hospital
equipment had arrived. However, these patients were admitted to
the wards in the Hotel Carlton and were taken care of to the entire
satisfaction and appreciation of the patients and also the French
Service de Sante. From this time on the center received a steady
flow of American, English, and French wounded.
Base Hospital No. 1 originally occupied nine hotels, and as these
were soon filled to theircapacity nine other hotels, including the Hotel
Ruhl, the largest hotel in Vichy, with a bed capacity of 1,400, were
opened by Base Hospital No. 1 and filled with patients. This or-
ganization had at this time been depleted by the withdrawal of two
surgical teams for service at the front.
Base Hospital No. 19 (Rochester, N. Y.), having arrived in Vichy
on June 22, 1918, was assigned nine of the buildings taken over
from the French Service de Sante, with the International Hotel as
their headquarters. They immediately opened these hotels as hos-
pitals with equipment drawn from the medical supply depots of the
American Expeditionary Forces. This equipment was later supple-
mented bv the arrival of their own personal equipment.
Their buildings rapidlj^ filled up with the wounded from the
Chateau-Thierry offensive. This organization deserves credit for
the wa}^ they handled their patients so promptly after their arrival.
They had not received their own equipment nor had time to adapt
themselves to hotels used as hospitals which offer many inconveni-
ences.
The next unit to arrive in Vichy was Base Hospital No. 115, on
September 6, 1918. It had been organized in the Surgeon General's
Office as a unit consisting of specialists in surgery of the head and
face and neuro-surgery. Base Hospital No. 115 had a large and
very excellent personnel. It immediately took over the Ruhl Hotel,
1,400 beds, from Base Hospital No. 1 with 900 patients in the build-
ing at the time of transfer and proceeded to very ably care for gen-
A. E, F. HOSPITAL CENTERS. 1865
eral surgical cases of all varieties. A few of the personnel of Base
Hospital No. 1 remained until the surgeons of No. 115 could become
familiar with their cases. From this time on all the head, face, and
neuro-surgcry of the center was transferred to this hospital and cared
for in the Ruhl Hotel. This hospital gradually expanded, taking
over 13 other buildings.
The original equipment, which was a specialized one and which
had been selected with great care, never reached Vichy with the
exception of about 10 per cent of the entire amount. Owing to the
supplies on hand in our local depot and what could be requisitioned
from the medical supply depots of the American Expeditionary
Forces, everything needed for the efficient care of the patients was
secured and "no shortage of material was ever experienced in this or
in any other unit in this center during the period of its existence.
Mess equipment was difficult to secure, but this difficulty was over-
come by purchases in the surrounding cities. As with the other units
preceding them, teams consisting of surgeons, nurses, and enlisted
men were sent to the front, necessitating long hours and constant
work of the remaining personnel.
Hospital Train No. 14 arrived on September 8, 1918, and was at-
tached as an auxiliary unit to increase the personnel of Base Hos-
pital No. 19.
Base Hospital No. 76 arrived on September 23, 1918, and opened
12 hotels, the largest of which was their surgical hospital, the Hotel
Albert Notre Dame, a large modern hotel.
Convalescent Camp No. 9 arrived after the signing of the armis-
tice, but owing to this fact was never put into operation, and the
personnel of this unit was distributed for duty among the base hos-
pitals operating at the center.
Base Hospital No. 109 relieved the units already operating at this
center of a number of buildings which they had been operating as
hospitals by spreading their personnel beyond a point of safety for
the care of patients and proper management of hospitals. At the
time of the arrival of this unit the 4 base hospitals on duty in Vichy
were operating 86 hotels as hospitals, averaging over 20 buildings
per unit, with 36 separate messes. Later when Base Hospital No. 1
ceased to function as a hospital. Base Hospital No. 109 took over the
larire surgical hospital in the Hotel Carlton, which they operated
until March 12, 1919.
Evacuation Hospital No. 25 and Evacuation Hospital No. 33 ar-
rived in Vichy January 13, 1919. Neither of these units ever func-
tionated as a hospital either in Vichy or elsewhere in the American
Expeditionary Forces, although some of their personnel was used
for various duties in connection with other base hospitals on duty in
this center.
The center was very fortunate in securing as consultants men of
such wide experience, excellent judgment, and loyalty. Their inter-
est, attention to duty, and enthusiasm added greatly to the center.
In the period innnediately following the arrival of Base Hospital
No. 19, July and August, many hotels were secured by lease from
their owners in addition to those originally taken over from the
Service de Sante, bringing the number of hotels occupied as hos-
pitals in this center up to 86. In addition to these, 13 buildings were
1866 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
also leased for medical siippl}- and supply and qnarterniaster ware-
houses and garages.
(iround Avas secured by requisition for the establishment of a con-
valescent camp of 2,000 patients. At the time of the signing of the
armistice negotiations had been entered into for the acquisition of
the large civil hospital here which, with the additional constructions
planned, was to pvovide 2,000 beds. The total bed capacity of the
center had reached its maximum of 19,000. This does not include
the convalescent camp and civil hospital, which would soon have
added 4,000 more beds to the center.
The addition of various buildings for special use offered a consid-
erable problem, the largest hotel, the Euhl (No. 115), with 1,400
beds, was knoAvn as our head and face hospital. Base Hospital No.
115 was originally organized as a head and face unit, Init it was soon
found impracticable to use this large and handsome building exclu-
sively for head and face cases. In consequence many surgical cases
of every type were admitted and treated at this building, in addition
to all the "head and face cases arriving in the center. These were
placed in sej^arate wards in the hospital.
The second largest hotel was the Carlton (No. 1), which was the
hospital for general war surgery. A new building, the Amiraute,
was used for medical cases admitted to No. 1, as was also the
Havre and New York for medical cases admitted to No. 19. The
Lutetia (No. 19) was set aside as the pneumonia hospital of the
entire center. This was done in order to separate the pneumonia
cases, prevent contact, and thus limit the spread of the disease. The
Amerique (No. 19) was used as a contagious hospital for the center,
and all contagious cases except pneumonia were sent there. The
Neva (No. 19), adjoining the Amerique, was used for contacts and
other less serious cases of a contagious nature. The Institute Physio-
therapique was used for the psychiatric clinic and the orthopedic
clinic. The problem of venereal disease never reached a serious
aspect in the center, the cases few in number, and were easilj'^ segre-
gated and confined in one ward in the Hotel Carlton.
The base laboratory located in Hotel Cherbourgm was one of the
most interesting of our center problem, and one of the best equipped
in the American Expeditionary Forces. A large amount of excellent
work was accomplished and a great deal of valuable material col-
lected for the medical history of the war. In the art department
were many excellent artists who added gi'eatly to the accumulated
records.
HOSPITAL CENTER, VICHY. ALLIER. BASE LABORATORY.
Introdt'ctiox.
The hospital center at Vichy had its origin in March, 1918, when
Base Hospital No. 1, organized at Bellevue Hospital. New York
City, was ordered to Vichy, taking over about 10 hotels for hospital
use.
With the arrival at Vichy of Base Hospital No. 19 (Rochester,
N. Y.) in June: Base Hospital No. 115 (a special Army hospital
organized for the treatment of injuries of head) in September; Base
Hospital No, 76 (Army base hospital) in September; Base Hospital
A. E. F. HOSPITAL CENTERS. 1867
X(). 101» (Army hase liospital) in Xoveiuber: and the organization of
a headquarters stati' containing consultants in surgery, medicine,
neurology, a laboratory ofiicer. grouj^ (juarternuister. medical supi)ly
officer, evacuation officer, assistant })rovost nuirslial. railway trans-
poit officer, officers, etc., the center so shaped itself that at its high-
water mark it was taking care of some 1.">.000 patients and was
housed in some !S0 hotels.
During the center's period of activity some -lr.").UUU i)atient>, have
l)assed through the center, with only '200 deaths. The incidence of
communicable diseases has been very low, wliich is remarkable, con-
sidering the pandemic of influenza and pneumonia which visited
this center during the montlis of October and November and the con-
stantly shifting ])atient popuhition (hu» to raj^id evacuations.
riic discipline at the center has been excellent. es})ecially when
we recall the fact that Vichy is popularly known during the season
as a " little Paris '' and is one of the fastest summer resorts in France.
This has been shown in a remarkable way by the very low incidence
of venereal diseases at this center.
The center's rapid growth demanded the organization of a well-
equipped base laboratory. It is due to the keen appreciation and
foresight of the conmianding officer of this center and to the con-
stant aid of the director of laboratories of the American Expedi-
tionary Forces that the laborat(uy attained its present degree of
development.
It should certainly be borne in mind that preconceived Army plans
I'oi- the organization, housing, and running of a general laboratory
in connection with a single hospital built on barrack plans and prac-
tically undei- one roof could for obvious reasons not l)e applied in
many instances in this center. This center consisted of hospitals
scattered in some SO hotels, hotels ranging in size from first-class
hotels, able to acconunodate 1,200 beds, to small third-class hotels^
accommodating 50 beds each; a sort of de luxe center, requiring dif-
ferent organization than that existing perhaps in any other center.
Conditions, therefore, have had to be met as they arose, involving
many new ideas which hitherto had not been adopted in Army
methods.
I'liKiKisi'iTAi. ( 'k.ntki; I'KiMoi) (Maiuii. 1!)1S, to .Ill.Y o(t. 11)18).
Alil!l\ Al. ()!■ IMTKl) STATKS AKMV BASK HOSIMTAI, NO. 1 IN VICHV.
On March 12. liase Hospital No. 1 (Bellevue Hospital I'nit. New
York City) arrived in Vichy and immediately began to take over
and eijuip 10 hotels assigned to them as hospitals.
These hotels had to be thoroughly cleaned and equipped for hos-
pital use. During March and April practically no patients were re-
ceived at Vichy, except those who were taken sick in the personnel
of the center and a few French wounded. It was the 1st of May,
therefore, due to the delayed arrival of beds and equipment, before
Base Hospital No. 1 was really functioning as a base hospital.
In May a few convalescent patients began to be sent to this center
from organizations farther front.
It became necessar}^ to establish a laboratory for this organiza-
tion. The fifth floor of the Hotel Amireaute was selected for this
1868 REPORT OF THE SURGEON GENERAL OF THE ARMY.
purpose and five rooms equipped and furnished for laboratory work,
consisting of rooms for clinical pathology, bacteriology, serology,
supply room, and office. This laboratory was sufficient to take care
of all the work at this center until the 1st of August. It was under
the direction of the pathologist to the Bellevue Unit.
In June and July a large number of patients were being sent to this
center and the work of the laboratory in all branches rapidly in-
creased. The large part of the equipment used in supplying this lab-
oratory was brought over with the original equipment of Base Hos-
pital No. 1 ; in fact, the central laboratory, which was organized later,
would have been seriously liandicapped if it had not had this original
equipment.
ARRIVAL OF UNITED STATES ARMY BASK HOSPITAL NO. 10, VICHY.
On June 22, Base Hospital No. 19 (Eochester, N. Y.) arrived in
Vichy. They were assigned about 10 hotels to be equipped and used
as hospitals. It was August before this organization was actively
functioning as a base hospital. They brought Avith them two medical
officers in charge of their laboratory, three civilian employees trained
as laboratory technicians, and a considerable amount of laboratory
equipment.
What little laboratory work this unit required during this period
was performed by their laboratory officers in the laboratory of Base
Hospital No. 1.
ARRIVAL OF UNITED STATES ARMY' BASE HOSPITAL NO. 115 IN VICHY.
On September 6 Base Hospital No. 115 arrived in Vichy. This
hospital was organized by the Army for the purpose of treating head
injuries. Its staff consisted of eminent consultants in various
branches of surgery and medicine pertaining to the diagnosis and
treatment of head injuries.
Their staff also included a medical officer in charge of their labora-
tory, two medical officers in charge of a special unit for neuropatho-
logical work, including trained technicians, two sanitary officers in
charge of a medical art department, and an expert wax modeler.
Their laboratory equipment, which was very complete and in-
cluded about $18,000 worth of neuro-pathologic equipment, was lost
and never reached this center.
Toward the end of September, Base Hospitals Nos. 1, 19, and 115
were actively established as base hospitals and their bed capacity
filled. These three base hospitals took care of practically all the
wounded who reached this center, the other organizations which
reached here later helping with the care of medical cases at the end
of the influenza pandemic.
It will be noted that as far as was possible we have endeavored
to have each base hospital perform its own laboratory work ; in this
way a healthy competition was established, and, what is more im-
portant, the laboratory officers could keep in closer touch with their
clinicians, obtaining a"^ much better result than if one officer or man
was constantly performing one monotonous laboratory procedure.
Wassermann tests, the typing of pneumococcus, and water analyses
were carried out by officers or men specially detailed to this work;
A. E. F. — HOSPITAL CENTERS. 1869
otherwise each base hospital performed and was responsible to the
director for their own work.
The size, organization, and efficiency of this laboratory may be
better realized by the statement tliat the employment of the staff in
civilian life would cost approximately $70,000 to $80,000 per year
in salaries alone; this being a rather low estimate. The cost for
salaries alone to the Army would approximate about $28,000, or
about one-third of that paid if in a civil institution. It may be
recalled that very few institutions could afford to pay a laboratory
staff of such size. For the proper handling of laboratory work
required in the modern diagnosis and treatment of disease, such a
staff is, however, not too large or elaborate; the whole experience
emphasizes the very inadequate and meager laboratory personnel
and equipment of most of our civil institutions.
OKGANIZATION OF DEPARTMENTS; WORK OF EACH.
The following was the working order of the laboratory :
Bacteriological department : This department was in charge of the
assistant director of the laboratory and its work comprised prac-
tically all of the clinical bacteriology and clinical pathology for all
the base hospitals. He had under liim the patliologist of each base
hospital and their assistants, and the work was so arranged that
each base liospital did its OAvn work, and its pathologist signed their
reports; all being responsible to the chief of this department. The
plan worked very well. The department had a large room for bac-
teriology which was well equipped, a room for serology, a media
room, and two stock rooms.
Serological department : One medical officer was placed in charge
of the serological work, which consisted mainly in performing the
Wassermann tests twice a week and typing pneumonia sputa. Most
of the other agglutination tests were done in the bacteriological de-
partment by the individual members of the various base hospitals.
Pathological department: This dei)artment was in charge of the
laboratory officer, who had with him the chief of the neuro-pathologi-
cal department. Its work consisted in performing autopsies on all
patients dying in this center ; the examination of surgical specimens
removed at operation, especially the stumps and limbs from amputa-
tion cases, from which a large amount of material was gathered.
Practically every case in this center that died was autopsied; the
autopsies were protocoled to a stenographer, and almost every post-
mortem included an examination of the brain, spinal cord, and acces-
sory sinuses of the head. A large number of museum specimens were
preserved, after being properly photographed or drawn, and are on
their way to Washington.
Art department: This department started with a small unit of
artists brought over witli Base Hospital No. 115 from the Army Med-
ical Museum. Finally, other artists were transferred to this center,
and it was contemplated making this a collecting point for drawings
and photographs relating to medicine and surgery in the American
Expeditionary Forces. As more detailed account of the work of this
department will be given later, it is sufficient to say that during their
short working period of about four months they secured about 250
1870 RKPORT ()V THE SURGKON GEXKRAL OF THE ARMY.
drawin<is, oxci- SOO i)li()t<),iii:ii)hs. mul many a\:ix models of facial
cases.
The j)hotoiii'aj)hic department worked under tlie direction of the
chief Of the art dei)artment. Its personnel Avas obtained from the
various base hosjjitals in the center and from pooling their equipment.
Suhsidiary laborntor'ies. — The only one of these laboratories estab-
lished was a small room in the Hotel Ruhl for a clinical laboratory..
The work done in this laboratory was practicall}' confined to clinical
microscopy and it did not seriously take away laboratory equipment
from the central laboratory. The" Hotel Ruhl had about 1.-200 beds,
being the largest liotel in the center, and a small clinical laboratory
in the building greatly aided the clinicians. The lalioratory was in
charge of a sergeant (first class) and Avas visited every morning by
the pathologist from that unit. There is no doubt that the establish-
ment of such laboratories are useful; they have a distinct disadvan-
tage, however, in that they scatter equipment and men and get away
from a central control. On account of scarcity of both laboratory
men and equi})ment, the establislnnent of numy of these laboratories
is very impi-acticable.
\V(i};i-: OK I>i;i'.\HT.MK.\Ts.
The work of this laboratory can be best appreciated when we-
glance at a combined report of the work for a period of one year.
AVhile the period covered is one year, still the actual work was done
in a period of five months' activity. During this time a total of 44:,767
laboratory examinations were made. This represents, very roughly,,
about one-fourteenth of the laboratory work done in the American
Expeditionary Forces, which included the work done by 9 base sec-
tion laboratories, 15 hospital centers. 93 base hospitals,. 11 evacuation
hospitals. 4 mobile hospitals. 21 division field laboratories, 4 water-
suii]:)ly laboratories, and 2.") camp hospitals.
Q. CONCENTRATIOX AREA. .lOlXVILLE ( HAUTE-MARNE) .
The plan for the establishment of a medical department of such-
an area in the zone of the advance, where mobile organizations such;
as ambulance companies, surgical teams, mobile and evacuation hos-
pitals could be mobilized, equipped, and trained, and after active
duty could be sent for rest, had been known for some time, but it
was not until October, 1918, that the plan materialized. G-4 had
previously obtained from the French military authorities an assign-
ment of 10 towns to be used as a concentration area for the Medical
Department.
The area is situated on the Chaumont-St. Dizier Road, in the-
Marne Valley, 50 kilometers north of Chaumont. 70 kilometers south-
west of Toul, and 119 kilometers southwest of Verdun.
The billeting space afforded by these towns, as shown by the
French billeting figures, was 290 officers and 9,830 men. This was
afterwards found to be incorrect, and the billeting space for enlisted
men had to be materially decreased, while that for officers was
increased.
Owing to the shortage of Medical Department personnel at that
time, it was necessary to form a skeleton administrative organization,.
A. E. F.— HOSPITAL CENTERS. 1871
consisting of four officers and four enlisted men from the Medical
Department, depending upon the balance of the organization being
obtained from the organizations casually in the area. This proved
to be a very unsatisfactory arrangement for clerks, sanitary squads,
truck drivers, guards, etc., were no sooner made familiar with
their routine work than the organization to which they belonged was
•ordered out of the area, and the whole organization had to be rebuilt.
Tliis arrangement proved to be so unsatisfactory that in December
re(juest was made for authority to transfer to the headquarters fro.ii
•organizations coming into the area, such personnel as was required,
and in addition to hold one exacuation hospital to be organized as
n guard comi)any. and one ambulance ( ompany to be used as a trans-
portation company. In the mean time, the necessary steps had been
taken to have assigned to the area such personnel other than Medical
Department personnel as was required to properly conduct the work.
The original ]olan for mobilizing, equipping, and training organi-
zations sent to the area was as follows:
Storage space was to be obtained Avhere the equipment of mobile
and evacuation hospitals, arid sjiare parts required by mobile hos-
pitals could be stored. The equipment of evacuation hospitals was
to be shipped to the area from the medical supply depots, and the
equipment and spare parts for mobile hospitals to be shipped to the
area from the instruction and assembly park for mobile units. Paris.
One evacuation hospital and one mobile hospital were to be set up
and kei)t in active operation receiving patients and functioning as
hospitals. The permanent personnel of these two organizations was
to be selected from similar organizations that had had sufficient serv-
ice at the front to (jualifv them as in.'^tructors. When the personnel
of a new organization arrived in the area each member from the
commanding officer down was to be paired off with the exi^erienced
personnel, actually running the permanent hospitals. When this
personnel was found sufficientlv qualified to efficiently operate such
a hospital, new equipment was to be issued to it, and tlie new organi-
zation reported ready for assignment. In addition, it was planned
to have the men who were to operate the technical trucks for the
mobile hospitals given .special training in the care and repair of these
trucks: also, at least once a month, mechanics were to be sent from
the area to visit all mobile hospitals that were operating in the zone
of the advance to inspect the special apparatus of these organiza-
tions and see that it was being properly cared for. Steps had been
taken to have one of the mobile hospitals and one of the evacuation
ho.s])itals sent here from the front to establish hospitals and to act
as instructors, l)ut the armistice was signed before the above plans
were carried out.
The following plan was adopted for the administration of organi-
zations when they arrived in the area :
Headquarters was established at Joinville and an area adjutant,
urea supply and mess officer, area billeting officer, and an area sani-
tary inspector detailed, whose duties were to supervise the work of
the different officers api:)ointed to fill similar ))Ositions in each town.
When troops were billeted in towns other than Joinville there was
ai)pointed from the personnel of organizations billeted in the town a
commanding officer, adjutant, sanitary inspector, mess officer, supply
officei'. billeting officer, and an officer in charge of dis])ensary and
1872 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
propliylac'tic station. The town commanding officer was instructed
to have officers call daily when matters requiring the attention of
headquarters was to be taken np, and the town adjutant instructed to
bring this information to the adjutants' meeting held at headquarters
each day.
Theoretically this plan appeared to be ideal, but practically it
proved to be unsatisfactory, principally due to inexperienced officers
and the frequent change of personnel. The frequent change of per-
sonnel resulted in an organization being ordered away about the
time these officers became familiar with the work they were supposed
to do. If it were to be done over again, officers would have been
permanently detailed from the headquarters to be in charge of the
administration of the various towns.
The armistice was signed in such a short time after the area was
organized that the permanent evacuation hospital and mobile hospi-
tal were not established, nor were supplies for incoming organizations
sent here, except those for one evacuation hospital. New organi-
zations arriving from the United States were sent to the area await-
ing assignment, and also organizations from the front that were no
longer required there, and these organizations held for assignment.
Mobile hospitals were sent here for demobilization, and ambulance
companies held for assignment to the First, Second, and Third
Armies. Ambulances from demobilized organizations were sent
here for repair and reassignment.
From November 1 to March 1, 651 officers and 5,838 enlisted men
ca)ne into the area, there being in all 13 evacuation hospitals, T mo-
bile hospitals, 6 skeletonized sanitary trains, 16 evacuation ambulance
companies, 16 sections Ambulance Service, 1 mobile operating unit,
6 mobile hospital units, and 4 mobile surgical units. During that
time the disbursing quartermaster paid out $369,115.56 and the bil-
leting officer $6,557.38.
While the area did not function as it was originally intended, due
to the signing of the armistice, it is believed that enough was accom-
plished to fully demonstrate that many of the problems facing the
Medical Department in the advance section during the past year
would have been solved had such an area been established six
months earlier. It is also believed that in the future organization
of the Medical Department such an organization should be included
in the tables of organization.
R. GAS HOSPITAL,, JUSTICE HOSPITAL GROUP.
The gas hospital. Justice Hospital group), was a provisional hos-
pital and not 'an organized unit. Its formation was hastily planned
in anticipation of the activities in the St. Mihiel sector to meet the
requirements of an emergency. The hospital performed an active
and useful service from August 29, 1918, to October 8, 1918, when
it was taken over by Base Hospital No. 87.
On August 30, 1918, 50 enlisted men from the special training
battalion stationed at St. Aignan, then on duty with Evacuation
Hospital No. 3, stationed at Toul, reported at the gas hospital in
compliance with Special Orders, No. 7, headquarters, Justice Hos-
pital group, dated August 29, 1918.
A. E. F. HOSPITAL CENTERS. 1873
Buildings. — The buildings selected for the gas hospital were those
known as the Lamarche Annex and adjoined Caserne Lamarche.
They were originally constructed for hospitalization and in times
of peace had been used by the French as the hospitul for the entire
garrison stationed here. On this account they were perhaps better
arranged than the buildings that were occupied by the other hos-
pitals in the group.
There were four large ward buildings, constructed of stone and
concrete, a small administration building, two kitchens, and a large
Bessanneau tent.
They were divided into rooms that would accommodate about 15
patients without crowding, and these rooms were well ventilated
and very light. The possibilities of isolation were very good. The
corridoi-s and stairways were spacious. The four buildings would
accommodate comfortably 1,000 patients, but owing to the lack of
storerooms and mess accommodations it was only possible to pre-
pare for a normal capacity of 650 beds.
In certain respects the buildings were very poorly arranged for
hospitalization. Running water was to be found in but one room
in each building and there were none fitted up as service rooms.
There was no arrangement whereby even a liquid diet could be pre-
pared. There was no arrangement in the buildings for the disposal
of waste matters.
The latrines were of the usual French tj^pe of can latrine and
these were emptied by French civilian contractors.
The water supply was from two sources. A tank situated on the
area received water from the wells located on the area of Caserne
Fabvier and pipes had been extended from a tank situated on the
area of Caserne Lamarche which received water from the Moselle
Eiver after passing through a filter.
The sewer system consisted of a series of pipe lines and drains
which received, through catch basins, rain water and liquids from
the kitchens, baths, and urinals.
French civilian contractors had been emj^loyed to carry away
garbage and there was a good incinerator in the rear of the area.
As has alread}^ been stated, this hospital was formed in anticipa-
tion of activities in the St. Mihiel sector, and as originally planned
it was intended to give initial treatment to gas casualties. Later
events showed that tliis was a miscalculation, which experience would
have recognized immediately, inasmuch as Toul was about 15 miles
from the nearest point to the front line. As a matter of record,
only 1G9 cases out of a total of 1,281 came to the hospital without
first passing through a field hopital. where the initial treatment was
gi^•en. Furthermore, it was thought that the gas casualties would be
the first to arrive in the group, and the commanding officer was
instructed to have the hospital clean and with 650 beds set up and
ready for patients within 72 hours.
The arrangement of the hospital was as follows:
The Bassanneau tent was used as the triage and as a receiving
ward. In one corner of the tent a room was sci'eened otf for the
treatment of cases of phosgene-gas intoxication. In this way the
patient was spared the unnecessary handling, oxygen could be admin-
istered promptly, and, if necessary, phlebotomy done at once. This
room was i^romptl}' fitted up and all necessary equipment obtained.
1874 KEPOKT OF THE SURGEON GENKRAT. OF THE ARMY.
Building B was set aside for these cases as soon as their condition
permitted their being moved. Cases of severe mustard-gas intoxica-
tion Avere also sent to building B. inasmuch as this was the only
building equipped Avith bathing facilities. Each of the four large
buildings had in one end, on the lower floor, what was called the
" bathroom," but these rooms were onlj' equipped with small faucets
and there Avere no facilities for bathing. In the building B, hoAv-
CA'er, a French portable bath had been installed in the bathroom and
this shoAver would bathe six persons standing, but only one lying.
It Avas evident that no large number of cases could be handled, and
another portable shower that Avould bathe eight persons standing
was installed before the first patient was admitted.
Equipment. — The equipment was supposed to be complete, and
was fairly complete according to the original French inventory, but
some of the other hospitals on duty in the group had taken many of
the supplies to make up for their oAvn deficiencies before these l)uild-
ings had been specified for hospital ])urp<)ses.
Enlisted 'personnel. — The enlisted men from the special-training
battalion were all classified as class B men, and none of them were
strong and vigorous. Ten of the number Avere not physically equal
to the demands that were made on the others. None of them had
CA^er been attached to the Medical Department and none of them
had any special qualification that made him useful to the hospital.
It Avas evident from the start that each man would have to be taught
the particular work he had to perform. The majority of the men
did not enter into the work with enthusiasm, and their discipline was
very poor.
^Yater y-upply. — The Avater supply was very limited, and so much
so that in running the bath it was necessary to see that the bath was
used at its full capacity at the hours during bathing was permitted.
It was planned to be able to giAe baths to the cases of mustard-gas
intoxication whenever they came in, and we were able to do this
throughout the life of the hospital.
By September T. the hospitals Avere fairly Avell equipped and sup-
plied : the men had been assigned to their various duties and had been
started in their training. The entire plant had been camouflaged
and everything Avas ready for action. On September 8, the first
patient Avas admitted.
On September 8, 15 nurses Avere assigned to the hospital for tem-
porary duty per Special Orders, Xo. 40, headquarters, Justice Hos-
pital group. These nurses were attached to Base Hospital No. 45,
and Avhile they were quartered at the gas hospital they Avere messed
and carried on all reports and returns of their own organization.
On the afternoon of September 18, 1918, the hospital Avas in-
structed to admit medical as well as gas cases. At this time a
severe epidemic of influenza had made its appearance and oAving to
the croAvded condition in the other hospitals it Avas necessary to
admit some of the cases to the gas hospital. This presented a rather
serious problem, owing to the danger to gas cases of secondary in-
fection. All of the respiratory gas cases were immediately segre-
gated and in so far as possible the cases of influenza were isolated.
The installation of cubicles was immediately begun and while
juaterials were lacking the Avork was pushed as rapidly as possible,
A. E, F. — HOSPITAL CENTERS. 18.75
cubiclecl observation ^Ya^ds being established in each building within
24 hours.
After September 20, the number of gas cases admitted begun to
diminish and the number of medical cases to increase. Medical
cases were almost entirely respiratory and enteric.
About this time a rather severe epidemic of pneumonia, due to
the streptococcus hemolyticus, made its appearance and assumed
severe proportions. The severity of the epidemic added very much
to the work of the very limited personnel, both officers and men,
and repeated attempts to have more officers, nurses, and men assigned
to the hospital were made, but the demand was so great in other
units of the group that none could be spared, and on October 8, 1918,
the patients and property of the hospital were turned over to Base
Hospital No. 87, which had just arrived in the group.
Of this total number of 1,281 gas cases, only 169 came directly
from the front, and these found their way by accident and were not
sent back by medical direction. There were but five deaths, all fol-
lowing intoxication with mustard gas. Post-mortem examinations
were made.
Some very interesting facts developed in this very short experi-
ence. Unfortunately there was not time to take careful notes and
collect statistics, but many of the patients were closely questioned,
and the general impression is probably not very far from correct.
First of all, one is impressed by the fact that the large majority of
the cases, fully 75 per cent, were not severely gassed. Of this number
20 per cent were probably not gassed at all. They were rather vic-
tims of exhaustion, shell fumes, etc. Fully 25 per cent of the cases
could have been returned to duty within 24 hours, and fully 50 per
cent could have been returned to duty within from 4 to 6 days. Of
the 828 mustard cases the 5 that died were the only cases that were
considered seriously ill. In only about 20 per cent of the most cases
was the condition severe enough to confine the patient to bed for more
than 48 hours.
The division between respiratory cases and contact mustard cases
was about equal. While some of the skin burns were seveie and ex-
tensive, in none did it appear that the healing would be prolonged to
any degree. The eyes were affected in about 40 per cent of the cases
to a degree to require treatment, but the rapiditv with which they
improved was surprising, and in no case was there real danger to
the sight.
In about 20 per cent of all the cases the diagnoses were by no means
certain. They had been sent back with a diagnosis of mustard-gas
intoxication. On the field card the history was mustard-gas intoxica-
tion, but the signs at the time of admission were the ones that one
might expect of man's being exhausted. They had been without sleep
and their eyes had been irritated bv dust.
Of the phosgene cases less than 12 were sick enough to be confined
to bed for more than two days, and in only one case was it necessary
to do a phlebotomy. Of the other cases of the gas intoxication none
were sick enough to re(]uire any treatment. The cause of the casualty
was always determined in the general way, and it is the opinion of
tlie officers of the hospital that the great nuijority of the casualties
was the lack of discipline in the use of the gas uiask and the lack of
precaution against gas bombardment. Many of the men said that
142367— 19— VOL 2 57
1876 REPORT OF THE SURGEON GENERAL OF THE ARMY.
they took their masks off, as they would rather take a chance without
it than fight with it on. A good number had their masks knocked off
in one way or other. Some admitted that their masks were defective
and that they knew it before going into action. One convoy that was
brought in was shelled in the night and caught in the dugout. No
alarm was sounded until it was too late to protect themselves.
5. Base Hospitals.
a. provisional hospital no. 1.
Mobilization of Provisional Base Hospital No. 1 includes a series
of dates extending from January 3, 1919, to January 10, 1919, during
which time officers, nurses, and enlisted personnel reported for duty^
haying been transferred from various hospital organizations in this
vicinity, moving into fully equipped quarters vacated by Base Hos-
pital _No. 18, situated on the west bank of the Meuse Eiver, adjoining
the village of Bazeilles-sur-Meuse (Vosges), France, functioning as
a base hospital. January 9, 1919. This hospital was organized for
the purpose of continuing the work of Base Hospital No. 18, ordered
evacuated to the United States, taking care of the same class of cases
and assuming control of patients in hospital. The surgical cases are
similar to those encountered in civil practice; medical are largely
made up of contagious cases; meningitis, typhoid, diphtheria, and
scarlet-fever cases from this section are transferred to this hospital
for treatment; pneumonia and influenza cases make up the larger
portion of additional patients.
Total admissions, all classes 1, 877
Total evacuations, all classes 1. 418
Total remaining, all classes, Apr. 1 4.59
B. BASE HOSPITAL NO. 3.
Mount Sinai Hospital, of New York City, the parent of Base Hos-
pital No. 3. was among the first of the civilian hospitals in the late
spring of 1917, when peaceful relations between the United States
and Germany were breached and a state of war declared, to express
its willingness to the Government, through the American Red Cross^
to place a base hospital in the field. Approximately one year before,
shortly after the Mexican outbreak, it had agreed to undertake a
similar project. The need for assistance of the character never be-
came acute, with the consequence that the hospital was not then
ushered into military service.
Assured of a competent group of professional men and a well-
trained corps of nurses, the Army accepted the former into its Medi-
cal Reserve Corps, left the latter in the hands of the Red Cross for
the time being and authorized the recruiting of men for the enlisted
personnel of Base Hosj^ital No. 3.
Confidential orders directing the mobilization of the enlisted men
were received by the commanding officer on November 14, 1917. The
armory of the first field hospital, 56 AVest Sixty-sixth Street, New
York City, was designated as the mobilization and training center.
The entire command was mustered into active service bj' the 20th of
November.
I
A. E. F. BASE HOSPITALS. 1877
Base Hospital No. 3 was officially designated for foreign service
and placed on the priority list on December 15, 1917.
The command comprised of 24 medical officers, 1 quartermaster, 65
nurses, 5 civilian stenographers, and 154 enlisted men, embarked for
over-seas duty on the steamship Lapland at 4 p. m., February 6,
going via Halifax and arriving at Glasgow, Scotland, February 25,
1918. On March 3, organization took station at Vauclaire, Depart-
ment of Doroogne.
An old monaster}' which traces its history back to the fourteenth
century, rehabilitated by the French Government for institutional
purposes, was turned over to Base Hospital No. 3 as its post. The
institution is ideally and beautifully situated in a valley by the side
of the winding stream L'Isle.
The two months following the occupation of the monaster}^ at
Vauclaire were primarily given over to preparatory work, in which
surgeons and physicians alike played the roles of carpenters, road
builders, and plumbers. There were innumerable defects to eradi-
cate, principally, faulty plumbing. Lack of bathing facilities,
though partly alleviated by the presence of the stream L'Isle, was
a drawback. The early arrival of the hospital equipment from
America aided materially in the formative period, expediting the
opening of the hospital.
The first patients to be received into the hospital from sources
other than command were the Artillery Center in Libourne and Peri-
gueux, in accord with plans to have Base Hospital No. 3 receive
medical cases from the neighboring training centers. The initial
hospital train. Hospital Train No. 53, arrived at the railroad station
in Monpont, 2^ miles from the hospital at 7 p. m., May 13, with 104
patients from Base Hospital No. 9, Chateauroux. The evacuation
was completed b}' 9.12 p. m.
Two surgical teams were organized by the direction of the director,
division of general surgery. The teams were later given the desig-
nations Surgical Teams 39 and 40.
Hospital train arrived on the 11th of June, bringing 381 patients
from Base Hospital No. 1. Vichy, by transfer. With the assistance
of ambulances sent from infirmaries at Libourne and Perigueux and
the transportation of the hospital, the patients, many of them con-
valescents, were evacuated in less than an hour and a half. Five
hundred and fifty-eight patients in the wards on that day represented
the largest number in the hospital since its opening. The assign-
ment by the Motor Transportation Service of the motor transporta-
tion, originally purchased bv private subscription, supplemented by
Ked Cross funds, in the second week of June will obviate the neces-
sity in the future of requesting assistance in the evacuation of hos-
pital trains.
Under the provisions of Circular 33, office of the chief surgeon,
American Expeditionary Forces, June 12. 1918, Base Hospital No. 3-
was designated a collecting and observation center for pulmonary
tuberculosis and suspected pulmonary tuberculosis in the American
Kxpeditionary Forces. Cases arising in other liospitals. after a
definite diagnosis is established in which the tubercle bacilli are
found in the sputa, are to be evacuated to Base Hospital No. 3 or
to the other tuberculosis center. Base Hospital No. 8. Cases of
suspected tuberculosis, the circular provides, are to be diagnosed as
.1878 REPORT OF THE SURGEON GENERAL OF THE ARMY.
" tuberculosis observation " and are to be evacuated to the two hos-
pitals mentioned or to Base Hospital No. 20. By this circular,
cases arising onl}^ in Base Sections Nos. 2, 6, and 7 are to be re-
ceived at Base Hospital No. 3. To the end of June no cases of the
nature described had been received by Base Hospital No. 3.
C. HASE HOSPITAL NO. 5.
Infroductwn. — On November 11, 1918, United States Army Base
Hospital No. 5 was situated in Bouloone-sur-Mer, occupying th(
large municipal building in the city and operating No. 13 General
Hospital, a G50-bed hospital which belonged to the British Expedi-
tionary Forces. AX the time the armistice was signed the hospital
had been serving with the British Army since May 30, 1917, function
ing as a British base hospital, and was so organized as to be part of
the Boulogne base, which constituted a hospital unit of some 10,000
beds.
Function of the hospital. — The chief function of the hospital, there
fore, was to act as an integral part of a large unit and to take care of
the sick and wounded admitted according to the plan of the British
deputy director of medical services in the area. The patients in a
general way were drawn from the northern end of the line, extend-
hig from the Belgian front to Cambrai. The majority of the hos-
pital admissions were British troops, although after January 1. 1918
many sick and wounded from American divisions brigaded in this
area^vere treated in our hospital. Our. patients were brought from
British casualty clearing stations on ambulance trains to railway
sidings near Boulogne, when they were admitted by ambulance to the
various hospitals in the base, according to the directions of the Brit-
ish evacuation medical officer. Our share in the service can best be
illustrated bv quoting the hospital admissions from November 1^
1917, when we entered the hospital, until January 1, 1919, when oui
work practically stopped. During this time we admitted 11,608
British soldiers "^suffering from disease, 9,183 suffering from wounds
or shell gas poisoning, 3,502 American soldiers suffering from dis-
ease, and 1,320 with wounds or shell gas poisoning, making a grancT
total of 25.G21 admissions in the 13 months under consideration,
Obviouslv, with so much material, it was necessary to evacuate on
si( k and wounded as fast as possible. This was done in three waya
The lightest cases were kept in hospital until they could be returne'
to the tine for dutv. The mildly sick, gassed, or wounded were kep
in hospital until tliev were sufficiently fit to go to adjacent convales
cent depots, where they remained under less stringent observation
until they were well. Finally the -eriously sick and Avounded were
sent to England by hospital ships as soon as they were able to travel
The American soldiers were treated in the same fashion as th^
British. . . ^ . .
Orqariizatioih of the hospUal.— The internal organization ot the
hospital was relatively simple. The commanding officer, adjutant
company commander.' and quartermaster attended to the hospital
•administration and such problems as discipline, paper work, anc
rations. The professional services were divided into medical anc
surgical staffs, each under the head of a senior officer, who supervisee^
A. E. F. BASE HOSPITALS, 187 9"
the Avork of his juniors. The nursing staff was under a matron, who
delegated the nurses to their various duties. Finally, close coopera-
tion amongst all these branches of the hospital was maintained by
frequent conferences.
Accomplishments of the hosjntal. — The accomplishments of the
hospital were fourfold. The main accomplishment was to keep the
work and reputation of the hospital at as high a point as possible.
Of second importance was the training of medical officers for work
with the American Expeditionary Forces, so that they became con-
sultants, teachers in the Armv medical school, or laboratory workers.
Thirdly, was the formation of a mobile hospital which operated
with the American Expeditionary Forces and was developed from
a nucleus of our original officers, nurses, and men. Finally, was the
accomplishment of research work in medical and surgical problems
by members of the hospital staff, even at times when the pressure of
routine work was greatest.
Chronological account of the hospital. — ^This hospital was organ-
ized about a year before the United States declared war upon Ger-
many. Of the original members two were detached before we ac-
tually began operating a hospital in France. The unit, consisting
of 24 medical officers, 2 dental officers, 64 nurses, and 153 enlisted
men, sailed from America on May 11, 1917; passed through Eng-
land, where it was treated with great hospitality by various distin-
guished persons, and landed in France May 30, immediately begin-
ning to operate British General Hospital No. 11, situated between
the small towns of Dannes and Camiers, about 14 miles outside of
Boulogne-sur-^Ier. The work was new to officers and men and was
throughout the summer fairly arduous. We were obliged to ask
for reinforcements, as the hospital contained 2,000 beds and we were
only equipped to take care of 1,000. These reinforcements consisted
of i.) nurhics, who arrived July 19, 1917, and 40 enlisted men, who
arrived July 30.
The total number of cases handled since the hospital started opera-
tions was 45,837. It inay be mentioned that during one period of
24 hours we admitted to hospital and cared for 964 cas s of sick
and wounded. On the whole the hospital has been busy all the time
since it began to work and was driven at full speed in June, 1917,
after the Battle of Messines Ridge, in September and October, 1917,
after the Battle of Passchaendale Ridge, and in March, 1918, after
the German offensive near Cambrai. During the night of Septem-
ber 4, 1917, the hospital was attacked by enemy aircraft and we sus-
tained the first casualties of the American Army in France since the
declaration of war. The hospital was plainly marked and there
seems little doubt but that this was a deliberate attempt by the enemy
to well ome the first American troops into the fighting zone. Owing
to the somewhat insanitary conditions of the camp ground the hos-
pital was moved on November 1 to Xo. 13 General Hospital, British
Expeditionary Forces, in Boulogne-sur-Mer, occupying the large
municipal casion building, where it has remained ever since. Though
containing fewer beds than the hospital at Dannes-Camiers the cases
were of a more severe character, involving great care and additional
surgical and medical attendance.
1880 REPORT OF THE SURGEON GENERAL OF THE ARMY.
D, BASE HOSPITAL SO. G.
Base Hospital No. 6 organized and preparations made for mobili-
zation of unit, June, 1916, to June, 1917.
June 1, medical detacliment proceeded to Fort Strong.
June 29, nurses left Boston for Ellis Island.
July 9, officers and men left Boston.
July 10, went on board Steamship Aurania at New York.
July 11, unit sailed at 4.45 p. m.
July 23, arrived at Liverpool at noon. Traveled directly by spe-
cial train to Southampton.
July 24, spent the day in Southampton waters, off Cowes, on Aus-
tralian hospital ship Warilr/a. Sailed for Le Havre at 7 p. m.
July 25, arrived at Le Havre at 2 a. m.
July 28, arrived at Bordeaux at 11.30 a. m.
September 1, Frt^nch Hospital Complementaire No. 25 (Petit
Lycee de Bordeaux), Talence, turned over.
April 3, first large convoy received, American Ambulance Train
No. 53, from up the line. Patients chiefly convalescent, some from
slight wounds received in action. Number of patients, 326.
April 8. French convo}- received, mostly sightly wounded. Number
of patients, 99.
May 13, second large convoy chiefly convalescent from slight
wounds and gas. Number of patients, 399.
June 4, second French convoy, mostly slighty wounded. Number
of patients, 80.
June 14 and 19, third and fourth convoys, together more than a
thousand Americans, fresh from the front at Chateau-Thierry and
Montdidier, chiefly wounded and gassed.
First patients admitted August 21. 1917.
July 9, 1918, Convoy No. 7, French train, from French hospital,
Beauvis. 128 patients, American.
July 22, 1918, Convoy No. 8, Sanitary Train No. 64, from American
Eed Cross hospital. Paris; 630 patients, American.
July 23, 1918, Convoy No. 9, Sanitary Train No. 60, from Ameri-
can Red Cross hospital. Paris; 662 patients. American; 37 French
patients received from French convoy.
July 24, 1918, Convoy No. 10, French train, from American Red
Cross hospital, Paris; 50 patients. American.
July 26. 1918. Convoy No. 11, Sanitary Train No. 58. from Ameri-
can Red Cross hospital, Paris ; 578 patients. American.
July 29, 1918, Convoy No. 12, British Train No. 36, from Evacu-
ation Hospital No. 8 ; 204 patients, American.
The striking thing for the month of July is the emptying of the
pneumonia, meningitis, scarlet fever, mumps, and measles wards.
During the month there have been only occasional cases of these in-
fections. The medical wards are now filled with a rather mild type
of poisoning by gas, chiefly mustard gas, and by a fairly large group
of war neuroses.
A system of tests has been inaugurated to determine the fitness of
men who have been gassed to return to the front. By seeing how
long they can hold their breath, how hard they can blow, how they
bear walking or running with gas masks on, and by watching base-
A. E. ¥. BASE HOSPITALS. 1881
ball games organized between gas wards, it has been possible to check
lip statements of patients as to their degree of disabilitj'.
Dysentery, chiefly acute bacillary, with occasionally a chronic case
of amebic, has begun to appear.
Number of admissions to hospital during July, 3,115.
Number of patients in hospital July 31, 2,332; number of beds,
2,600.
Number of surgical operations during July. 325.
August 1. 1918, Convoy No. 13. British Train No. 37. from Evacua-
tion Hospital No. 7 : 150 patients. Americans.
August 9, 1918, Convoy No. 14. Sanitary Train No. 53, from Paris
hospitals; 489 patients.
August 10, 1918, Convoy No. 15, British Train No. 31, from Paris
hospitals; 501 patients, Americans.
August 18, 1918, Convoy No. 16, Sanitary Train No. 61. from Base
Hospitals Nos. 18. 66, 116; 300 patients. Americans.
August 20, 1918, Convoy No. 17, Sanitary Train No. 52, from Base
Hospitals Nos. 46, 18; 360 patients, Americans.
August 23, 1918, Convoy No. 18, Sanitary Train No. 51, from Base
Hospital No. 17 ; 305 patients, Americans.
August 28, 1918, " crisis emergency " capacity of hospital increased
to 3,898 beds and cots, including Red Cross huts and corridors.
August 30, 1918, Convoy No. 19, Sanitary Train No. 53, from Base
Hospitals Nos. 31. 32 ; 398 patients. Americans.
Number of admissions to surgical service during the month, 2,475.
Number of operations, 673.
Number of admissions to hospital during August, 3,165.
August 31, 1918, number of patients in hospital, 2,971; normal ca-
pacity, 2,600 beds.
September 5, 1918, Convoy No. 20, Sanitary Train No. 54, from
Base Hospitals Nos. 66, 17, 15 ; 380 patients, Americans.
September 6, 1918, Convoy No. 21, Sanitary Train No. 56, from
Base Hospitals Nos. 18, 42, 43. 46. 116; 180 patients, Americans.
September 26, 1918. Convoy No. 22, Sanitary Train No. 64, from
Evacuation Hospitals Nos. 6, 7; 449 patients, Americans.
September 28, 1918, Convoy No. 23, Sanitary Train No. 54, from
Base Hospitals Nos. 52, 58 ; 450 patients, Americans.
The epidemic of short fevers reported in the history for August,
1918, became much more serious and extensive during the month of
September, whereas in the earlier months many of these fevers were
over in three days, the majority of them run from four to eight days,
and the incidence of broncho-pneumonia has very much increased.
Indeed, a great majority of the cases probably had some infection of
the lungs. About 10 per cent of the cases were very serious, and
nearly that number proved fatal, the autopsy showing in every case
extensive broncho-pneumonia.
Largest number of patients in hospital during the month (Sept.
7). 3,134.
The epidemic of influenza reached its height during the first week
of October, declining sharply during the second week and at the end
of the month was nearly extinct, so far as concerns cases originating
in our own unit or brought here from the base. This corresponds
roughly with the condition of things the Avorld over. Indeed, there
seems to have been only a few weeks' difference between dates on
1882 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Avhich the epidemic be^ran in each of the countries of the world. As
one attack appears to give immunity, we do not anticipate a renewal
of this epidemic from local sources, though the hospital beds may
again be occupied by cases of influenza brought in from epidemics
originating elsewhere. The cases originating in our own unit, and,
therefore, "seen early and promptly put to bed, have, as a rule, been
mild. Tlie severest cases have been those in persons debilitated
either by the nature of their work or by the travel to which they
have been subjected on their way to the hospital.
The receipt of large numbers of wounded made the surgical service
busy again after its relatively quiet month of September. A change
occurred this month in the "policy regarding the work of the dis-
ability board, whereby surgical cases which formerly were kept in the
hospital for operation are now sent directly to the United States,
three hundred and eighty-two operations were performed.
The epidemic whic-h attacked us during October did not recur
in November, though a few cases were admitted from time to time,
all very light, and few. if any, such as would be recognizable outside
of an epidemic. Approximately 63 enlisted men, 18 nurses, and 8
officers of our own command were attacked — approximate figures be-
ing given because of the number of cases in which the diagnosis was
doubtful.
There were 1,009 surgical cases received during the month of
November, a marked falling oft' from the previous month. Opera-
tions to the number of 446 were performed.
Cases were evacuated to the United States rapidly throughout the
month, in convoys of 100 to 400. Early in the month it became im-
possible to evacuate "A" cases, which accordingly have accumu-"
lated and been segregated in convalescent wards, without nursing,,
or medical records.
There has been no recurrence of the September-October epidemic,
though scattered cases have been given that diagnosis.
The number of cases of pneumonia and meningitis has been also
notably small so that we have had no pneumonia ward, a striking
contrast with last year and with our expectations.
For the most part our ward space has been taken up with cases of
rheumatism, bronchitis, flat foot, hernia, etc., sent down from hos-
pitals nearer the front. Most of the cases are for evacuation to the
United States.
SUKGICAL SERVICE.
The large majority of surgical cases received were sent from other
hospitals for classification and return to the United States. Only
urgent operations such as acute appendicitis, abscesses, empyemas,
and hemorrhages were performed. At the end of December 3,442
operations liad been performed in this hospital out of 17,466 cases
on the surgical service.
January 1, 1919, Convoy No. 39, Sanitary Train No. 53, from Base
Hospital No. 7; 394 patients, Americans.
January 6, 1919, Convoy No. 40, Sanitary Train No. 64, from
Vichy hospital center; 485 patients. Americans.
January 8. 1919, Convoy No. 41, from Camp Hospital No. 39 and
Base Hospitals Nos. 19, 1, and 115; 60 patients, Americans.
A. E. F, BASE HOSPITALS. 1883.
January 14, 1919, United States Army Base ITospital Xo. G closed
all hospital records and ceased functioning as a hospital at midnight
of January 1, 1919.
February 4, 1919, orders received for United States Army Base
Hospital No. G to prepare for embarkation.
February 10, 1919, embarkation orders received placing United
States Army Base Hospital No. 6 on priority list at Bordeaux.
I February 14, 1919, 24 officers, 69 nurses, and 3 civilian secretaries
i embarked from Bordeaux on steamship Ahengarez.
E. BASE HOSPITAL NO. 7.
As the result of a visit to Boston on February 22, 1916, by Lieut.
Col. Kean, a Red Cross base hospital unit was organized, which after-
wards became designated as Army Base Hospital No. 7. The offi-
cers, nurses, and enlisted personnel were originally chosen from the
medical and nursing staff of the Boston City Hospital. The hospital
as originally organized was financed and equipped by the Red Cross
to care for 500 patients, and was to be made use of in a civil capacity^
such as a flood or fire, and in case of war was to be taken over by
the AVar Department. After the declaration of war in April, 1917,
the medical director was informed that the hospital unit would be
taken over as an Army base hospital and that the members of the
staff should apply at once for commissions in the Medical Reserve
Corps; also that since the new plan for Armv base hospitals called
for a staff and equipment for a 1,000-bed hospital, it would be neces-
sary to make an addition of about 12 officers, 25 nurses, and 50 men.
A number of the officers were called into service during the middle
and later part of 1917. but no official orders toward the mobilization
of the hospital as a whole were received until February, 1918, when
the enlisted personnel (numbering then 153) were sent to Camp Dev-
ens, Mass. On July 6 the unit (except the nurses) left Camp Devens
under overseas orders, arriving at Hoboken, N. J., July 7, from
where it sailed on the Leviathan July 8 and landed in Brest, France,
on July 15, 1918, wliere it camped for two weeks near Pontenezen
Barracks. It was then ordered to Jaue-les-Tours, arriving July 30,
1918, where buildings had been completed for one 1,000-bed hospital,
with buildings under construction for similar unit adjoining the
first, both units on the estate of Le Conte du Chauffault at " Clos
St. Victor."
r. BASE HOSPITAL NO. 8.
Organization. — In February, 1917, the postgraduate hospital. New
York City, formulated the plan to equip a medical unit from that
hospital, should later events prove that the United States would be
drawn into the war and troops ordered to France. It was planned
to raise $100,000 by private subscription to be used in the purcliase of
supplies and equipment for a 500-bed hospital unit, and then to
recruit to authorized strength of approximately 30 officers, 65 nurses,
and 150 enlisted men. The Government gave its official recognition
and ordered the recruiting to start. The American Red Cross was
the first sponsor, but Washington assigned the unit a number and
advised that when the formation was ' ompleted the United States
Army would appoint a connnanding officer and all orders would be
1884 REPORT OF THE SURGEON" GENERAL OF THE ARMY.
transmitted through him. Tlie final enlistments for the men were
completed on May 26, 1917. The unit reported " ready " at this time,
and between rumors of France, Russia, Egypt, and Siberia as a de-
barkation point, everyone was kept in a more or less expectant state.
But delays arose and changes came, and it was not nntil July 18,
1917, that the orders finally were issued calling everyone into active
service and bidding them report on that date for dntv at Fort Jay,
Governors Island, K Y. (S. O. 14, Jnly 17, 1917, Hq. S. E., U. S. A.)
G. PROVISIONAL BASE HOSPITAL NO. 8.
As the autumn of 1918 waned and the increasing activities along
(he entire front caused the casualties to mount into thousands, the
need and urgency of increased hospital space and facilities became
manifest. To meet this need was issued General Order No. 16, on the
15th day of October, 1918, which established Provisional Base Hos-
pital Unit No. 8. A medical officer attached to Base Hospital No. 54
was placed in command of a body of medical officers, assembled from
various organizations throughout the center.
In mood appreciative, rather than critical, mention must be made of
conditions which all war-time hospitals had to meet, and some few
others peculiar to Unit No. 8, making a personnel less fearful, aghast,
but in its ultimate analysis proving how versatile may be a body of
men working under a most efficient executive. The wards, 10 in num-
ber, were planted in 2 feet of mud. Their hurried occupation made
impossible any system of drainage, and daily this sacrificing body of
men and women waded through pools of mud until the comfort of
their sick charges was assured, after which minds schooled in sur-
gery and medicine turned to problems of masonry and carpentry,
resulting in the luxury of the walks outlining the hospital streets
to-day.
The water system was most primitive; no water other than that
transported by water waofons was available. An innovation, which
counteracted this Old World method, was a hospital order placing
lister bags under the control of the laboratory, with a trained man in
charge. He gave his undivided attention to the filling and cleanli-
ness of the bags and disinfection of the water, thus cutting down the
bacterial count in a water supply that had been proven to be far from
satisfactory.
With carpenters completing unfinished roofs the wards were
opened to receive patients the 19th day of October, 1918. The
patients proved to be disal)led German prisoners of war, and aside
from a few medical cases, they were of a minor character. From the
first day it was possible to give every patient a comfortable bed, an
abundance of substantial food, and by untiring effort medical and
surgical care. As the enrollment grew so the need of a larger staff of
officers and nurses.
The surgical department of the hospital has been one of constant
activity, receiving more than 50 per cent of patients admitted. The
general plan of all wards has been the same. In five wards are gath-
ered general surgical cases, Avhile venereal and minor surgical cases
were imtil recently housed in wards of smaller limitations. Each
ward had been under the care of at least one medical officer, and when
the roster permitted, two, directed by the chief of the surgical serv-
A. E. F. BASE HOSPITALS. 1885
ice. Rounds of each ward are made twice daily by the chief of service,
accompanied by the ward surgeon and nurse in charge, who are held
responsible for the cases in their respective wards.
The large majority of patients have been battle casualties, of which
80 i^er cent have been returned to duty. There have been admitted
for surgical treatment since October 19, 1918, approximately 1,100
cases, embracing civil surgery and line casualties. There have been
no mortalities, and while some 5 per cent may be disabled for some
lengthy period, 95 per cent will return overseas equally self-sustain-
ing and independent of family helps and Government care as when
they left their threshhold. In our experience of caring for war
wounds the Carrel-Dakin technique, it would seem, has been most
efficacious. Extensive wounds are rendered sterile, enabling us to do
secondary suture. 85 per cent of which have been successful. Those
of minor extent are healed with great rapidity. These results have
been effected with constant and generous cooperation of the labora-
tory and with vigorous bacteriological control.
A feature of the surgical department is the operation pavilion. Its
efficiency is attached by the fact that every commonly called " clean
case " ]ias been unattended by infection. The abnormal war-time con-
ditions inimical to sterile surgery have been met with by constant vigi-
lance, daily inspection, and by educating the corps to sense the import
of ceaseless scrubbing and unquestioned cleanliness. Two operating
tables furnish adequately our needs. The regulation supply of in-
struments furnished to base hospitals were available, and all equip-
ment necessary to a functioning operating pavilion were supplied.
The establishment of a central dressing station has been found not
only satisfying but an economizer of time and supplies, and has
tended to standardize the method of treatment for wounds of all
ambulatory patients.
Influenza patients were considered if not virtual at least potential
pneumonias, and the appearance of acute symptoms or recurrence of
temperature prompted us to treat such cases as utter bed patients.
Suspicious pneumonias were isolated in the smaller wards of the
building and special care and attention exerted in their behalf. As
an apparent result of these ]irecautions. but few cases of pneumonia
developed at this hospital at a time and under conditions when this
complication was rampant and mortality alarmingly high.
As we write this brief sketch in our present comfortable adminis-
tration building of well-ordered offices, we recall the day of our ar-
rival, when we were obliged to lay down the pen and paper to wield
the hammer and saw. Records had to be kept, statistics compiled,
and reports rendered. But where could it be done? This serious
problem was fortunately solved by the discovery of a dingy ante-
room of the patients' bathliouse. In spite of the fact that it afforded
no protection from the inclemency of the weather, being both door-
less and windowless, the sign " Headquarters Provisional Base Hos-
pital Unit No. 8, A. P. O. 798," was hung over the wide and gaping
portal of this haven. With the meager shelter of tar paper covering
the holes meant for windows, our resourcefulness was taxed to de-
sign and build office furniture. As boxed provisions arrived at the
mess hall and wood cartons were emptied, we " managed " crude,
unplaned sides and covers of boxes for potential chairs and desks.
With ability more practical than artistic these boards gradually as-
1886 REPORT OF THE SURGEON GENERAL OF THE ARMY,
Slimed the shapes and forms of benches and tables, upon which were
Lnid oiir office equipment — a typewriter, some tissue paper, histories
of patients and their field medical cards.
Some statistics must be given here which would indicate in a
measure the work achieved by Provisional Base Hospital Unit No. 8.
Since the 15th day of October, up to this present date, 2,348 patients
have passed through the receiving ward of this hospital. Of this
number, 2,311 have come to us as casualties from the front lines, while
37 patients were members of the hospital detachment taken ill or sus-
taining injuries in line of duty. To-day 715 patients occupy beds in
our hospital, there being no class A men present, these being evacu-
ated as fast as they accrue. Of the 1,598 soldiers sent from this hos-
pital, 95 per cent are fit to render useful service to their country and
themselves.
H. BASE HOSPITAL KO. 9.
In spring of 1916, at the request of the American Red Cross, the
board of governors of the New York hospital, West Sixteenth Street,
New York City, organized what was then known as a Red Cross base
hospital unit. This unit existed simply on paper and did not take a
more definite shape until after the United States entered the war, in
April, 1917. It was then that the personnel was assembled and the
equipment provided. On July 21, 1917, the organization, which was
called United States Army Base Hospital No. 9, was mobilized pur-
suant to paragraph 1, Special Orders, No. 13, Eastern Department,
July 16, 1917 — the officers and enlisted men on Governors Island and
the nurses and civilian employees on Ellis Island. The personnel at
the time consisted of 27 officers, 1 noncommissioned officer, 64 nurses,
5 civilian secretaries, and 150 enlisted men. This organization left
New York on the U. S. transport Finland on August 7, 1917, and
arrived at St. Nazaire, France, August 20, 1917. The next day the
organization proceeded to Savenay, where it was quartered with
Base Hospital No. 8. On September 2, 1917, 10 officers and 75 men
of the hospital arrived in Chateauroux, Indre, the permanent loca-
tion of the hospital. These officers and men constituted the first
American troops in that town. The detachment began the work of
preparing the hospital buildings for occupation. The buildings had
been constructed shortly before the war for an insane asylum, but at
the outbreak of the hostilities had been taken over and used as a
French military hospital. Some of its French patients were still
there under treatment when the American unit arrived. On Sep-
tember 7, 1917, the nurses and the remainder of the officers and men
came to Chateauroux. and on the 15th of September the first patients
were admitted to the hospital. During the month of September
tentative plans for the enlargement and alteration of the hospital
plant were completed, and at the end of this month a detachment of
Engineers arrived to begin work. This group was later augmented
by a small detachment of Infantry, which was ordered away before
the completion of the work. The construction continued as steadily
as the arrival of material would permit. It involved the making of
innumerable repairs, a thorough overhauling of the heating system,
marked enlargement of water supply and sewage-disposal plants,
the erection of some 14 barracks to be used as wards and 11 others to
be combined and form as a group the admission building, the in-
A. E. F. BASE HOSPITALS. 1887
stalling of the X-ray plant, and the enlargement of the electrical
system.
On March 31, 1918. the first gi'oup of wounded patients came in on
a hospital train from the Montdidier sector, and from this time on
until the signing of the armistice the wounded came in at frequent
intervals. The number became larger and larger until the 1st of
August, Avhen it became obvious that more provision must be made
to house them. A detachment of Engineers was hurriedl}' sum-
moned from Montierchaume and erected four new barracks. About
the same time the ecole normal at Chateauroux was taken over as
an annex and 150 patients were sent there. Plans were formed for
a convalescent camp to care for 1,000 patients, and this camp was
nearly completed when the armistice was signed. At this same time
the hospital had the largest number of patients under treatment at any
one time during its history, the figure being 2,250. The total number
of patients treated during the time that Base Hospital No. 9 was
operating was 15,200.
During the spring of 1918 Base Hospital No. 9 became an ortho-
pedic center. Reconstruction aids were sent to help in the treatment
of the cases, and an orthopedic workshop was started. Further,
officers who were to be detailed to orthopedic work elsewhere in the
American Expeditionary Forces came here to spend two weeks study-
ing and observing the cases before being sent on to their proper
stations. At the same time the hospital continued to care for a great
number of medical and surgical cases.
I. BASE HOSPITAL XO. 11.
United States Army Base Hospital No. 11 was organized and
equipped by the Chicago Chapter of the American Eed Cross May
1, 1917. It was called into active service March 4, 1918, went to
Camp Dodge, Iowa, April 2, trained at the base hospital there for
11 weeks, embarked from Hoboken, N. J., June 28, arriving at Nantes,
France, July 16, and immediately set to work. For six months it
operated, caring for 5.902 patients and losing only 51 by death.
Then, January 14, 1919, plant and equipment were turned over to
another organization. The medical, nursing, and enlisted personnel
of base 11, as casuals, turned faces westward, eventual!}' sailed for
home, and all were back in civil life again two years from the time
the organization was born.
Originally planned as a 500-bed hospital, base 11 was composed of
25 officers, 65 nurses, and 153 enlisted men. After mobilization, the
bed capacity was doubled. The medical staff was increased by 10, the
nursing staff by 35. the enlisted personnel by 50. Three weeks after
joining the American Expeditionary F'orces the hospital was caring
for 750 patients, and shortly its capacity Avas increasd to 1,500 beds.
A little later base 11 took its part in the terrific Argonne forest drive
hundreds of miles northeastward; the 1,500-bed capacity became
almost overnight a 2,500-l)ed capacity. On October 15 the hospital
reached the peak of its activities in caring for 2,386 patients.
The medical and nursing staffs were drawn from St. IVIary's of
Nazareth, St. Joseph's, and Augustana Hosintals, Chicago. The
enlisted personnel was composed of young business and professional
men and college students from Chicago and surrounding communi-
1888 REPORT OF THE SURGEON GENERAL OF THE ARMY.
ties. From the time of organization until called into active service
the enlisted men drilled often and regularly in armories and parks
and attended ^veekly technical lectures given by members of the
medical staff or by soldier lecturers back from the front. Thus by
the time the men were mobilized they were acquainted with many of
their officers, were able to drill fairly well, knew something about the
work they were to do in France, in short they were an outfit.
As a unit composing United States Army hospital center at Xantes,
France, base 11 occupied wooden barracks of the standard type, situ-
ated on an estate. Grand Blottereau, at Doulon, a suburb about 3 miles
from the heart of the city.
The record of the hospital stands without necessity of praise.
Speaking for themselves and for nearly 6,000 patients, officers and
men of the organization pay tribute to the devotion, energy, skill, and
gentleness of the nurses in caring for the wounded and sick under
circumstances frequentl}^ harsh. As for relations between medical
staff and enlisted personnel, each group champions the intelligent,
capable, whole-hearted labors performed by the other. General ac-
tivities of the organization in full detail are given under various
departmental headings on the following pages.
The surgical patients gradually increased in number from the time
of opening the hospital until the maximum of 1,680 was reached on
Xovember 1. As far as possible different types of cases were segre-
gated to resi^ective wards: that is, fractures in certain wards, chest
cases in certain other wards, etc. Dakin solution with Carrel tech-
nique was used on all cases at all times in this service. Surgical
cases upon arriving at the hospital were fed, bathed, and allowed to
rest until the following day before being dressed, except in cases of
emergency. The time of delayed primary and secondary closures
was based entirely on culture and bacteriological count. Fractures
were treated as far as possible by suspension from Balkan frames
with extension in Thomas splints. Casts were applied for trans-
portation to the States when wounds permitted.
Medical-service cases consisted of gas. pneumonia, influenza, and
war neurosis. Gas cases were treated by the American Expeditionary
Forces' method as advised by chief surgeon's office. Pneumonia : All
cases treated symptomatically, no serums being used. Pneumonia
wards were thoroughly ventilated and patients cubicled, with en-
forced rest in bed for at least two weeks after convalescence. In-
fluenza : Treated symptomatically, no serums being used. All cases
were isolated in separate wards and cubicled.
The patients treated were only those who were confined to the
hospital and the medical detachment on duty at the base. Although
Base Hospital Xo. 11 arrived at its present location in the American
Expeditionary Forces July 16. 1918. it was not until about the 10th
of August, 1918, that the dental department was able to continue its
work, due to the fact that equipment which was shipped from the
States had not yet arrived.
In the maxillo-facial work of the dental department 24 cases of
mandibular fracture and 9 cases of fracture of the maxilla were re-
duced, immobilized, operated, and dressed. All but two of these
cases were the result of gunshot wounds received in ad ion, and many
of them required plastic operation, localization, and removal of
A. E, F. BASE HOSPITALS. 1889
foreign bodies, bone fragments, etc. Of all cases treated at Base
Hospital No. 11 by this department none were evacuated without
having first been permanently splinted, and only two cases were sent
out in which consolidation was not at least partially established.
Two patients in this service died, one 48 hours after arriving at the
hospital, the other after one week's treatment. In both cases the
cause of death was found on autopsy to be due to pneumonia.
Conjunctivitis, acute, due to gas contact, usually mustard; cases,
147. Four of these entered the hospital with definite corneal lesion,
strippling, and haziness. No permanent lesion resulted. About 50
per cent of cases cleared up in from 3 to 4 weeks, 25 per cent left the
hospital for duty in from 6 to 8 weeks, and 25 per cent suffered from
lachrymation and photophobia after 3 months, in which strenuous
treatment was instituted. Treatment during the first few days con-
sisted of boric acid flushings several times a day, cold compresses,
and in the severe cases atrophine, dionin, and occasionally cocaine
was necessary. Dark glasses were not used, but the patient was en-
couraged to build up tolerance to light. After acute stage subsided
some cases were not treated to compare with cases treated with copper
citrate and tannic acid. It was found that the treatment did not
hasten recovery.
Gunshot wounds of face, affecting eyes and lids, 14 cases. Two of
these had resulted in enucleation of both e3^es. One case in which
both eyes Avere rendered blind by scars on the cornea. Two cases in
which rupture of choroid resulted in loss of eye. Detached retina
in one case. One case of traumatic cataract, and two of traumatic
iritis. Orbital cellulitis, in one case, by extension. Plastic repair
of the lids was required in three cases. Enucleation was required in
two cases, in which foreign bodies had been removed at evacuation
hospital and panophtalmitis resulted.
During four months 1,400 individual patients were X-rayed.
Foreign bodies were encountered in 216 patients. Thirty-five foreign
bodies were localized, most of which were removed in the general
operating room.
All executive and administrative departments connected with the
detachment of patients were conducted under one head in the depart-
ment of the registrar. These various departments were in charge of
members of the hospital medical detachment whose efficiency in the
discharge of their duties was obvious throughout the period of opera-
tion of the hospital and contributed largely to the success of the
hospital as an effective institution.
The registrar, as commanding officer of the detachment of patients,
assumed control of the entire department, personally attending to
the discipline of patients, and to the answering of the large volume
of correspondence relating to patients.
The receiving ward entered all patients into the hospital, assigned
them to the proper wards, made record of the initial clinical data,
and renderecl the required reports of the admission and diagnosis
of each patient. During the period between July 16, 1918, when
the personnel of United States Army Base Hospital No. 11 arrived
at Nantes for duty, and January 14, 1919, when the hospital and
patients were transferred to Evacuation Hospital No. 28, 5,900
patients were thus admitted.
1890 ni:PoitT of the suRGKOisr general of the army,
J. BASE HOSPITAL NO. 13,
On July 15 we reported that we could receive 500 medical cases,
and on July 19 we received 585, of whom 450 were surgical and 135
medical. These cases were received and distributed to the wards and
given their first attention without confusion or delay. By July 31
we had received 1,057 cases, of whom we had returned 94 to duty.
Our hospital was suddenlv expanded from its normal capacity of
1,500 beds the latter part of the month to 2,300. This was due to
pressure from the front areas, apparently. Every available space
has been utilized for patients and personnel. Many patients are
sleeping on straw-filled ticks, and as many beds as possible have been
procured from other hospitals and the hospital center of Limoges,
but in spite of the best efforts all of our patients can not be given
beds. The lighter cases have been put to sleep on the floor of build-
ings never intended for ward purposes, such as the assembly room in
the large Eed Cross hut. Many severe gunshot wounds are received
and many severe medical cases, some in an extreme condition and
two dead. The extra work thrown on our personnel, which is already
depleted, is overworking all, especially officers and nurses. During
the month we have had under treatment 3,105 patients, of whom 305
were returned to duty, 510 sent to restricted duty, 132 invalided home,
32 died, and 11 transferred to other hospitals, a total of 918 cases,
leaving on our hands and having in hospital 2,187 on October 30.
K. BASE HOSPITAI. NO. 20.
American Red Cross Base Hospital No. 20 was organized at the
University of Pennsylvania. All of the original medical officers
with one exception were connected with the latter institution. The
great majority of the nurses and a large percentage of the enlisted
men came from the same institution. Several of the officers, nurses,
and men were ordered to active duty as individuals, and the ma-
jority of the officers and men were mobilized in Philadelphia on
November 30, 1917, and were trained for their future duties till
April 1, 1918, Avhen they went to Camp Merritt and sailed from
New York on the Leviathan on April 22. The majority of the
nurses were mobilized at Ellis Island, N. Y., on February 18, 1918,
and remained there till they sailed with the unit on April 22. Base
Hospital No. 20 arrived at Brest, France, on May 3, and at their
final destination, Chatel Guyon, on May 7, 1918. Base Hospital
No. 20 brought to France hospital equipment and cash to a value
of about $125,000 which had been provided by private subscrip-
tions very largely through other than Red Cross channels. Chatel
Guyon is a charming summer health resort situated in the Auvergne
Mountains southeast of the center of France, in the French Province
of Puy-de-Dome. Base Ho^^pital No. 20 was assigned to various
summer hotels (formerly used as French military hospitals), villas,
and garages, and from time to time further buildings up to a total
of 33 were rented and occupied.
It is worthy of comment that officers, nurses, and enlisted men
alike worked with unfailing energy and devotion in order that
Base Hospital No. 20 should functionate as a hospital as quicklj^ as
possible. An eloquent tribute to their hard work is the fact that
\\
A. E. F, BASE HOSPITALS, 1891
one month after the organization landed at Chatel Guyon, the
hospital was opened and 500 beds were ready for the reception of
patients. The first train of patients, consisting of 359 cases, ar-
rived on Hospital Train No. 51 on June -8. They had all been
evacuated from base hospitals nearer the front and none of them
was very serious.
On July 17, Hospital Train No. 53, carrying 411 patients, ar-
rived. These were the most acute battle casualties that had been
received up until that time. Many of the patients were gassed,
mostly by mustard, some by phosgene and chlorin. There were
also a large number of acute surgical cases, many of whom had
passed so rapidly through the field and evacuation hospitals that
they had not been operated upon. On their arrival at Base Hospi-
tal No. 20 it was necessarv^ to locate the foreigTi bodies and also
perform debridgements on a number of the wounded. This trainload
of patients came from the Chateau-Thierry front and were among
the early casualties of the second battle of Chateau-Thierrj'.
On July 25, Hospital Train No. 54 brought the largest and most
serious trainload of patients to Base Hospital No. 20 that arrived
at any time during the summer of 1918 : There were 587 cases,
all from the Chateau-Thierry front, and the majority of them sur-
gical, suffering from various types of gimshot wounds. Most of
these patients had had primary operations done upon them in the
evacuation hospitals around Paris, but even so, a considerable num-
ber had to be operated upon immediately after their arrival at Base
Hospital No. 20.
On August 5, Hospital Train No. 59 brought 227 patients. On
August 11, the same train returned with 460. Most of these patients
were serious surgical cases and had been wounded in the fighting
around Soissons and Fismes. On the 24th of August, 384 patients
were brought in on Hospital Train No. 52. These cases were mostly
surgical and gas cases, but were not nearly so serious as those that
had come on the three preceding trains.
On September 6, Hospital Train No. 66 brought in 229 patients
from the Base Hospital at Toul. These patients were nearly all
walking cases and were in no way serious. Many of them were
convalescent from slight medical conditions and others were sujffer-
ing from various deformities and orthopedic troubles, such as flat-
foot. Evidently at this time, a movement was on foot to evacuate
the hospitals nearer the front back of the Toul sector.
On September 15 Hospital Train No. 56 brought down 390 patients.
These came from Base Hospital No. 116 and were moderately severe
battle casualties that had been sustained in the St. Mihiel salient.
On September 21 Hospital Train No. 62 brought in 402 patients
evacuated from the hospitals at Bazoilles. They were moderately
severe surgical cases and there were also a few gassed patients among
them. These also came from the St. Mihiel salient.
On the 27th of September a French hospital train arrived with 280
slightly injured and sick, evacuated from the hospitals around Lan-
gres. They had originally come from the St. Mihiel salient and were
not serious. Another French train arrived on October 2 with 380
slightly injured and convalescent sitting patients. These patients
liad been brought from the Verdun region.
142367— 19— VOL 2 58
1892 REPORT OF THE SURGEON GEXP:RAL OF THE ARMY.
United States Arm}^ Base Hospital Train No. 56 again arrived on
October G with 294 patients. These patients were more seriously
injured and more acutely ill than any that had been received for a
month. They also came from the Verdun region. The following
day a French train brought 301 patients, many of them moderately
severe surgical cases that had been hurt in the Argonne. On Octo-
ber 10 another French train brought 192 cases, mostly surgical, but
also with a fair number of medical cases, especially cases of influenza
and bronchitis. These cases also came from the Argonne.
On the 15th of October 385 slightly injured and convalescent sick
sitting patients were brought in by another French train. They had
also been wounded in the fighting north of the Argonne.
United States Army Hospital Train No. 54 arrived on October 23
with 302 patients. One-third of these were moderately severe surgical
cases, the remainder were suffering with or convalescent from in-
fluenza, various acute infections of the respiratory tract, and a few
were gassed.
During the serious fighting around Chateau-Thierry, the latter
part of July and the early part of August, when the hospital was
crowded with the most serious kind of surgical cases, the surgical
work had to be done by a group of junior surgical officers, assisted by
medical men and others of jDractically no surgical experience. It
should be made a matter of record that in spite of all the difficulties
under which they labored this small group of medical officers success-
fully and ably took care of an average of 1,500 to 1,800 seriously sick.
During the latter part of August, following the rapid allied ad-
vance above Chateau-Thierry, an enormous number of severe cases of
diarrhea developed throughout the American Army. Nothing but
the wholesale immunization against typhoid and paratyphoid fever
that had been practiced prevented a disastrous epidemic, for it was
shown that many varieties of organisms, including those of the
typhoid and dysentery groups, were responsible for many of these
diarrheas. The trains arriving at Base Hospital No. 20 during the
latter part of August and early September brought large numbers of
these cases of diarrhea. They were segregated as far as possible and
carefully studied. In a few the organism of bacillary dysentery
(types of Shigo, Flexner, and the Y bacillus) were isolated. Fortu-
nately no spread of the disease occurred among the personnel or
patients of the hospital.
L. BASE HOSPITAL KG. 2 2, BASE SECTION NO. 2.
Milwaukee County Red Cross Hospital organized December, 1916.
Taken over from Eed Cross complete by United States Government
as United States Army Base Hospital No. 22 on December 19, 1917.
Called into active service January T. 191S.
Leaving the St. Paul station. Milwaukee, at 4 p. ni. May 19, the
hospital arrived at Dumont. N. J., near Camp Merritt late in the
afternoon. May 21. It remained in camp at Merritt until June 3,
when it proceeded to New York City and embarked on the White
Star Line Baltic^ then known as steamship 506. The equipment was
shipped overseas on the steamship II. B. Mallery^ except a few boxes
which were sent by a later transport. The sailing of the Baltic was
A. E. F. BASE HOSPITALS. 1893
delayed one day by a report of the activities of German submarines
off the coast. Leaving Xew York on the 4th, just before noon, the
Baltic proceeded without incident to Liverpool, arriving in that port
June 15, the passengers debarking June 16.
United States Army Base Hospital No. 22 arrived at Southampton
at 1 a m. June 17, spent the night at a point outside of that city
designated as a " rest camp," sailing late the following afternoon on
the ( hannel steamer Sf. George for Le Havre, whence the hospital
took train as a whole for Beau Desert, Gironde, near Bordeaux. On
the morning of June 22 the train conveying United States Army
Base Hospital Xo. 22 was joined at St. Marie Yzbac, a few miles
from Bordeaux, by the train carrying the personnel of Base Hos-
pital Xo. 114. On arrival at Beau Desert, a hospital center with
two hospitals completed, 2 others well advanced under construction,
and 13 others planned, LTnited States Army Base Hospital Xo. 22
was assigned to temporary quarters in the buildings later occupied
by Base Hospital Xo. 114.
From September 15 until the end of October a constantly increas-
ing pressure on the capacity of the hospital from the front was
greatly augmented by the epidemic of Spanish "flue" and pneu-
monia. On October 1 the hospital held over 2,000 patients, October
27 there were 3,200 under treatment, and October 30 4,036, although
the hospital was discharging patients at an average rate of 150
per day.
When it berame apparent that the emergency maximum capacity
of the hospital (which had been set at 1.500 beds soon after its ar-
rival in France) must be exceeded the hospital extended without in-
crease of personnel (except of the drafting of convalescent patients
for light work) first into tents and then into the unit immediately
to the south, which was first used for the housing of ambulant
patients. As the similar units to the west and southwest were
roofed (though not in all places glazed) the south hospital was u^ed
for medical cases and the west hospital for ambulant patients. By
Xovember 10 four hospital units were under operation. The first
unit was used altogether for serious surgical cases requirin.q: constant
attention. The south hospital was used for serious medical cases.
The west hospital as a separate unit for medical cases re eived at
the height of the rush from the front. The southwest hospital was
made a barracks for ambulant patients whose hospitalization was
deemed sufficient if they were sheltered, fed. and had an opportunity
to attend si- k call each day. At this period, except for the servi es
of ambulant convalescent patients as noted and of medical-officer
patients (two or three in number), the hospital was fun'tioning with
far less than the personnel estimated in the United States as neces-
sary for a 500-bed hospital.
The statistics for the month of October were as follows:
Patients received 5, 448
Returned to duty 1, 322
Transferred to otlier hospitals 449
Average evacuated per day 175
Forwarded to convalescent camps 1,282
Deaths 84
The greatest population of the hospital was reached Xo\ember
10, when after 4 train convoys had been unloaded within 24 hours
1894 REPORT OF THE SURGEOIST GENERAL, OF THE ARMY.
there were 5,098 in the hospital. This figure was maintained for but
a few hours, as 259 patients were discharged later on in the same
day.
United States Army Base Hospital No. 22 with Base Hospital
No. 114, was designated as a hospital for evacuations only, except
for maxillo-facial cases, December 1. In the meantime Base Hos-
pitals Nos. 106, 104, 111, and 121 had arrived at Beau Desert and
acted as receiving hospitals.
January 1 notice had been received from the office of the chief
surgeon, American Expeditionary Forces, that Evacuation Hos-
pital No. 20, then at Dax, would at the earliest possible moment,
relieve the original personnel of this hospital which would then be
returned to the States.
From January 22 to 25 the actual functioning of the hospital was
performed by the personnel of Evacuation Hospital No. 20 with the
personnel of Base Hospital No. 22 standing by to sign papers and
in rate instances to answer questions and make suggestions.
Up to January 1, 1919, 16,448 patients had been cared for; 140
of these had died. Ninety of these deaths had been due to pneu-
monia including 8 of the 24 deaths of patients received as surgical
cases. When the hospital closed, January 25, 17,202 patients had
been handled.
M. BASE HOSPITAL KO. 2 4 (TULANE UNIVERSITY).
On September 3 the command left for Fort Oglethorpe, Ga.,
arriving on September 5. The unit was stationed in Camp Green-
leaf. Classes of instruction for the enlisted men were immediately
organized.
^ Arriving at Fort Oglethorpe on September 5, 1917, the organiza-
tion remained in encampment there until February 4, 1918, on which
date we entrained for Camp Merritt, N. J. We sailed from New
York on the steamship Carmania on February 16, landing at Liv-
erpool on March 4, finally reaching our destination (Limoges) on
March 15, 1918.
We occupied the " Mas-Loubier " (Haviland china factory) and
immediately began receiving convoys of patients. Base Hospital
No. 39 (Yale) had preceded us in this location but had received
practically no patients up to the time of our arrival. The normal
capacity of the hospital plant is 650 beds ; however we have carried
as high as 911 at one time. At the present time w^e have 749
patients.
October 30, 1918: There have been 1,287 admissions this month,
over 1,000 being received between October 16 and 27. The greatest
number of patients in the hospital at one time was 1,241. To take
care of these patients there have been seven officers, exclusive of
the oculist and the ear, nose, and throat surgeon, in charge of surgical
wards, and four officers in charge of medical wards. In order to
increase the capacity of the hospital the enlisted men have been
compelled to leave their barracks.
November 30, 1918: During the 10 days preceding and the week
following the signing of the armistice the capacity of the hospital
was gi-eatly taxed. This had, however, been increased by the taking
over of a school building with a bed capacity of 350. As there wer
1
A. E. F. BASE HOSPITALS. 1895
no operating-room facilities there only convalescent surgical and.
slightly AYOunded were admitted. It was used also for convalescing
medical cases. During the first 14 days of the month there were
over 1,200 admissions. The maximum number of patients in the
hospital at one time was 1,741. Since Xovember 15 the hospital has
been unable to dispose of any of its cases to the convalescent camp.
There have been no discharges since November 20 except to organi-
zations in the vicinity of Limoges. At the present time there are
1,413 patients in the hospital.
December 30, 1918: During the month the hospital evacuated
837 patients, who were recommended for transfer to the United
States, to the hospital center at Beau Desert. On the 15th of
December a convoy of 436 patients was received from Base Hospital
No. 15. There are now 295 patients in this hospital, 17 of whom
are not now evacuable to the United States. The others will either
be I'eturned to duty or evacuated to the United States.
On January 7 those patients who Avere considered nonevacuable at
that time and those who Avould become fit for duty within two months
were transferred to Base Hospital No. 28, Limoges. Those remain-
ing had been selected for transfer to the United States and were
^ent to the hospital center at Beau Desert on January 9. The work
of closing the records and turning over the hospital equipment and
supplies was then begun and is now practically completed.
In reviewing the work of the center we find that during the last
influx of patients Base Hospital No. 24, with approximately one-
fifth the bed capacity of the center, took care of about one-third
of the patients. AVe report the mortality rate in our hospital to
have been 0.96 per cent.
N. BASE HOSPITAL NO. 28.
General. — This organization was originally conceived on April 1,
1917, at a meeting held at the Christian Church Hospital, Kansas
City, Mo. The Kansas City Chapter of the American Eed Cross
furnished the complete equipment for a 500-bed hospital. The per-
sonnel, officers and enlisted men, were recruited, and on January
21, 1918, were mobilized at Kansas City in accordance with tele-
grapliic authority department surgeon, Chicago, 111., dated January
15, 1918. One hundred and fifty-three enlisted men were mustered.
On February 25 to June 2 organization was in training at Fort
McPherson, Ga.
In accordance with Confidential Order No. 58, Headquarters
Southeastern Department, Charleston, S. C, dated May 29, 1918,
the organization departed from Fort McPherson, Ga., June 2, en
route to Camp Merritt, reporting to that camp on June 4. From
Jime 4 to June 11, 1918, stationed at port of embarkation awaiting
(uders to embark for overseas.
June 12 to June 24, 1918, en route overseas by steamship Megani^.
March 24 arrived Liverpool, England. Strength of organization^,
34 officers and 201 enlisted men. June 25, 1918, arrived South-
ampton, England. Stationed at rest camp, Southampton, England,,
June 25 to June 28. June 28 en route from Southampton to Chjer--
burg, France. June 29 stationed at rest camp, Cherburg. June 29
to Julv 2 en route from Cherburg to Limoges, France, per para-
1896 REPOET OF THE SUEGEON GENEEAL OF THE AEMY.
graph 3, Special Orders, No. 5, Headquarters Base Section No. 5,
dated June 25, 1919. July 2., 1918, arrived in Limoges, France, and
assigned to duty Route de Lyon site in accordance with paragraph 3,
Special Orders, No. 5, Headquarters Base Section No. 5. dated June
25, 1919.
At this time the hospital was in course of construction; building
barracks type; 50 per cent comiDleted; bed capacity about 15 per
cent serviceable. The personnel of the organization were all tem-
porarily detailed for construction duty. On July 23, 1918, the hos-
pital received its first patients, and on that date began functioning
as a hospital. The enlisted personnel were assigned to the various
individual duties, as is shown by list hereto attached.
O. BASE HOSPITAL NO. 2 9.
The officers and enlisted personnel of the unit arrived at the north-
-eastern fever hospital, London, England, on the night of July 19,
1918. The nurses arrived the next day.
The hospital was taken over on August 1, 1918. The personnel
at this time consisted of 33 officers. 200 enlisted men, 100 nurses, and
5 civilians.
Total number of surgical cases admitted, 2,351 ; total number of
medical cases admitted, 1,625.
Construction work on the new building began on August 20, and
when work was discontinued 40 new buildings had been started, 12
of which were practically completed.
A total of about $350,000 has been spent on this work.
p. BASE HOSPfTAI. XO. 3 0.
Organisation, mohil'zation, and travel. — Base Hospital No. 30,
United States Army, was organized under the auspices of the Amer-
ican Eed Cross Society in the University of California, department
of ipedi- ine, in the spring and early summer of 1917.
We left Fort Mason IMarch 1. 1018. on board the steamship North-
ern Pacific, making a record trip through the Panama Canal, arriv-
ing at Panama on the evening of March 9. sailing again the next
morning and arriving at New])ort News March 15. sailing again the
Sfime night and arriving at Iloboken March 17 and reaching Camp
Merritt after dark that day. About one day was lost between New-
port News and New York owing to confusion of naval orders, caus-
ing the ship to partly retrace her course. From Camp Merritt a
number of the officers were able to attend clinics and courses in New
York City, including the Carrel-Dakin course, and instruction in
pneumonia and meningitis technic at the Rockefeller Institute. Two
enlisted men were sent there to learn the preparation of Carrel-Dakin
solution.
We left Camp Merritt April 22. and sailed from Hoboken on the
Leviathan the morning of April 24. The voyage of eight days was
pleasant (except for the inevitable crowding of the enlisted men)
and uneventful. We arrived at Brest May 2 and the officers and
men went ashore May 3. and. after a two-day stay at Pontenezen
Barracks, we entrained (May 5), and arrived at Rovat the morning
of May 7.
A. E. F. BASE HOSPITALS. 1897
EstahJishing and opernting the hospital. — An American liaison
officer met us with transportation and conducted us to unfurnished
temporary quarters, and the next feAv days were occupied in establish-
in<i kitchens for personnel, temporary offices, and surveyino: a ^rroup
of buildinfrs. which comprised 12 of the poorer buildings in town.
The following hospitalization report, prepared by American officers
v.ho preceded us and rented the buildings, gives the salient features
of the town, and details of the buildings we were to occupy.
Geographical location. — Royat les Bains is a small town situated
in the veiy heart of France in the Auvergne Mountains, Department
of Puy-de-Dome. It is on the eastern slope of the chain of mountains
of the west of Clermont-Ferrand, which is the administrative center
of the Department and the seat of the general staff of the 13th
Region. From the center of Clermont to Royat is about 3^ kilo-
meters.
Our first trainload of .360 patients arrived June 12. These were
mostly convalescent patients, but, coming before we had been able to
complete the kitchen installation, they were a considerable problem.
We were somewhat, though not much, better prepared for the sec-
ond trainload of 461 cases from the Chateau-Thierry fight. The
train commander stated that this was the worst trainload he had
even seen. There were dozens of cases of severe skin, lung, and eye
poisoning from nuistard gas; and the staff worked night and day
trying to keep up with the work of dressing the enormous burns.
The following general description of these mustard-gas cases is con-
tributed by one of the medical officers:
On .Tune 17 a train aiTivtd in two st'ctious. containing many gas cases. Tlie.se
were distributed for the most part in wards 17 and IS in the continental annex,
although a number of cases were scattered through other parts of the hospital.
These cases had been gasse<l on June 14. IMany of them had severe skin burns,
some comprising as much as one-eighth to one-half of the total skin surface. In
the more superticial burns the skin was dusky purplish to reddish-purple hue.
The deeper burns were pale, translucent, edematous with many blisters. In
most cases serum was drained from these blisters. Some large blisters were tilled
with gelatinous material that would not drain away. The serum from these
blisters was very irritating to the skin of the hands of the dressers, causing in
some cases a mild dermatitis to be set up. Boric ointment, vaseline, zinc oxide,
dry powders such as talc and l)oric powders, aluminum acetate (5 per cent), and
soda bic;irl)(inate saturated solution, were used for dressing these skin burns. For
the lids and conjunctiva, saturated solution of soda bicarbonate was used ex-
clusively. Nearly all of these cases had burns of the scrotum and penis which
were painful and very slow in healing. Also nearly all of the c;i.ses had l»urus
of the lids and conjunctiva, with occasional burns of the face and .scalp. Many
ca.ses of broncho-pneumonia we:e already present when the patients were ad-
mitted, and a nunibci- of cases developed shortly after admission. These cases
were nearly all fatal. The complicating pneumonia was a broncho-pneumonia
in almost evei-y case, although two of the cases developing after a week or two
in the hospital were of the lobar type. These cases ran a rapid course and did
not respond to medication. There was no particularly marked :'ir hun'jer. but
great restlessness, delirium, and toxicity. Oxygen was of very little use. The
oases were markedly cyanotic. I'o.st-mortem examination of these cases showed
nuich serum in the alveoli with small areas of consolidation. The nnicous mem-
brane lining the larger bronchi was necrotic and sloughing, and where the
mucous membrane had sloughed away there was very little attenipt at tibrln
formation. Two cases that had resisted the pneumonia for about two weeks
showed the formation of small and medium-sized nuiltiple abscesses lilled with
dirty, brownish-gray, pululent material.
Tiie cases with superticial burns liealed for the most part very slowly. New
skin formation progressed slowly and the crusts that formed invariably con-
tained pus beneath them. The average stay of these patients in the hospital
was from four to five weeks.
1898 REPOKT OF THE SURGEON GENERAL OF THE ARMY.
The surgical cases of the train of June IT were remarkable for the
cleanliness of their wounds, extensive debridements done, and the
favorable progress of the wounds. The following account of these
cases is contributed by one of the medical staff :
The train of June 17 was interesting from a surgical standpoint, because it
liad a large number of wounded men whose wounds were in most excellent con-
dition and whose morale was most excellent. These wounded men were largely
marines, and of all the patients received at Base Hospital No. 30 there were
none who arrived in better condition and none who were more pleasing to treat.
The train of Augu.st 21 from the American Red Cross military hos-
pital at Paris was remarkable for the peculiar psychology of the men,
described as follows by a member of the staff:
On August 21 a train of wounded arrived who were very interesting on
account of their peculiar psychological state. Their wounds were not in good
condition and the patients were very difficult to dress because they seemed to
have lost their grip. Possibly one explanation for this is that these wex-e the last
remaining cases at certain ho.spitals toward the front, and iliey had probably
been kept there because of badly infected wounds and the difliculty in getting
them clean. Of all the patients that we received at Base Hospital No. 30, these
were the most difficult to deal with.
The train of Sej^tember 22 was a French train without an Ameri-
can officer in charge, and came to us without indicating to us in
advance the nature of the cases. We were extremely crowded at the
time, and managed to j)repare particularly surgical beds where we
could find them. It was regrettable to find that practically all of
these men were cases of acute respiratory infection. Arriving in
the middle of the night, there was nothing to be done but distribute
them throughout the hospistal.
Althougli we are but a few hundred meters from the railway sta-
tion, the detraining of aiw consideraljle number of stretcher cases has
exceeded the capacity of our three ambulances; and, in order to
expedite the work and release trains promptly, it has been customary
to borrow French ambulances on these occasions.
Surgical Team Xo. 50 departed from Base Hospital No. 30 on the
morning of June 6, 1918, arriving the following day at 3 p. m. at the
American Red Cross hospital, Juilly, Seine et Marne. This hospital
was situated in the buildings of the old College de Juilly, and had
been in continuous service as such since the onset of the war in 1914.
It was, at the time, the first hospital for American soldiers back of
the regimental aid station. The Arm}' was then in the act of stop-
ping the advancing Hun at Belleau Woods, and it was their wounded
who filled all beds, were lying upon stretchers in tlie hallways, in the
courtyard, and along the country highway's. Tlie team was immedi-
ately assigned to the operating room, and remained on duty until 8
o'clock the following morning. The wounds were very severe in type,
many fractures, and a high percentage were infected with gas group.
There were also 300 gassed cases, who were first treated at this hos-
pital. The sight of these gassed men lying on stretchers and filling
the entire courtyard — blinded, choked, begging for water, for pro-
tection from the sunlight for their sensitive eyes, and for something
to relieve their pain — was pitiful. By a remarkable coincidence
some of these first cases upon Avhich the team operated were evacu-
ated to its own base hospital. June 16 saw the end of this tremendous
rush of wounded. The succeeding month was filled with the care of
A. E. F. BASE HOSPITALS. 1899'
the retained seriously wonnded. and the opportunity was taken of
visiting the several Parisian hospitals. It was hj dressing and ob-
serving these patients that the best princiiDles of caring for the
wounded were learned. Again wounded soldiers, this time from the
Chateau-Thierry fight, began to arrive, and continued until July 21.
The type of surgery was, as previously mentioned, entirely new. since
no "preparatory training had been afforded the surgeons of tlie team.
It was with some fear that the team's first cases were observed post-
operatively, but, fortunately, all did well. The wounds were treated
by the so-called debridement, packed lightly open with plain dry
gauze, and theji left undisturbed for 36 to 48 hours. During the two
periods of work the team operated for the most part at night, and
during its watch cared for all neurological cases and approximately
a total of 240 wounded.
On July 30 the team joined Evacuation Hospital Xo. 4, located
at Chateau Pereuse, near La Ferte. This hospital was quartered in a
large chateau and in Besoneau tents camouflaged in the near-by
forest. xVfter seven days at this location the hospital was moved
forward into the fresh battle-scarred area at Coincy, approximately
30 kilometers back of the Vesle River. Six days from the time of
starting the advance move the team operated its first case, and re-
mained more or less busy up to September 12, 1918, when the last of
the United States forces were withdrawn from this sector. Again the
team had a large share of night duty. and. as this was now the most
advanced evacuation hospital, it received a large proportion of the
severely wounded. The team operated only this type, and amongst
these had approximately 10 abdominal and 12 chest cases. The op-
portunity was given of using dichloramine T, chloramine T paste,
the green soap solution, and the vaseline strips in the wounds post-
operatively, with results no better, and in some instances not even as
good, as obtained with plain dry gauze. While with this hospital
the team cared for approximately 200 wounded. The food question
was a severe one, and due to this as well as to the insufficient care,
the amateur preparation and the careless serving of the food, the
different members of the team were ill at various times with a severe
form of enteritis. However, with effort they continued at their
regular posts of duty.
Fortunatel}' the team was ordered to the general headquarters of
the American Expeditionary Forces at Chaumont, France, where for
12 days during the St. Mihiel drive rest and excellent food were
allowed, by which all again regained their usual state of good
health.
September 26 brought us again amongst old friends, Evacuation
Hospital Xo. 8, now located behind Verdun, at Petit jMoiige. The
hospital was located upon the slope of a hill, was well planned and
laid out, and had a well equipped and managed triage department,
efficient shock wards, and a most excellent operating room of 18
tables. Good records were kept of all operations, and everywhere
one would go there was an atmosphere of do the best for our sol-
diers. The team was again assigned all neurological cases during
its hours on duty, and had approximately 32 such tyi)e of cases.
This hospital also served in a large extent for the severely wounded,
and so very little rest was given from the arrival, on September 26^
until 2 o'clock on the morning of the day, October 25, when the team
1900 REPORT OF THE SURGEdST GENERAL OF THE ARMY.
left for its home. Base Hospital Xo. 30. The team at many times
served as two surgical teams, and at all times was able and took its
regular turn on duty. All the patients of the team were cared for
postoperatively by its oAvn officers. The following summary shows
the amount and type of wounded which the team cared for while
upon its five months' servi e on the western front :
Surgical Team Xo. 51 left Base Hospital Xo. 30 on September 10
for Evacuation Hospital Xo. 1 at Toul, Meurthe et Mozelle. Train
connections were very bad and the team did not arrive at Toul until
the morning of September 12, at the beginning of the St. Mihiel
drive. Evacuation Hospital Xo. 1 is situated about 3 -miles north of
Toul in an old French barracks. It is one of the first American evac-
uation hospitals to be established in France and is supposed to serve
as an ideal evacuation hospital for the American Expeditionary
Forces. The wards are in the old French' barracks, Avhich are very
comfortable, and the arrangements and facilities for hospital work
are exceedingly good. When we arrived at Evacuation Hospital No.
1 the wounded were beginning to come in in large numbers, as it was
the nearest evacuation hospital to the line at that time. The team
was put to work shortly after arriving and worked for 17 hours out
of the first 24. The hospital only cared for the men seriously
wounded and the stress of work kept up for a period of five or six
days. "Waiting rooms were always filled with seriously wounded men
and all teams worked full time. The teams were unable to pay any
attention to their cases after operation, because they were rapidly
evacuated, and there were special dressing teams to do this work.
After the St. Mihiel drive was over there was very little work at No.
1, except for occasional cases coming in from the more distant front.
We were able to make side trips into the captured St. Mihiel salient
and look over the captured ground. We were ordered from Toul to
the Argonne Forest on October 8 and received transportation by am-
bulances to Evacuation Hospital Xo. 14, situated in the Argonne For-
est near the village of Les Islettes. This hospital was situated in the
heart of the Argonne Forest, near the line of American advance, and
in a country that had been completely destroyed by the Germans in
their former campaign. The hospital was entirely under canvas,
except for a small chateau, which housed the nurses and senior
officers. This country was very wet ; it rained nearly every day, and
there was mud everywhere. The operating tent was pitched on the
ground and for the first few days there was considerable mud on the
operating-room floor. In order to go from the operating room to the
wards one had to wade through about 6 or S inches of mud. While at
Les Islettes the team was busy all the time, working on the 12-hour
night shift. There never was a time when anyone had a breathing
spell, as the triage was always filled with patients and there was fre-
quently a line of ambulances waiting in the road. At this hospital
only the seriously wounded were treated, and there were a very large
number of gas infections. Many times patients were brought in from
two to three days after being wounded, and a patient was rarely
operated on within 15 hours after being wounded. It was difficult to
get supplies in this region and the hospital was rather poorly
equipped. On the 25th of October the team was ordered to return to
Base Hospital No. 30.
A. E. F. BASE HOSPITALS. 1901
Q. BASE HOSPITAL NO. HI.
Base Hospital No. 31 was called into active service on September
6, 1917. On the arrival of the hospital in Centrexeville, January 1,
1918, two hotels, the Continental and the :Martin Aine, with the ca-
pacity of 500 beds, were assigned for the care of medical cases, ex-
clusive of officers, who were to be cared for at the Hotel Thiery.
Until the last month of the war it was seldom known until a
train arrived what type of patients were to be expected. During
the Chateau-Thierry drive one train, supposed to be carrying
wounded, brought 500 gas cases.
The chief of medical service might perfect a theoretically per-
fect organization one day and the next find himself giving anes-
thetics. Consequently, it was necessary to keep the organization
from becoming too fixed so that changed conditions could be rapidly
met.
It was therefore his duty to see that all possible efforts be made
in the diagnosis and treatment of cases : that all cases ready for duty
be returned as rapidly as possible : prevent return to duty of those
men not yet ready; to prevent spread of contagious diseases: battle
with the vermin and skin diseases; see that cases were properly
classified for evacuation: that all consultants, treatment, and trans-
fer from other depai-tments be promptly attended to ; that all orders
in so far as they applied to the medical service be faithfully obeyed;
that records l)e properly kept, and, on the other hand, to handle the
interesting clinical material in such a way that as much as possible
be available to each officer of the service.
Usually as soon as a patient's examination was complete he was
grouped according to the condition found, either as nontransportable,
for evacuation to the United States, for reclas-^ification by the dis-
ability board, for transfer to some special hospital, or to the rear
by hospital train, or in the duty class to be sent as rapidly as possi-
ble to the convalescent ward. Contagious-disease cases were imme-
diately sent to the hospital for contagious diseases at Vittel.
It was attempted thrnugliout the war to keep as many empty beds
as possil)le in tlie hospitals in this area. Consequently, special efforts
were made to dis])ose of cases rapidly. Evacuation was practically
alwavs bv hospital train, excepting those cases going direct to special
hospitals or returning to duty.
The criterion foi- evacuation to the rear varied, depending upon
transportation facilities, hospital space in the rear, and expected
demand for beds in this particular area. Usually those cases
whose convalenscence would require more than two weeks were evac-
uated whenever trains were available. Occasionally all were evacu-
ated who were not exj^ected to return to duty in four days. This
would naturally omi)ty the hospital quicklv and prep-u'e us for
heavy admissions of battle casualties, which, so far as the medical
service was concerned, consisted ))rint'i))ally of gashed cases
The convalescent ward was organized for the purpose of building
up as rapidly as possible the strength of the soldier weakened by
disease or wounds and combating the tendenr-y toward " mauvais
esprit " engendered by more or less prolonged hospitalization. The
result was a success beyond our expectations. Later, when the con-
valescents camps were organized in certain areas for care of cases of
1902 REPORT OF THE SURGEON GENERAL OF THE ARMY.
this tA'pc, none was available to us. Nevertheless our own convales-
cent ward met our needs so well that we were never inconvenienced
by the lack of a convalescent camp.
Gas intoxication. — Perhaps the most interesting group of cases, on
account of the novelty of the condition, was comprised of those suf-
fering from the effects of poison gas. Although absolutely accurate
statistics as to type of gas encountered in each individual case was
not possible, the records show 551 cases of mustard-gas intoxication,
in which the chief s3^mptoms were due to inhalation and 198 due to
body-surface contact.
Most of the cases showed some effects both from inhalation and
contact. Of the 376 cases, due presumably to the other types of gas,
the vast majority were caused by chlorine and phosgene. A few
cases due to the effects of lachrymatory, arsenical, and certain rare
gases were seen.
It would not be worth while to discuss in this place the full
sjanptomatology and treatment of gas intoxication, but merely to call
attention to a few points regarding treatment. The cases coming to
this hospital very quickly demonstrated the value of the alkaline bath
treatments. Those thoroughly treated showed remarkably few skin
burns, while those untreated often showed extensive burns, some of
which required prolonged stay in hospital.
It was also quickly noted that when acute lower respiratory tract
infection occurred in gas-inhalation cases the condition was liable to
be severe and prolonged. It was therefore considered wise to keep
gassed cases as far away as possible from all tjpes of respiratory
disease.
The troublesome cough was benefited occasionally by inhalation,
but most by sedative mixtures containing opium derivatives. It was
necessary in man}^ cases to push the sedative treatment in order to
prevent the development of bronchiectasis of the small tubes, because
of the extreme violent racking cough. This condition, described as
fairly frequent in certain units, was extremely rare among our cases,
possibly on account of the free use of sedative.
Perhaps the most troublesome conditions found during convales-
cence was the onset of effort syndrome, which was so frequently de-
veloped as the patient began physical activity. While there can be
no doubt as to the genuineness of the curious pains usually referred
to the region of the precordium, the psychic element played a large
part, sometimes the most important part, in the clinical picture
presented.
The soldiers were apprehensive as to the effects of gas in striking
contrast to their nonchalance toward wounds. All of them had heard
stories as to how men inhaling gas sometimes suddenly dropped dead
without warning. Consequently, the onset of any unusual pain, par-
ticularl}' if it happened to be in the region of the heart, frightened
them. It was, therefore, necessary in the treatment to recognize this
psychic factor.
They were assured and reassured that the pains, shortness of breath,
etc., were conditions to be expected during convalescence from gass-
ing; that they were temporary and of no particular importance. As
soon as a man was able to run up two flights of stairs without unduly
persistent tachycardia or breathlessness he was removed from the
A. E. F. BASE HOSPITALS. 1903
hospital and sent to the convalescent ward, provided, of course, that
careful phvsical examination was negative.
In the convalescent ward he was no longer treated as a sick man,
but as merely undergoing process of hardening. He was put through
a regime of gi^adually increasing exercise and work. If the improve-
ment was not as rapid as looked for the activity was cut down again
and very carefully increased. During this stage the precordial pain
and pains in various parts of the trunk were frequently markedly
relieved by the application of iodine over large areas.
Impressive visual effects were sought in the application of this
iodine and possibly were responsible for the benefits. Under this
regime the percentage of cases of effort syndrome that did not yield
to treatment was small. If we exclude these cases with previous his-
tory of this condition the number of cases requiring reclassification
for effort syndrome or disordered action of the heart following gas
intoxication was almost negligible.
Influenza. — The influenza here as elsewhere occurred in two dis-
tinct waves. During the epidemic in ^lay the disease was of trivial
character, lasting only a few days. Very fcAV cases were sent in and
the men being cared for in their own medical formations.
The symptoms were dry mouth, chilly sensations and feverishness,
headache, aching in back and limbs, nausea and vomiting, and cough.
The pulmonary complications were slight. As a rule no rales could
be elicited. Out of 66 cases there was but one case of broncho-pneu-
monia. The cardio-vascular system was practically unaffected.
During the epidemic beginning the latter part of August the dis-
ease was of more serious character. In the initial stages it resembled
the type seen in May and some of the cases ran a similar course. But
as a rule the course was much prolonged. The vast majority had
bronchitis with numerous rales, which not infrequently went on to a
definite broncho-pneumonia.
Acute sinusitis and otitis media were not uncommon. The cardio-
vascular system was usually affected, sometimes profoundly, necessi-
tating long convalescence. A few cases had to be reclassified on ac-
count of post influenzal myocarditis.
Influenza, except in so far as it predisposed to pneumonia, v,as
not found to be fatal among healthy young adults. There is not a
single death due to influenza or any of its complications except
broncho-pneumonia.
The tremendous physical exertions, terrific nervous strains, and
dietary irregularities incident to fighting might have been expected
to cause increase in metabolic disorders and disturbances in glands
of internal secretion. There were two cases of exophthalmic goiter,
two of simple goiter, and one of gout.
Until the time of the Argonne drive, typhoid fever was very
rarely found. During this battle many of the men were forced to
drink water from whatever source it could be found. Consequently,
the admission for typhoid and paraty])hoid increased somewhat.
At the same time there was a mild epidemic in Contrexeville.
Four of the enlisted personnel of the organization developed typhoid.
Two patients developed typhoid and one paratyphoid beta. All of
them had been in the hospital too long to have acquired the infection
previously.
1904 REPORT OF THE SURGEOIS^ GENERAL OF THE ARMY.
It was found that two of the cases among personnel might have
been acquired through the viohition of the technique established for
the care of typhoid. None of the othere could be explained by con-
tact. A rigid control of drinking water and revaccination of the
personnel stopped the local epidemic completely.
The incidence of typhoid showed no particular relation to the time
of vaccination. The severity of the disease seemed somewhat less
than that seen among the unvaccinated.
There were no deaths among the uncomplicated cases; two were
admitted moribund with a combination of typhoid fever and broncho-
pneumonia. The other case, who died, had severe intestinal hemor-
rhage, was greatly improved following transfusion, then developed
broncho-pneumonia and bilateral parotitis.
There were but three cases in which the diagnosis of trench fever
seemed fairly certain. There was no way of proving the diagnosis
in these cases but the clinical picture closely resembled the descrip-
tion of that disease. A fairly large number of cases were sent in
the hospital labeled as having trench fever, but further observation
showed the diagnosis to be erroneous.
Among the 8,762 cases handled by this hospital there were ad-
mitted, or developed after admission, 15 cases of diptheria, 14 of
scarlet fever, 2 of measles, 5 of epidemic meningitis, and 10 of
mumps. These cases, except mumps, were sent, if transportable, to
the hosi^ital for contagious diseases at Vittel.
Most of the men were admitted for some other condition during
the period of incubation of the contagious disease. A few of the
cases, particularly of diptheria, developed here, but in no instance
could any such causes be traced to contact with au}^ preexisting case
of the same disease. Contagious diseases were entirely of a sporadic
character as far as this institution was concerned.
This work was of no particular medical interest except the group
of cases sent in with some diagnosis indicating that the condition was
thought to be due to some form of war neurosis. Xaturally quite a
few cases so diagnosed were found to be suffering from some definite
medical conditions, such as tuberculosis, cardia vascular diseases, etc.
Others were true concussion, a number were simply exhausted and
were entirely well after a few days' sleep and food. Of the 147
cases diagnosed here as psychoneurosis, the vast majority responded
quickly to a regime of instruction, plenty of work, and exercise-
First the men were taught that the neurosis or " shell-shock" of
which some of them were rather proud, was an evidence of weakness
to be greatly deplored and overcome as quickly as possible.
Whenever possible they were put on the heavy work details in
order that they might become physically tired and their attention
diverted from their mental disturbances. Out of 1 series of 114
cases all but 7 were returned to duty in less than 4 weeks. In the
refractory cases a history of previously existing nervous instability
could usually be obtained.
Insistence on the closest possible supervision from the moment of
removal from hospital train on arrival to the hour of discharge to
duty of evacuation to the rear has, in a large measure, been respon-
sible for the success of all surgical work at Base Hospital No. 31.
Every effort has been made to minimize handling of patients,
thus saving much valuable time during rush periods and eliminating
A. E. F. BASE HOSPITALS. 1905
confusion to a marked degree. At all times utmost regard for the
personal comfort of patients has been insisted upon from the arrival
of hospital train or ambulance to the day of evacuation or discharge.
Upon classification by the detraining officer all stretcher cases have
been sent to one of two places. Postoperative fractures have been
sent to the bone-and-joint hospital, Building Xo. T, immediately,
where records and dressings were immediately examined by the
officer in charge and patient either assigned to bed, or elsewhere
should further immediate attention be needed.
Preoperative cases of all descriptions have been sent to the dress-
ing room in Building Xo. 8, where old dressings have been removed,
exact nature of wound ascertained, and immediate future deter-
mined.
If in the judgment of the examining surgeon the patient required
immediate operation he was dispatched to the X-ray room, conven-
iently situated between the dressing room and surgery, which is the
next stop.
From the operating room patients have been returned to the ward
designated for the care of that particular t3^pe of wound. Cases not
calling for immediate surgical attention have been dressed and as-
signed to the proper ward and immediately put to bed, awaiting the
first opportunity at the X-ray and operating room.
A close adherence to this policy has made it possible to give re-
quired prompt attention to most seriously wounded, while others
have been allowed to profit by rest and food prior to operation.
Walking and sitting cases sent from the train to the bathhouse
by the detraining officer were given a second superficial examination
by a surgeon to determine if a tub bath was advisable. Following
the bath such patients have been sent to the X-ray room (either at
the regular hospital X-ray, or to the X-ray in the bathhouse in rush
periods), or direct to the proper surgical wards.
Despite the fact that a number of staff surgeons originally in-
cluded in the operating force of Base Hospital Xo. 31. were on de-
tached service during most of the rush periods, the work of clearing
cases through to the wards was carried on with considerable dis-
patch, all available personnel, including officers, nurses, and enlisted
men displaying most unselfish devotion to the work before them.
Medical officers and members of specialty services, nurses, and
properly trained enlisted men were pressed into service as anesthetists,
rendering most efficient aid. The comparatively small staff of sur-
geons worked long hours, immediately following arrival of convoys,
and then with only too brief respite went to the wards to assist with
dressings.
Unlike many other base hospitals, there were no surgical teams
from other institutions available, the depleted staff doing all the
work. A single surgical team was attached but its service was re-
quired in tlie wards.
The fact that a number of nurses and enlisted men had become
proficient as surgical assistants proved a great advantage.
Operations completed and the patients returned to the wards for
dressing and recjuired treatment; it has been the policy of the sur-
gical staff' to keep cases with wounds of the lower extremities confined
to bed until they are well on toward recovery, as it has been found
190G REPORT OF THE SURGEON GENERAL OF THE ARMY.
that they not only heal faster, but are not so apt to become hospi-
talized.
Because most of the surgical cases operated came to this hospital
from 36 to 120 hours old very little primary suture was attempted,
with the exception of wounds of the face. Almost all of the cases
required liberal opening for the establishment of drainage. Sec-
ondary closures were attempted later, no primary closures, delayed,
being done.
During the first few months of hospital's experience the rule of
bacterial counts and final control culture was carried out, but later
we learned that one could tell by the clinical appearance of the
wound as well as by bacteriological count when a wound was ready.
As a result all Avas dispensed with except control culture and that
only for hemolytis streptococcic infections. A considerable number
were done Avith only the clinical judgment as to when ready with good
success.
The routine treatment of wounds has become more or less stand-
ardized as a result of experiences here and elsewhere. The principal
treatment was the Carrel-Dakin method. Adequate equipment for
this work was not always aA'ailable frequently necessitating the use
of a syringe to supply the fluid at specified intervals. It has been
our observation that cases " on the bottle," so to speak, have made
better progress than others.
Hypertonic salt solutions have been used, frequently, with very
good results, oftentimes as a follow-up after Dakin solution.
The use of dichloramine T produced varied results, many cases do-
ing very well. A few cases had irritated skins which cleared rapidly
with the use of ointment or discontinuance of the chemical.
During a considerable period Avhen our hospitals were serving
the American forces in their independent offensive it was not possible
to follow this procedure closely because our hospital was transformed
into an evacuating base hospital, as such it was required to evacuate
its beds within a comparatively short time after arrival. This con-
dition was created because of our location quite close to the theater
of activities.
(a) Cases ready for duty in from 10 days to 2 weeks.
(h) Cases not ready for duty in from 10 days to 2 weeks.
(<?) Cases immediately evacuable.
(d) Cases not able to stand travel and so nonevacuable.
As a result of this classification only two sets of patients were
retained in the hospital, all others being evacuated at the first oppor-
tunity. Class A, or cases ready for duty within two weeks, were
held that they mijiht return to their command with least possible
wastage of time. Class D, or cases too ill to permit of transportation,
were retained until their condition permitted proper disposition.
Because of this circum.stance much special treatment was not used,
patients being prepared for evacuation as rapidly as possible.
The same cautious methods followed in our actual base hospital
work were followed religiously through the period of duty as an
evacuation unit, every effort being made to insure against premature
transportation of patients.
The surirical service maintained facilities for transfusion, an
accurate list of typed donor being available at all times. Trans-
fusions were given in cases of serious wounds and to counteract
A. E. F. BASE HOSPITALS. 1907
ireneral infection as well as to supply fluid when patients seriously
ill during period of early convalescence have ceased to make the
progress normally expected or have lost weight unduly. Several
medical officers have been available for the work of transfusion at
all times.
The one type of case in which ward A was practically a complete
failure was in the flat-foot group. Wearing of the orthopedic strap
helped some, but we were never able to really benefit their condition.
The only benefit they derived from ward A was that the}^ left the
hospital in better general condition.
Probably the most marvelous cure worked 1)}^ the ward X treat-
ment was on the ground of some 14 hysterias affected with the
so-called shell shock. These men came into ward X just at a time
when the quartermaster had several cars of coal to be unloaded.
Classed as A these men were put under a hard noncommissioned
officer and sent to unload this coal. Within less than a week all
were on their way to rejoin their organizations — cured and carrying
with them the impression that shell shock was viewed in the vast
majority of cases as an evidence of a yellow streak.
Having had the opportunity to participate in the surgical activ-
ities of one evacuation hospital, a base hospital serving as such; and
a base hospital serving as an evacuation hospital, and to observe the
work of several front mobile and field units. I have formed some
fixed impressions of what has been done well and what might be,
done better to improve military surgery in active campaign.
Because the lessons learned in the emergency work near the front
lines and the larger work at the bases must have a bearing on the
future policy of American Army surgeons it is interesting to trace
the workings of the various Army hospital formations as we have
experienced them.
On arrival at Contrexeville there came a call for the organization
of surgical teams from staffs of all base hospitals. One of these
was made up from the personnel of hospital unit G. As its chief,
I was sent to Elvacuation Hospital No. 1. for observation. This was
for demonstration of the new methods adopted in the primary care
of wounds.
Evacuation Hospital No. 1 was located at Sebastopol, about 6
kilometers north of Toul and about 20 kilometers behind the lines.
During the period that I was there practically all operations peculiar
to war surgery were exemplified, and daily visits were made in the
wards. Beyond this there was no special method of instruction in
vogue, although there were many interesting discussions following
ward observations.
Arriving at Eoury during the night of the 9th, it was found the
hospital was in course of erection. No officers were present, all being
billeted in the town more than a half a mile away. Tents had been
pitched and the members of the team got a few hours sleep under
rather trying circumstances.
The hospital was in the open field, without supplies of light or
water, for which arrangemeuts had to be made with a French hos-
pital near by. The French did not seem to understand the tempo-
rary character of our hospital, and would not give light before the
erection of permanent poles, or water without laj-ing pipes in
trenches 2^ feet deep.
1423G7— 19— VOL 2 59
1908 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
The hospital had been there four days when our team arrived,
but "was not yet ready for business, because manj' such difficulties
had been encountered. On the 15th work started to come from the
then very active front. The detachment, 175 men, worked like
beavers, and lights and water were in the operating tent and some
other places in time for its use that night. X ray and sterilizing
units were put in commissions, and all was in readiness when at 6
p. m. the first four surgical teams started on their first 12-hour shift.
There were six visiting attached teams, and two made up from the
hospital personnel. The second day after work began Mobile Hos-
pital Xo. 2 came to Eoury, having been shelled out of Bussy, and
its teams worked with us for several dnjs.
There was a great variation in the skill and rapidity with which
some teams worked. While one team would do 40 or even 50 cases
in a 12-hour shift, another would do but 10 or 12. After a short
time certain teams were being called upon to do all the most severe
cases.
For a period of two weeks work was very heavj^, at times as many
as 100 to 150 cases were awaiting operation, while new ones were
coming continually.
Teams got tired under the strain and worked slower. The threats
of bombing added to the fatigue, Chalons, 5 kilometers away, being
bombed every night. The Boche never failed to fly over our heads
at such times, and this was followed by showers of antiaircraft
shrapnel, necessitating wearing metal helmets even when operating.
The camp was bombed one night, one large bomb falling 100 yards
from the two officers' sleeping tents. The following night this was
followed by machine gunning, but without casualties.
The shock work during this period was particularly fine, and the
triage work was better than at any time later.
It was during this trip that I became particularly impressed with
the fact that specialists who had entered the Army to aid in their
particular line should be treated with protective care as one does a
race horse, instead of being used for such drudge work as having to
spend a night on foot on the road looking for an ambulance loaded
with nurses which had been lost on the journey. Provision for a
night's rest would have better fitted one for the morrow's intensive
work. Such fatiguing procedures, combined with the fact that no
food was available from noon one day to the next during the trip,
never tended to increase the efficiency of operating surgeons and their
assistants.
Five kilos from La Forte and 15 kilometers south of Chateau-
Thierry we found ourselves stationed in Chateau Perouse, a fine
building with spacious grounds, owned by a French woman.
Our work at Chateau Pereuse was intense all the time we were
there (July 21 to August 4). When the German retreat had gotten
well under way, plans were made for us to follow the advancing
lines. Our next move was made, as before, by auto and camion, to
Coincy.
Most soldiers who overcome abject fear do so by becoming fatalists
and so, in a way, stoics. Consequently, there was a minimum of
complaining, and no opposition to such suggestions as operations.
Too, when they took their anesthetic, while few talked, those who
did almost invariably showed their true and dominant feelings in
A. E. F. BASE HOSPITALS. 1909
this war at a time when they felt the moment for them was a ques-
tion of life or death.
Almost immediately after our arrival at the base heavy trains of
preoperative cases began to arrive at our own center and the team
went to work here. This work continued up to the time of the
armistice.
The problem of first aid to the wounded at Contrexeville was much
different than at the front. Though some trains contained cases but
two da3's wounded, the cases were for the greater part four or more
days old when they reached this base. Some had been properly
selected, but others not. Some had traveled directly from the front
dressing stations, riding three or four days in trucks, and were much
the worse for it.
Properly selected cases as to the character of their wounds and
not in shock suffered little from an additional delay of a day, but
in other cases it was often well-nigh fatal. Especially was this true
if the delay were more than two days and the patient suffered marked
physical exhaustion from previous exposure to cold and lack of
food. This selecting was, therefore, of the greatest importance.
In cases of gas infection received under these conditions, whether
as preoperative or infection secondary following previous operation,
operative methods that had been employed successful!}^ at the front
failed and high amputations gave the only chance.
In affected wounds showing cultures of streptococcus ha^molitious
amputation before the advent of general septicemia was usually
indicated, though I had several notable successes by complete re-
moval from origin to insertion of the entire muscular area in-
volved
In the cases received, previously operated at front hospitals, we
experienced ample proof of the poor ultimate results of hurried or
improper work, which justify*- the statement that, whatever the press
of work, a front hospital should only operate in so far as the work
can be carefully, properly, and thoroughly done, and that further
work should be sent on to a properly equipped hospital base. If
these cases are at all carefully selected, the additional delay is less
disadvantageous.
r>rhr'nJi inent. — In the use of del)ridement I noticed two points
particularly that have not been emphasized in most writings on
debridement, {a) In its application in front surgical hospitals.
Many men employed a general technic of debridement without ap-
parently any true appreciation of its limits of applicability, or
what they were undertaking to accomplish, i. e., render a wound
sterile by mechanically reviving all contaminated tissue without
reinfecting his wound or injuring nature defenses in the tissues
remaining, {h) The technic was followed in cases when, due to
the general condition of the patient or nmltii)licity of wounds
present, the time element necessary should have deterred.
Triage. — The officer who reviews, classifies, and decides the ques-
tion of immediate disposition of the case has the most important
position in a front hospital. It is his dut}' to divide cases into the
following general classifications: Those that do not need operation,
those that can safely wait if necessary, cases for shock ward, and
those that need immediate operation. xVnother class could include
those that need both shock treatment and immediate operation.
1910 REPORT OF THE SURGEON GENERAL OF THE ARMY.
This iiiiin should also be the one to say, in a rush, what cases can
be best shipped as pi-eopeiatives to base hospitals and decide in
Avhat cases the surgeons should be called in consultation before
sending them to the opoi.iting table, where often the surgeon to
operate sees his patient i.'ly when the anesthetic is about to be
administered or had already been begun.
X-ray. — Essential to tell presence and size of foreign body, es-
pecially chest, head, abdomen, and pelvis. Exact localization very
^"aluable, but not essential if one follows tract and dissects in layers
l>3' Avhich method the tract need never be lost.
Joint eases. — Much argument has arisen over the proposition of
early and continuous active motion being employed in all joint
cases. My own opinion is that after closing without drainage a
joint that has been thoroughly cleaned, motion should not be em-
ployed for four to seven days, unless the advent of infection has
required reopening, when active action will keep the synovial
pockets emptied.
Pnmai^l dressings.— \i surgical or operative sterilization (de-
bridement) of a wound is well done, the essential of the first dressing
is simply protection. A dry sterile dressing, amply large, and surely
fixed in place, to assure the greatest possible protection therefor,
completely satisfies this condition. The possible advantage in a wet
dressing is in preventing scabbing and in furnishing a dressing less
painful in its removal, but to hold this advantage the dressing must
remain wet until it is changed and which is frequently impossible
where the wounded are often two or more days in transportation.
Packing a wound should never be done. When gauze is packed
deeply and firmly in a wound it has been clone for one or two reasons :
{a) To arrest bleeding, this should be accomplished entirely by
ligation ; oozing may be controlled by painting the surface with a
5 per cent solution of iodine or ether; {b) to keep the deeper parts
of the wound open to drainage, this should be accomplished through
the technic of the operative procedure, long incisions and relief of all
fascia and other tissue tension. Packed gauze is not a drain but a
cork.
The Carrel use of Dakin solution is practically impossible in an
evacuation hospital which is sending back its wounded as quickly
as they are able to stand trans])ortation. Moreover, following de-
bridement it is not indicated. When both are employed one or the
other was incorrectly chosen. The Carrel-Dakin method has a defi-
nite indication in the presence of increasing local infection not
amenable to operative procedures. In such a condition, like water on
a fire, it lessens the virulent activity and gives needed time to nature
and the surgeon.
War surgery has brought the surgeon to a fuller realization than
ever before that ultimate results depend largely on the thoroughness
and technic employed in the postoperative dressings and care.
Pest oration of function, rapid cleaning and healing of the wounds,
avoidance of secondary or mixed infection depend fully 80 per cent
on the ti'ained aftercare and the wound dressing which should be
performed with all the technical skill and care of detail of a sterile
operation.
Chest cases. — Operate all but those with no rib fractures or not
marked pneumothorax or ha^mothorax. Close after operations all
A. E. F. BASE HOSPITALS. 1911
but skin. If a drainage tube is used, it should not be too long, should
be sealed in the wound, and connected with bottle apparatus.
R. BASE HOSPITAL XO. .S3.
The governors of the Albany Hospital were prompt in offering the
services of the hospital to the Government. This offer resulted' in
earli' authorization by the Government to organize a unit under the
direction of the American Red Cross. The official title was the
Albany Hospital and INIedical School Base Hospital Xo. 33. The
Albany Hospital gave $25,000 in cash and residents of Albany. Sche-
nectady, and vicinity and corporations and business firms brought the
total cash donations up to nearW $100,000. Special donations and
more than a hundred cases of surgical dressings and supplies, fur-
nished by the Red Cross Chapters of Albany, Amsterdam, Ballston,
Cobleskill, Cooperstown, Gloversville, Johnstown, Lowville, Saratoga,
Schenectady, Watervliet, and White Plains, brought the final value of
the hospital equipment up to $114,662.73.
The active work of organization began in May, 1917, and by August
23 the American Red Cross certified to the War Department that this
unit was equipped and ready for service. The organization was ac-
cepted by the War Department. Under the direction of the com-
manding officer, a rigid schedule of intensive training was imme-
diately started and continued until the unit was ordered overseas in
April, 1918. The period of training was brought to a close on April
23, 1918, by the receipt of orders to report at Camp Merritt, X. J., for
embarkation overseas. April 26 the unit was entrained and on its
way to Camp ^Ferritt. On May 2 the unit was moved from Camp
Merritt to Hoboken, X. J., and embarked on the steamship Carmania
for transportation overseas. The nurses of the unit, who had been
mobilized for nine weeks at Ellis Island, were already embarked on
the same vessel.
The Carmania docked at Liverpool late on the afternoon of May
16 and at 8.30 p. m. the detachment of nurses was landed and en-
trained for Winchester. Upon arrival at Winchester the following
day the detachment of niirses was sent to United States military hos-
pital (later United States Army Base Hospital Xo. 201), Hursley
Park, where they remained until June 1. Late in the afte!:noon of
May 16 the officers and men of the command disembarked and pro-
ceeded to the rest camp at Knott}^ Ash, where they remained for two
days, and were then transferred to the American rest camj), AVinnall
Down, Winchester. The command remained at Winnall Down rest
camp awaiting permanent assignment until June 3.
On June 3 negotiations with the British authoiitics had reached a
point where it seemed probable that the organization would be as-
signed to permanent duty at Portsmouth and would occup}' that
portion of the fifth southern general hos]utal known as the Fawcett
Road section. Accordingly the command proceeded from Winches-
ter to Portsmouth and entered upon the process of taking over the
hospital from the British authorities and of making the necessary
alterations.
The equipment of the organization had been shipped in advance
and had gone on to France. Every effort was made to expedite the
return of this material, but the conditions in France were such as to
1912 REPORT OF THE SURGEON GENERAL OF THE ARMY.
render it impossible, and it was not until June 13 that any of it was
received. December 31, 1918, there were still some seventy-odd cases
unaccounted for.
The entire command was occupied from June 4 to June 14 with the
work of preparing the Fawcett Road hospital for the reception of
American patients, but the hospital was never formally transferred
to the United States Army. There were certain obvious disadvan-
tages in the Fawcett Eoad hospital, the most important of which was
the fact that there was no room for future expansion. The asylums
committee of the Portsmouth borough asylum offered that asylum.
The asylum buildings consist of one main building, capable of holding
a thousand patients, and several detached villas, which, with one ex-
ception, were to be retained by the asylum authorities. The offer of
the asylum authorities was promptly accepted, and on July 8 the
command was transferred to the asylum.
On July 21, 1918, the flag was formally raised by Sir William
Osier.
There were in the asylum at the time the organization took occu-
pancy 825 patients for whose care the asylum authorities had made
arrangements in various asylums throughout England. The work
of transferring these patients to their various destinations was un-
dertaken by the command working under the direction of the asy-
lum authorities. The chief surgeon determined to increase the
capacity of the hospital to a total of 3,000 beds with an emergency
total capacity of nearly 4,000. The progress made during August
was slow, but during September, October, and November it pro-
ceeded with increasing rapidity, and by November 23 wards were
ready for occupancy. By July 24, when the first patients were ad-
mitted, there were accommodations ready for 600 cases. The first
cases to be admitted were overseas surgical casualties arriving on
hospital ships at Southampton and transferred to Portsmouth by
motor ambulance or ambulance train. Small convoys were being
received daily during the month of August and the first three weeks
of September, and the daily report showed a steady increase in the
number of patients in hospital. These came very largely from the
33d Division, and although they were divided nearly equally be-
tween the medical and surgical services, the surgical cases predomi-
nated.
On the 22d of September the hospital was filled. There were then
in the main building over TOO patients and about 3,000 personnel.
Word was received from Southampton by telephone that the Olym-
jyic. with 6,000 troops on board, had arrived in port, and that a large
and increasing number of those on board were suffering from in-
fluenza in a most virulent and rapidly fatal form. Tents were
hastily secured from the British authorities locally and erected in
the various courtyards. The members of the detachment were moved
into tents and convalescent patients were placed under canvas. As
rapidly as the wards were evacuated they were prepared for the
reception of influenza cases. Medical officers, nurses, and orderlies
were ordered to wear long operating gowns, close-fitting caps, and
gauze masks fitting snugly over the mouth and nose while on duty
in these wards. Nurses on duty in these wards were ordered to re-
main out of doors for two hours each day. Within 48 hours after
word was received from Southampton 316 cases of influenza had
A. E. F. BASE HOSPITALS. 1913
been admitted to this hospital, and within a week more than 600
cases had come in. This total was later increased to 734. Of these
admissions 144 were nurses and telephone operators. It was soon
demonstrated that the desperate condition in which many of these
cases were admitted was due not to influenza but to a closely fol-
lowing pneumonia of an extremely virulent type. Before long
meningitis made its appearance, and, like the pnen.monia, this proved
to be in a large percentage of the cases a fulminating varietj^ resist-
ant to all forms of treatment. Autopsies were performed on all
cases resulting fatally, and the causative organisms in the pneumonia
cases were B. influenza, pneumococci. and streptococci, the strepto-
coccus hsemolyticus appearing to predominate in the latter group.
It is noteworthy that of the 256 cases of pneumonia which developed
following influenza ]:)ut few developed empyema. The cases of
meningitis were carefully typed whenever possible and were given
prompt and active serum treatment. Various sera were used, in-
cluding the Gordon serum.
Patients on admission were carried directly to the w^ard and placed
in bed. The clerks, Avearing caps, gowns, and masks, took the data
necessary for the registrar's office at the bedside. As soon as the
patient became sufficiently convalescent to be transferred to a tent
he was furnished with a blue hospital suit, on the left arm of which
had been sewn a red brassard. By thus facilitating recognition of
those cases it was thought that any attempts on the part of the con-
valescent patients to break quarantine would be readily detected.
It is to their credit, however, that no case of this kind occurred. One
of the tents in the courtyard set aside for the influenza patients was
equipped as a mess tent, and the patients were strictly forbidden to
enter the main building or to mingle with the other patients. Xo
case of influenza developed among the other patients in hospital at
any time, and only one officer, five nurses, and six enlisted men of this
command contracted the disease.
The course of the disease varied widely. Some cases were fatal
in 48 hours; man}' ran from 6 to 10 days, and in some instances a pro-
tracted course of from 15 to 25 days was noted without complications
occurring. In this latter group the fever terminated by lysis,
whereas in the group running a shorter course termination by crisis
was hardly more frequently noted than termination by lysis. The
average duration of nonfatal cases was six days. Empyema occurred
in but three cases, one of which was fatal. One case of endocarditis
is recorded and six cases of purulent bronchitis, of which one re-
sulted fatally. Death was usually due to toxemia.
Influenza was not epidemic in Portsmouth at the time the first cases
were admitted to this hospital, and the commanding officer volun-
teered to ({uarantine the entire hospital if the town authorities so de-
sired. The medical officer of health decided after he had visited the
hospital and noted the precautions which were being taken that this
step would not be necessary, and it was accordingly not done. At a
later date influenza did become epidemic in Portsmouth Town, but
as at that time none of the convalescent influenza cases from this hos-
pital had been permitted to visit the town or receive visitors, and as,
moreover, the other patients in hospital had not developed influenza,
it was evident that the infection was introduced to Portsmouth from
another source.
1914
REPORT OF THE SURGEON" GENERAL OF THE ARMY.
The fighting on the western front was increasing in severity, and
during the hitter part of October and the early days of November
battle casualties from the 27th and 30th Divisi< ns were admitted to
the hospital in as large numbers as our facilities permitted. On
November 17 the hospital had 1,586 patients, the highest number
recorded on any one day.
Total number of surgical cases admitted 1, 765
Application of splints 250
Removal of shrapnel (local anesthetic) __.
Removal of shrapnel (general anesthetic).
Secondary closure of woimds
Abdominal operations
Herniotomy
Amputations .
47
11
39
23
18
12
Other operations 1G3
Owing to the short period of time in which American troops were
actively engaged on the fighting front, and to the care which was
exercised in the United States to exclude all potentially unstable men
from the expeditionary forces, the total number of neuroses and
j)sychoses has been relatively small among the American Armies
serving in Europe. During the active operation of this hospital
only 160 men of this type of case have been admitted — 64 classed as
psychoses and 96 as neuroses. Of the psychoses, but three cases
were classed as battle casualties — that is, cases in which the symp-
toms developed in the front line. Of the 96 neuroses, 47 were classed
as battle casualties.
Urological service. — Since the opening of this hospital for the re-
ception of patients only 13 new cases of venereal disease have been
reported. Of these, four were acute gonorrheal urethritis, three
were complications of gonorrhea, and the remainder were syphilis.
All of these cases occurred among patients in hospital, and no case
of venereal disease has been reported in this command since landing
in England. The regular seminonthly inspection for venereal dis-
ease has been held for enlisted men of this command, and all patients
discharged from hospital have been inspected for venereal disease
by the officer in charge.
Since landing in England (May 16. 1918) 176 prophylactic treat-
ments have been given to members of this command. Since the
opening of the hospital 254 prophjdactic treatments have been given
to patients in hospital.
Final discharge classif.cation. — The classification of all cases
treated at this hospital was as follows :
Class A^ 1, 683
Class B-1 : 114
Class B-2__ 177
Class C-1.
Class C-2
Class D-1
106
229
895
Died in hospital, 142.
Acted on by disability boards of other hospitals, 201.
On December 1, 1918. there were remaining in hospital 1,213 cases.
All cases were evacuated before midnight of December 31.
S. BASE HOSPITAL NO. 34.
The project of organizing a base hospital, using the Protestant
Episcopal Hospital of Philadelphia as a parent organization, first
originated in the summer of 1916 during the Mexican crisis. No
A. E. F. BASE HOSPITALS. 1915
definite organization nor plans -were perfected at that time, and the
formation of a hospital was dropped until January, 1917. Applica-
tion was then made to form a hospital unit according to plans drawn
up by the Medical Department of the Army, using civilian hospitals
as a basis for organization, the equipment, etc., to be financed by
the American Red Cross Society, The quota of Army hospitals at
that time being fi^lled, it was decided to use the Episcopal hospital
organization as a naval base hospital. Increase in the number of
hospitals to be organized caused it finalh'^ to be placed among the
Army base hospitals, and it was given the number of 34.
On September 8, 1917. the organization, with the exception of the
nurses and civilian employees, left Philadelphia and proceeded to
Allentown, Pa., where it was equipped and trained. On December
14, 1917. the entire personnel, the nurses having been mobilized in
the meantime at Ellis Island, X. Y., was transferred to the U. S. S.
Leviathan, formerly the- Vaterlaiuh of the Hamburg- American Line.
On December 15 the ship cleared the port of New York, arriving at
Liverpool, England, December 24, 1917. Southampton was reached
by rail that night. The English channel was crossed on the night of
December 25 and 26, and the organization debarked at 7 a. m. at lie
Havre, December 26, 1917.
The organization after leaving Le Havre was sent to Blois, report-
ing to the commanding officer Medical Casual Camp Xo. 6. There it
was learned that Xantes would be the future location of the hospital.
The equipment of the hospital as originally planned and bought
by the committee was ample. The necessary supplies for an increase
to a 1,500-bed capacity were readily furnished by the Medical Depart-
ment. The plans of the building had been most carefully worked
out by the construction division of the chief of surgeon's office, and
in addition experience proved that the careful thought and time
given to details by the officers Avho first superintended the construc-
tion of the hospital were not in vain.
The opening of Base Hospital Xo. 34 occurred on April 2, 1918,
when the doors were opened for the reception of wounded men. On
this date 37 were received from the American Red Cross Hospital
Nos. 1 and 2. located in Paris. From that time until July patients
were regularly admitted, coming from base hospitals in the advance
section. The great majority of these arrivals were slightly wounded
or cases well on toward convalescent which had been treated at other
hospitals. The surgery during this period ^vas largely of routine
nature, a few operations were performed, chietly secondary sutures.
When the American forces became engaged at Chateau-Thierry
reall}^ began the active commencement of the surgical service at this
hospital. To make ready for them every walking patient was evacu-
ated to either Base Hospitals Xo. 11 or Xo. 38, which were not at this
time prepared to take serious cases, or else to some convalescent camp,
convalescent hospital, or replacement depot. Three months of pre-
paratory work had found every department in smooth running order
and now the real test was about to come.
The perfect unity of every department and the endurance of every
individual therein was tried to the utmost. Convoys were sent from
the hospital in the Paris area that were acting as evacuation hospitals.
Also several preoperative trains were received. With the sudden in-
come in the number of severely wounded men this hospital, which
1916 REPORT OF THE SURGEON GENERAL OF THE ARMY.
was organized to look after 500 cases, rapidly expanded to 1,600,
practically all of whom were bed patients. No additional personnel
was received nntil several weeks later, and doctors, nurses, and corps
men had little sleep dnrino; this period. Duties were arduous, and
hours long and weary, but there was never a let up in the attendance
of those under our care and treatment. Every ward in the main
building and the barracks was filled with surgical cases. Cots were
placed not only in every available space on the wards, but in hallways,
offices, attic, and basement. Some eiilisted men were moved from
their barracks to make additional room. Medical officers from Base
Hospitals Xos. 11 and 38 were temporarily assigned and gave valu-
able assistance during that most strenuous period. This was done as
34 was the only hospital during July and early August at this center
that was ready for the severely wounded and all such cases were sent
here.
During this period the surgery consisted of serious types of op-
erations and not those ordinarily met with in civilian hospitals.
Wound cultures mare made as the wounded arrived, both anarobic-
ally. and the chief types of the infections were due to the Welch
bacilli, sporogeenesi bacilli, hfemolytic, and nonhsemolytic strep-
tococcus.
The knowledge of the kind of infection present was a great aid in
the treatment and the operation of these cases. Many of the wounds
having serious infection, it was necessar^^ to perform many amputa-
tions, debridements, incisions for better drainage, and various other-
kinds of operations lor the presentation of life and future useful-
ness. Preoperative convoys were received at this city 31 to 40 hours
after the wounded left the trenches, and at one time 800 new cases,
mostly all litter patients, were admitted in 73 hours. This hospital
performed the function of an evacuation hospital in a limited way
during the Chateau-Thierry drive.
In the St. Mihiel push very few wounded were received, but again
in the Argonne drive a busy period, such as existed during the mid-
summer months was approached. In this latter instance, however,
the battle front being much farther distant. Base Hospital No. 34 did
not receive patients as soon after injury. The greater number of
patients came to us from evacuation or field hospitals and only one
train of preoperative cases was received. The wounded received
after this offensive, as a whole, were not in such serious condition as
during the previous great rush. The wounds were better operated
upon and splinted, and consequently when evacuated from the ad-
vance zone stood the transportation far better than those of earlier
months.
On January 16, 1919, the unit was officially relieved by Evacuation
Hospital No. 36; 9,080 patients had been admitted, and of this num-
ber the majority were surgical cases. Especially gratifying has been
the low death rate, the percentage being but a fraction above 1 per
cent. This fact is noteworthy considering the hundreds of very
serious cases that had been cared for during the past year.
Of interest also was the first epidemic of influenza which appeared
about May 30, 1918. This was of mild form, the so-called " three-day
fever." It affected about three-fourths of the enlisted personnel and
one-half of the nursing and officer personnel. Only one case developed
pneumonia and there were no deaths. Repeated laboratory examina-
A. E. P. BASE HOSPITALS. 1917
tions revealed nothing new with respect to cause, origin, etc., of the
epidemic.
Paralysis due to nerve injury where there has been no severing of
the nerve, has shown definite response. A case of injury to the median
nerve in the arm with no apparent response of finger or wrist motion
to the electrical test had full motion and fairly good strength when
the patient was evacuated. A case of spinal meningitis, with resultant
absolute double foot-drop and very weak hip and knee flexion, under a
month of treatment regained strong foot action and increased knee
and hip action so that the patient could walk with a cane.
Scar tissues responded in the majority of cases very satisfactorily
to the combination of massage and both hand and mechanical vibra-
tion, giving such increased looseness and flexibility to the scar tissue
that the muscles and joints involved regained freedom of motion
and power. In one case a scar across the extensor longus hallucis and
anterior tibial almost completely prevented the action of those mus-
cles. After a scar excision was made, massage and muscle training
were given with the result that perfect function and normal strength
of the foot were regained.
In fracture or other conditions that necessitated immobility of any
joint for a length of time the massage an muscle training gave return
of full power to the joint and muscles involved in many cases, and in
others a good beginning toward increased power before evacuation.
Xo case of this kind on record failed to show improvement if imder
treatment even for a few days. It has been our opportunit}' to start
work on many such cases before the adjacent joint or musculature has
had the chance to become stiff. The j)reventive element has been a
very great advantage both to us and to the patient.
Cases of muscular atrophy or muscle weakness showed often full
return of size and power under carefully graded and progressed exer-
cises.
Treatment given to tone up musculature of uninjured limbs of
bed patients was time well spent because of its prevention of foot-drop
and weakness against the time when the patient was able to walk.
Also general massage for cases of neurasthenia showed great benefit,
in most cases bringing the patient to practically normal condition.
Splendid results have been secured on stiff and sore joints and mus-
cles .by the paraffine bath, and the baker has been very effective in
arthritic and rheumatic conditions. The addition of these and the
electric battery to the massage and muscle training has helped us to
get more far-reaching and quicker results than we could otherwise
have done.
RESUME OF PNEUMONIA CASES TO NOVEMBER 1"., 19 IS.
Total cases numbered 65, which were divided into pneumococcus
and streptococcus types. Cases in Avhich both organisms were found
were classed according to the predominating organism, Avliich, in the
majority of these was streptococcus. Pneumococcus cases numbered
29, of which IG followed a definite attack of influenza. Of these 16
the majority were definitely broncho-pneumonic in type. The con-
solidation beginning as definite small patches, later spreading and
involving practically the whole of the lobe. The remaining 13 cases
were practically all lobar in type. There were 10 pleural effusions,
1918 EEPOET OF THE SURGEON GENERAL OF THE ARMY.
or 34.5 per cent, in this group. Of the 10, 5 were purulent and 5 were
sterile. In the ti\e purulent fluids, four contained streptococci as well
as pneumococci.
The mortality of this group was 14 per cent. Four deaths, of
v.hic'li three Avere uncomplicated and one complicated by effusions
and pericarditis.
Streptococcus cases numbered 36, practically all of which fol-
lowed a definite influenza. The average time elapsing between the
onset of the influenza and the onset of the pneumonia was 4.5 days.
As many of the cases came to the ward with well-developed consoli-
dation, the history of increased cough and respiratory embarrass-
ment was the only indication of the beginning of the pneumonia. In
those cases wliich developed under our observation, the process be-
gan in practically all of them with small patches of consolidation
Vvhich spread very rapidly throughout a lobe. Often small patches
would appear in two lobes practically simultaneously. The spread
of involvment in these cases was much more rapid than in the pneu-
mococcus cases.
Complications. — Effusion: Twelve or 33.3 per cent of these, 8 or
G6.6 per cent were purulent. Four or 33.3 per cent were sterile.
There were four cases of pericarditis. Of the pericarditis cases all
had a definite to and fro rub and in none was effusion demonstrated.
The mortality in this group was 28 per cent. Of the 10 deaths 3
were uncomplicated and 7 were complicated by effusion. One case
of pericarditis with moderate effusion and a heavy coating of heavy
fibrin on both parietal and viscoral portions was demonstrated at
autopsy. There were two cases which came to autopsy in which con-
siderable quantity of fluid had been undiagnosed.
The most interesting feature in comparing the two tj^pes of cases
was the striking difference in the blood counts, the streptococci
cases being above 12,000 W. B. C. in 13 per cent. Pneumonia cases
about 12,000 in 72 per cent. The streptococci cases were 12,000 or less
in 87 per cent, while the pneumococci cases were 12,000 in only 28
per cent. In the streptococci group the lowest counts were invariably
found in the fulminating cases with extensive involvement which were
very common at the onset of the epidemic. Later, as the streptococ-
cus cases became less fulminating, they were accompanied b}^ a much
larger number of effusions and the blood counts were strikingly
higher.
This group includes only cases with well-defined consolidation in
which there could be no question as to a definite pneumonic process,
either from physical signs or clinical course. There was another
group observed in the influenza wards in which fever was either un-
usually high or prolonged, in which only small areas could be dem-
onstrated by careful examination. All of these which were later
X-rayed showed confirmatory plates often indicating more extensive
involvement than was suspected. In these there were no extensions
and the course was uneventful except in two cases which developed
sterile effusion. Both of these made unusually rapid recoveries after
aspiration. In only one case did effusion develop in which no pneu-
monic process could be previously demonstrated.
There were throughout the house 27 other cases of pneumonia, of
which 15 cases were streptococcic, 11 were pneumococcic, and 1 was
undetermined. Total deaths were 10, or 37 per cent. Of these, 8
A. E. F. BASE HOSPITALS. 1919
Tvere in the streptococcic group, oi 53.3 per cent ; 2 were in the pneu-
mococcic group, or 18.1 per cent. The apparently great difference
in mortality between this and the group from the pneumonia wards
is readily explained by the fact that many cases in the latter group
were only recognized by diligent search in the influenza wards. The
total percentage of mortality for the hospital for this period, which
represents the height of the epidemic, was 29 per cent.
Influenza cases. — During the month of November all cases of in-
fluenza admitted had a culture taken from throat to determine the
presence of streptococcus in order to judge the prevalence of compli-
cations in the two groups. Of the 98 cases so examined 6 have de-
veloped otitis media. Three of these were from cases with positive
throats. Three cases of sinusitis, one of which was from a patient
with a streptococcus throat and two patients with pneumoco'cus.
Orbital cellulitis, one case in a patient with negative throat. Pneu-
monia, 11 cases, 7 of which were in patients with throats positive for
streptococcus and 1 in cases with pneumocccus throats.
There were two cases of meningitis, which developed apparently as
definite complications of their influenza. In one of these the Peiffer
bacillus was isolated from the spinal fluid, in the other the organism
was not found and although the fluid was turbid under in -reased
pressure and contained a large number of cells it remained sterile
throughout. Both cases made uneventful recoveries, being treated
as ordinary meningococcic cases with repeated doses of meningococ-
cus serum. Meningismus was marked in may severe cases.
In the cases developing pneumonia the mo3t common s^'mptoms
of onset were increased cough, slight chilliness followed by increase
in temperature and respiration. Practically none had frank chill,
and very few had pleuritic pain at this stage. The most striking
symptom initiating the pneumonia was epistaxis, which occurred fre-
quently in the pulmonating type of rapidly spreading and usually
fatal streptococcic cases. This reoccurred often in this type of case
and came to be viewed as ominous of a fatal prognosis.
There was one death from influenza. This occurred in a patient
who was gassed two weeks previously and was one of the earliest in
the epidemic. Xo pneumonia could be demonstrated, and there was
evidence of only moderate bronchitis. Clinically and at autopsy
the principal lesion being cardiac dilatation.
Of other diseases admitted to influenza wards as influenza tliere
were several cases of mumps, two of scarlet fever, two of measles,
and one of meningitis. There were no cases of cross infection in
spite of the fact that some of these remained as long as 21 hours be-
fore transfer.
The fatality in the surgical cases was largely due to hemolytic
streptococcus infection. The wounded from the Soissons, Chateau-
Thierry, and Rheims area seemed to be more i)ronc to infection than
those from the other areas of France. Quite a few ca^es of gas
gangi'ene were received or developed after admission. Bull serum
was tried on these, but with a questionable residt of value.
Operations to the number of 1,475 were performed, which number
included major and minor types. Among the latter were numbered
dela3'^ed ]:)rimary and secondary sutures. The surgery consisted of
two chief types, first those met with in civilian hospitals, which came
1920 REPORT OF THE SURGEON" GENERAL OF THE ARMY.
to US from the hospitals in and about Nantes, and, second, the war
injuries, and of this type all varieties were treated.
For the sterilization of wounds many solutions, those of prewar
use and those brought forth since the conflict began, have been used
in large quantities. The Carrel-Dakin solution was the best method
of sterilization of wounds. This was especially valuable prepara-
tory to suture, bacteriological culture having been first made. The
count of the number of bacteria per field aided greatly in giving
knowledge of the proper time for suture to be made.
The medical service of the hospital occupied the upper-floor wards
of the main building. The cases were general in nature. During the
latter part of June and the whole month of July the character of the
medical service changed entirely. From 300 or 400 patients it
dwindled to 50, because of the influx of battle casualties. This
continued during the months of August and Sejotember, 1918.
On September 22, 1918, the influenza epidemic assumed larger
proportions and proper precautionary measures were taken which
materially reduced the number of fatalities. The medical service
increased in numbers until it ultimately cared for more than half
of the patients in the hospital.
A certain number of wooden barracks were set aside for the care
of influenza cases and of pneumonia cases developing from the same.
Wards were chosen, well ventilated with large windows in the sides
and ventilators in the roofs. All beds were " cubicled " by means of
sheets suspended between each bed. Patients, ward physicians,
nurses, and orderlies were masked. No visitors were permitted.
All beds were placed 3 feet apart. All patients and ward attendants
were required to use a mouth wash and an installation of nucleo-
protein in nasal passages was daily enforced. Wards were set aside
in close proximit}- to the influenza barracks to which all cases
developing pneumonia were transferred.
Coincident with the increase in pneumonia cases occurred an in-
crease in number of cases of other contagious and infectious diseases.
This was largely due to the fact that the 38th Division was billeted
in the area directly" south of Nantes. The majority of cases admitted
from this command were cases of measles and mumps, notably the
latter. A few cases of diphtheria and epidemic cerebrospinal menin-
gitis were also admitted.
T. BASE HOSPITAL NO. 35.
In April, 1917, United States Army Base Hospital No. 35 was
organized in Los Angeles, Calif., under the sponsorship of the
American Red Cross. Its parent organization was the Hospital of
the Good Samaritan.
The raising of the funds, the organization of the hospital, and
the acquisition of equipment occupied the spring and summer of
1917. This labor was done gratuituously by members of the organi-
zation, aided unselfishly by large numbers of patriotic citizens of
Los Angeles, Pasadena, and neighboring cities. It is to be regretted
that it is not possible, through lack of data, to acknowledge to each
of these people the debt Base Hospital No. 35 owes them.
On March 9, 1918, Special Orders, No. 57, Headquarters, Western
Department, San Francisco, ordered into active service the enlisted
personnel.
A. E, F. BASE HOSPITALS. 1921
The men were mobilized in Los Angeles, on March 14, and pro-
ceeded on that date to Camp Kearney.
On July 4, the unit entrained at Camp Kearney for the first part
of the long trip to France.
The unit sailed from Hoboken on July 15 on the English steam-
ship Port Melbourne. The rest of the officers sailed in the same con-
vo}^ on the steamship Saxonia. A few days later our nurses were
assembled in New York to finish their over-seas training. Leaving
that port some weeks after the corpsmen embarked from Hoboken,
they crossed directl}^ to France on the steamship Leviathan and ar-
rived at the hospital center on August 21, less than two weeks after
the officers and corpsmen.
At Mars we found Units 68, 48, and 14 already on the ground, the
two former functioning, the latter, having come over on the same
ship, arrived at Mars one day before us. As our quarters were un-
completed, we set up an outdoor kitchen with marmites, and slept
in large tents. A number of corpsmen went to work in the wards of
the two hospitals which were receiving patients; the rest of the
detachment undertook the job of finishing our buildings, unloading
equipment, building roads, etc. As there was no headquarters com-
pany, our progress was materially hindered by the necessity for
furnishing men to handle camp medical and quartermaster supplies,
and for camp guard details. The first patients arrived on Sep-
tember 2, over 500 being admitted on that date.
AVith the exception of the four fracture wards, which had cement
floors, our wards and barracks, which were of the sectional type,
were entirely of wood. Good spring beds with mattresses were fur-
nished in every ward.
Our heaviest work was done during and immediately following
the drives at St. Mihiel and Argonne Woods. At these times men who
had been wounded four or five days before and had had only first-
aid dressings were sometimes received.
The highest number of cases under treatment at any one time was
2,800. This high mark was reached at a time when 40 corpsmen and
20 nurses were in hospital with influenza and pneumonia. However,
the situation was handled in such a way that each individual was
proud of the results obtained.
During the time we functioned in the American Expeditionary
Forces, 3,401 medical and 3,117 surgical cases were treated in our
hospital. The total mortality was 77, 2 of whom were nurses and 2
corpsmen.
The patients and property of Base Hospital No. 35 was turned over
to Evacuation Hospital No. 30 on January 15, 1919. Before this time
10 nurses had been transferred to the army of occupation ; 25 returned
to the United States, leaving 65 of the original number on duty with
the evacuation hospital. On February 19, 1919, the unit left Mai-s-
sur-Allier for Clisson, in the St. Nazaire reservoir area.
Surgical service. — The surgical service rendered by Base Hospital
No. 35 consisted of 500 operations performed in the main operating
room at Mars and the work done by our operating teams which func-
tioned as mobile units near the front. Numerous minor operations
wprp done in the wards by the surgeons in charge.
1922 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The operating pavilion at Mars was equipped with six modern
tables. Good sterilizers, abundance of instruments, basins, linen, and
other equipment made possible proper care of all cases. A great con-
venience was the proximity of the X-ray room, which adjoined the
main operating room. The fluoroscope was indispensable in locating
foreign bodies.
No work of remarkable interest was accomplished by this depart-
ment, except that the transfusion of whole blood by the syringe
method was developed to a degree of perfection by the younger sur-
geons, and was frequentl}^ used to the great advantage of large num-
bers of medical and surgical patients. In chest surgery, also, some
original work was done. In addition to freely draining cases of
pyothorax, encysted empyemata, intralobular abscesses, multiple ab-
scesses, intralobar abscesses, and the removal of foreign bodies, an
attempt was made to restore the mobility of lungs whose excursion
had become limited or nil by the cutting and tearing of adhesions and
the removal of limiting pyogenic membrane. The outcome or value
of this latter work was not known at the time of the departure of the
unit from Mars-sur-Allier.
First dressings on all fracture cases were done in the operating
room under supervision of the surgical chief immediately on arrival
of each train. This practice was found to be very desirable, as
traveling had sometimes brought about dangerous complications.
Oferating Team No. 132. — This team left with Team No. 133, on
August 31, and reported with them to Base Hospital No. 115, Chau-
mont, where they were outfitted with instruments, gas masks, and
helmets. They were then sent to Evacuation Hospital No. 1 for
temporary duty. In this hospital the team was on the regular oper-
ating staff and received its share of the hospital's work as a part
of the First and Second Armies. The team visited along the whole
American fighting front, from Chateau-Thierry and Verdun to
Luneville.
Operating Team No. 133. — Leaving Mars on August 31, it pro-
ceeded to Chaumont, where, after obtaining equipment for service
at the front, it was ordered to report at Mobile Hospital No. 3, near
Toul, for temporary duty. While en route at the railroad station at
Neuchateau, German aviators raided that place, dropping several
bombs. No material damage was done. On September 4 the team
arrived at Mobile Hospital No. 3, which was set up on the grounds
of Evacuation Hospital No. 1, Sebastopol, about 6 kilometers from
Toul, and serving as a reservoir for the overflow from that hospital
during rush periods. During normal times operating teams of Mo-
bile Hospital No. 3 served tours of duty in the operating rooms and
wards of Evacuation Hospital No. 1. Team 133 was on duty there
during the St. Mihiel drive of September 12-15.
On September 20 Mobile Hospital No. 3 moved to Kosiere-en-
Haye, about 10 kilometers nearer the line, in the direction of Pont-
a-Mousson. Here it occupied wooden buildings of the sectional type
originally built by the French for a hospital and later used by a
United States field hospital. At this place only the seriously
wounded were received, the slightly wounded going to Evacuation
Hospital No. 1 or to Toul.
On the night of October 9 the hospital caught fire, and the build-
ings, connected by corridors, comprising all the wards and the oper-
A. E. F. BASE HOSPITALS. 1923
ating pavilion, were burned to the ground. The patients were all
safely evacuated, but all operating and X-ray equipment was lost.
The hospital immediately pitched its wards and operating tents, and
in a few days was again able to receive patients.
On October 12 the team was ordered to Mobile Hospital No. 7, via
Chalons. The hospital had just changed its location from near
Suippes to Somme-Py, and was not yet set up when the team arrived.
The site was a battle field evacuated by the Germans 10 days be-
fore. The surrounding country was completely devastated and filled
with wreckage of battle, with many of the French and German dead
unburied. The hospital was behind the lines of the Fourth French
Army, with which were serving two American divisions. The
American wounded were cared for by Mobile Hospital No. 7 and the
French wounded by a French hospital in the neighborhood.
On October 31 the team was ordered to proceed to Mobile Hospital
No. 39, near Toul. Arriving in Toul, the team was quartered at
Base Hospital No. 82 until Mobile Hospital No. 39, which had re-
cently moved, was set up and ready to receive patients. A few days
later the team reached the hospital, which was situated in the woods
near Heudicourt, in the territory taken from the Germans during
the St. Mihiel drive. The team was at this station when the armi-
stice was signed, and remained until November 20, when orders to
return to Base Hospital No. 35 at Mars were received.
During its entire tour of detached service the team operated to-
gether, with the exception of a few days. As the mobile hospitals
were under canvas and followed the advance of the lines, only seri-
ously wounded were received. Others were sent to permanent hos-
pitals to the rear. The team's heaviest work was done during the
St. Mihiel drive.
MEDICAL SKRVICE.
A total of 3,401 medical cases were treated. The majority of these
were respiratory tract infections and gastroenterities. Of the former,
influenza predominated, there being 709 cases, pneumonias totaled
141. The majority of the gastroenteritis cases were not severe,
and were relieved by a few weeks' treatment of diet and rest.
All diplitheria cases of the center were treated in our hospital.
They totaled 46. We also handled all cases of typhoid, and para-
typhoid fever for the center, of which they were very few.
P^yc. cai\ nose, and tliroat department. — Most patients presented
acute infections of the upper respiratory tract. Numbers reported
with field diagnosis of chronic tonsillitis, some with recurring at-
tacks of acute tonsillitis. A goodly number of cases of chronic
middle-ear suppuration, mostly of many years' standing were en-
countered. Some cases claimed deafness due to concussion, but of
these only two genuine cases were found. The rest were regarded
as cases in which there were preexisting ear diseases, although prob-
ably in some cases the deafness had been augmented by explosion
or concussion. Acute middle-ear infections were treated by free
myringotomy whenever there was distension of the tympanic mem-
brance, and the insertion of a small, sterile wick. As a result of
this treatment of 110 cases requiring middle-ear drainage, two cases
only of mastoiditis developed. Irrigations of middle-ear infections
were not practiced. A culture of all middle ears was taken at the
142367— 19— VOL 2 60
1924 REPORT OF THE SURGEON GENERAL OF THE ARMY.
time of the myringotomy and sent to the laboratory for bacteriologi-
cal diagnosis. Cases of tubo-tympanic catarrh were frequently en-
countered, often "with fluid in the middle ear. These were treated
with myringotomy, and the removal of tonsils and adenoids when
indicated. Tonsillectomy was done by local anesthetic (cocaine)
except Avhen adenoids were also to be removed, in which case a
general anesthetic (ether) was employed. Not a few cases were sent
from the front for the correction of nasal obstruction due to devia-
tion of the nasal septum.
Many cases of sinusitis presented themselves, most of them acute,
being secondary to colds or influenza. Some dated the origin of their
disease from an attack of rhinitis, following mustard-gas inhalation.
Most acute cases of sinusitis responded to treatment of the nasal
mucous membrane, some required minor intranasal surgery, such as
removal of part of the middle turbinals. Empyema of the antrum
of Highmore was treated by repeated irrigations, using physiological
saline solution.
The X-ray was freely used for diagnosis in sinus disease and mas-
toiditis and found to be of great value. Seven cases of gunshot
wound of the head involving the sinuses were encountered, three of
which also involved one eye. One gunshot wound in the mastoid
region, involving the middle ear, required a radical mastoidectomy,
with ligation of the common carotid and obliteration of the lateral
sinus. The patient made a good recovery.
Five intraocular fat implants were done after evisceration, and
one fat implant in an orbit after extrusion of the glass ball of Mule's
operation. The last, as well as three of the implants after eviscera-
tion, "took," with good resulting stumps for prosthesis. One case,
previously diagnosed and cellulitis of the lid, proved to be luetic tar-
sitis, and cleared up on antisj^philitic treatment.
tr. BASE HOSPITAL NO. 37.
United States Army Base Hospital No. 37 was authorized by the
Surgeon General, United States Army, on April 2, 1917.
The Kings County Hospital, Brooldyn, N. Y., was the mother in-
stitution, and from the staff of this hospital officers were enlisted in
the Medical Reserve Corps.
On January 4, 1918, the enlisted personnel was mobilized at the
23d Regiment Armory, Brooklyn, N. Y. On February 5, 1918, moved
to the 14th Regiment Armory, Brooklyn.
On April 1, 1919, the nursing staff was mobilized at the Crescent
Athletic Club, Brooklyn, N. Y.
On May 19 United States Army Base Hospital No. 37 left the
United States, port of New York, on the steamship Lapland, arriv-
ing in Liverpool on the 31st. . On the 1st of June proceeded to
Southampton to the American rest camp. On June 5 the organiza-
tion left the rest camp and arrived at Camp Efford, Plymouth, Eng-
land. Camp Efford being a troop hutment, it was necessary to con-
vert the buildings into a hospital type of hutment.
July 1 to 8: Construction work is progressing rapidly at Camp
Efford. The huts are being connected so as to make the transport of
patients a very simple matter. A new sewage system is being in-
stalled. The health of the command remains excellent.
A. E. F. BASE HOSPITALS. 1925
The entire hospital staff and equipment left for Dartford July 18.
Tlie new institution is ideally situated on a marked elevation, about
16 miles east of London.
July 25 to August 2 : The first convoy of American wounded was
received. These patients were convalescent and came from a nearby
British hospital.
September 7 to 15 : Sir William Osier visited the hospital.
September 15 to 21 : We have at present about 1,100 patients in the
institution.
September 21 to 28 : Eeceived a convoy of 160 medical cases direct
from a transport. These men were very sick and with a severe type,
many of them having a broncho-pneumonia complication. All cases
were immediately isolated and every precaution to prevent the dis-
semination of the disease. Among the 160 cases received from the
transport Olympic were found:
Cases.
Pneumonia 54
Cerebrospinal meningitis, epidemic 5
Pneumonia 20
Pneumonia with meningitis of pneumococcic origin 1
Epidemic cerebrospinal meningitis 4
Among the complications were :
Cases.
Otitis media, 2 witli ruptured eardrums 14
Scarlet fever (scarlet fever developed in a case of broncho-pneumonia,
which recovered) 2
Measles 1
Mumps 1
Cervical adenitis, which required operation 1
Empyema 3
Erysipelas 1
In the uncomplicated influenza cases the disease cleared up in three
to four days.
1. Patients were isolated.
2. Patients wore a distinctive mark on their clothing during infective period.
3. All attendants wore masks and gowns. Nostrils were washed with an
antiseptic solution.
4. All wards were divided into cubicles.
5. All patients were carefully screened and segregated.
November 9 to December 1 : During this time we have had every
available bed occupied. Tents were put up about the grounds for
the men of the unit, while their beds were given over to the patients.
All construction Avork about the institution ceased under orders
from headquarters in view of th6 cessation of hostilities.
Two hundred and fifty patients were sent to Liverpool, and later
sailed for liome on the steamship Leviathan. These required no
special attention. On December 14, 963 cases were placed on board
the steamship Sasconia at Tilbury for transport to America. We
have now about 600 cases, although this number is being increased,
due to the fact that small convoys are coming in at intervals. Four
of our wards have been closed.
Number of surgical cases received 3, 111
Number of medical cases received 1, 239
Total number of cases received 4, 350
Number of deaths (1.08 per cent) 47
' Twenty-five of tbese have died since admission.
1926 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
V. BASE HOSPITAL NO. 38.
Base Hospital No. 38, United States Army, was organized in May,
1017, under the auspices of the American Red Cross, at Jefferson
Medical College, Philadelphia, Pa. The director of the unit was
responsible for the organization, for the accumulation of the per-
sonnel and equipment, for the efficient and rapid completion of all
requirements necessary for the proper functioning as a base hospital.
The bulk of the enlisted personnel were enlisted July 13, 1017, the
unit mobilized October 15, but remaining in training at Philadelphia,
Pa., until June 21, 1018.
The unit was held in a state of constant readiness for immediate
embarkation, which long hoped for, was finally realized on June 21,
1018. It arrived in France, July 5, 1918, in Nantes, July 11, 1018,
and began actual operations as a base hospital with patients, July 22.
1918. On January 26, 1010, Evacuation Hospital No. 31, officially
took over the administration of the hospital and Base Hospital No.
38 ceased to function as such. jNIarch 6, 1010, finds the detachment
of 173 men and 9 medical officers awaiting orders to leave for a port
of embarkation. March 2, 1919, 28 nurses left Nantes for La Baiile
en route to the United States.
The male personnel of Base Hospital No. 38 left Philadelphia, Pa.,
the 21st of June, 1918, arriving at Hoboken and embarking aboard
the steamship Nofathi and the steamship President Grcmt. After an
uneventful voyage the steamship No-patin landed at Brest, France,
July 5, 1018. They arrived in Nantes, Loir Inferieur, July 11, 1018,
detrained and marched to the Grant Blottereau, Doulon, Natest, to
be the first to occupy the new hospital buildings there under process
of construction.
Immediate steps were taken to bring about as soon as possible the
object of the organization, namely, the caring for the sick and
wounded ; occupying temporarily several partially completed wards
as barracks, every energy was at once devoted to assist in the comple-
tion of the remaining buildings. The all-important problem of a
kitchen and mess hall, operating rooms, and sterilizing apparatus,
the last to be started, had now first to be considered ; this work was
rapidly undertaken, with the result that buildings were so nearly
completed, mess facilities sufficiently adequate, such operating equip-
ment installed as to enable caring for the first patients as early as
July 22, 1018; 132 in number from the Soisson front, exactly 11 days
after arrival on the scene. B}^ unceasing efforts, by untiring work on
the part of an enlisted personnel of such a highh^ trained character
as to permit of their superintending and performing the construction
in all its branches, the buildings, 48 in number, less than half com-
pleted on their arrival, were practically completed within a month,
despite the fact that from 200 to 600 patients were carried on the
morning report over the latter half of this time.
The 20 officers aboard the steamship President Grant arrived in
Brest July 12, left Brest July 16 and arrived in Nantes to rejoin their
organization July 17, 1918.
Lack of material for hospital equipment soon became a problem.
Though a depot quartermaster was available for the district of
Nantes and Base Hospital No. 34 had a well-stocked commissary,
no advance provision had been made for the supplying of food and
A. E. F. — ^BASE HOSPITALS. 1927
clothing to the hospitals of the Grand Blottereau. Instead of having
an established quartermaster for the center, so organized as to care
for a stated number of patients, no depot for the center was even
begun until August 10, 1918, and was not fitted to supply commis-
sary goods and clothing for another month; still later a medical
supply depot was thought of and finally opened. Food for the ever-
increasing number of patients became more and more difficult to
obtain; long hauls made the problem still more serious and trans-
portation facilities were sadl}^ inadequate. Instead of building
capacity for patients around the food and clothing supply, the supply
facilities were guardedly constructed to comply onh^ to the most
urgent, crying demands, which necessitated uncalled-for delay.
However, telegraphic requisitions were admirably filled and
shipped by the medical supply depot at Corne; the original equip-
ment sent from the States for use of the organization slowly, but
surely, made its appearance in part. Transportation, comprising
ambulances, staff car, motorcycles with side cars, had all been
pixjmptly confiscated at the ports and never reached their intended
destination; several hundred cases of valuable material and needed
dresings were lost, but graduall}' enough was gathered to care for any
emergenc}'. B}- August 1, there were 264 patients in hospital with a
maximum at one time during the month of 959.
Shortly after arrival' in France the personnel became sadly dis-
rupted. Of the 100 female nurses who had arrived some six weeks
prior to the male personnel, but seven remained in Xantes on duty
with Base Hospital Xo. 34, which small number was assigned to
their original organization only after it was found impossible to
care for over 500 cases with an enlisted personnel, who in addition
to nursing were obliged to finish the construction of the hospital.
Nurses were added, a few at a time, till finally 36 were on duty and
caring for as many as 2,413 cases at one time.
The buildings consisted of 21 wards, a patients' kitchen with two
mess halls, three personnel barracks and mess hall, three officers'
barracks and mess hall, five nurses' barracks and mess hall, an
ablution shed for the men, a pei'sonnel bath, the receiving ward and
patients' bath house, three quartermaster medical supply and mess
supply buildings, a building intended for a laundry, a large operat-
ing pavilion and a laborator}^, and a well-constructed and orderly
arranged administration building. Wiring and plumbing kept
pace with the construction, due to the efforts and slvill of the per-
sonnel; sterilizing apparatus was set up in the operating pavilion,
steam heating therein installed, utilizing steam from the large steril-
izer, and constructing a radiating system with 3-inch pipe ; a S3'stem
of heating the developer in the tank of the X-ray dark room was
instituted by running a steam line with a control valve through it —
the expense for said construction and supplies being borne by
donated private funds.
Patients continued to accumulate despite the rapid clearance of
duty men, to such an extent as to require the erection of a tent hos-
pital as a convalescent camp, which in August was completed and
equipped to care for 550 patients. Grouped in series of three form-
ing Avards for 50 men each, 36 tents were j^itched, paths constructed,
latrines built, a dispensary opened, a headquarters established, and
from this group many of the patients were daily assigned to fatigue
1928 REPORT OF THE SURGEON GENERAJL OP THE ARMY.
duty of various kinds in and about the hospital. Certain tents were
used as isohition wards, and all cases of diphtheria, measles, mumps,
A^incent's angina, and allied conditions were isolated and treated.
September, 1918, showed a maximum of patients in one day of 1,116.
With the arrival of patients in July the problem of a ]aundr\' had
to be met. Provision for a laundry, though recommended in the
plans for the hospital a year previous, had not been made, no means
for handlinor the thousands of pieces of laundry weekly were avail-
able either locally or in the city of Nantes, no facility for caring for
the smallest fraction of the work of a hospital of any size. Laundry
equipment complete in every detail and crated for shipment, pre-
sented to the oi-ganization in the States, had been condemned as un-
necessan^^ and ordered left behind. A laundry promised to the cen-
ter early in July. 1918, was received several days after the amiistice
was signed, and in January, 1919, had not been completely installed
and put in operation. French female help was employed and an
emergency laundry put in operation; pipe was procured, a shed
built in one corner of the gromids and nmning water supplied;
G. I. cans were used for boilers, and with approximately 20 women
working con=:tantly. sufficient quantity of washing was done to fur-
nish material for 5 dryings every 24 hours in a dry house, hereinafter
to be described, in addition to that which could be dried in the open
air in the few bright days. Washtubs, ordered by telegraph, were
refused delivery because they were not considered an emergency,
despite the fact that at the time the requisition was sent there were
over 2,200 patients in hospital. However, sufficient towels, operating
gowns, and sheets, etc., were kept clean to supply the hospital in
part, though the laundry question was never adequately solved.
Difficulties were naturally expected, many were met, most were
overcome. The unit Avas occupied, completed, and in operation in
the shortest possible time, a time remarkable when the stupendous
extent of work done is considered. A spirit of zest for accomplish-
ment was rampant among the entire personnel, a spirit which still
exists to the fullest extent. On the eve of embarkation one and all
can lie down with an ease of conscience, a feeling of work well done,
with the certain knowledge of a splendid record.
Construction. — July 11, 1918, the date of arrival at the Grand
Blottereau found the state of construction of the three hospital units
far from completed ; one .series of buildings, one unit, constructed
entirelv of wood, was 90 per cent complete; one now occupied by
Base Hospital No. 216 had merely the framework of approximately
50 per cent of the buildings; completed; the central unit, then occu-
pied by Base Hospital No. 38. was nearly 50 per cent complete. The
most e^^sential requirement, a kitchen for patients, was barely begun,
likewise the operating room; personnel barracks and kitchen had
not been started, with the exception of the concrete bases for same.
Three wards were complete with the exception of plumbing and
lighting facilities, 10 others almost complete, and the balance of 48
buildings in various stages of semicompletion.
The enlisted personnel, made up of men with experience in all
walks of life, electrical and civil engineers, plumbers, carpenters,
masons, painters, telephone experts, and almost every needed profes-
sion and trade were available. Assisting the Engineers in charge of
the construction, at their instigation assuming charge of various de-
A. E. F. BASE HOSPITALS. 1929
partments, in harmonious conjunction with Engineers and French
civilian employee?, the unit was rapidly brought to state of com-
pletion. By the latter part of July it was well within 90 per cent
finished, including exterior grading, building of roads, installation
of poles and wire for electric lights, and the installation of sewage
pipes.
Far and awaj'^ above all others were the acute respiratory infections,
and during the period of intense activity at the front a high relative
percentage of gas contact and inhalation cases increased to a still
higher point the amount of respiratory pathology.
The figures quoted, here omitted, are of necessit}^ approximate and
in part deluding. For instance, some of the cases finally classified as
broncho-pneumonia were infectious superimposed upon gas cases;
the nervous cases are high because this hospital received all of these
diseases admitted or developing in this center after September, 1918;
the acute communicable diseases are very low because the bulk of
them were assigned to Base Hospital No. 31 and Base Hospital Xo.
216; exhaustion cases were more frequent than shown, this cause of
much incapacity in troops entering as an associated etiological factor
in many cases shown under other headings. It is not amiss to here
emphasize again the fallibility of all statistics, and especially those
derived from data accumulated under the stress, overwork, and in-
complete facilities of enormous emergency work. This comment
must of necessity apply to all general statements derived from indi-
vidual hospital experiences in the American Expeditionary Forces;
only the survey of the entire data of the Medical Department in
France can approach accuracy, and even here conclusions will ulti-
mately have to lie drawn from records prepared hurriedly, briefly,
and without the lengthy positive and negative statements so necessary
for scientific study, comparison, correlation, and deduction. The
greatest opportunity ever presented to the medical profession of our
country has had to pass without the full realization of all the lessons
to be learned, because it was not possible to have a surplus of medical
talent to overwhelm the clinical material rather than what actually
existed, an irreducible minimum of medical officers desperately work-
ing to meet an ever-expanding maximum of patients. It is to be
regretted that well-balanced, well-trained thinking staffs were not
constantly present and at work in the various clinical centers, front
and base sections, for purely scientific work, unhampered by routine
dutie'^ of treatment and interest in those details only as they entered
into the mass of facts which might have been accumulated and which
are necessary, primai^y, and indispensable for the philosophical con-
sideration of any subject. We delight in the care and attention we
were able to give our sick and wounded ; we are disheartened at the
knowledge we have failed to gain for future professional generations.
Tlie respiratory infections. — In general, these nowise differed from
the classical types of civilian practice. There are a few exceptions to
this statement. Haemolytic streptococci infections were insidious, of
indefined symptouis and signs, and hopelessly fatal. Broncho-pneu-
monia showed in fatal cases a particular tendency to coalescent mas-
sive types simulating lobar. Either type superimposed upon gas cases
was extremely fatal, a secondary infection proliably being the major
cause of death in long-standing cases, and was a constant pathological
concomitant. Extrarespiratory complications were not unusual.
1930 EEPORT OF THE SUEGEON GENERAL OF THE ARMY.
Empyema was of ordinary incident. It was impossible to obtain
complete typing of organisms in all cases. In the large number
which it was done, however, the clinical results conformed to the
accepted statements of their relative virulence.
Gas cases. — These having only conjunctivitis by contact did well
and recovered promptly without local after effects. Gas inhalation
cases were treacherous, uncertain, of prolonged symptoms and signs,
often fatal in cases after several weeks, furnished 10 per cent of all
deaths in hospital, and often came to autopsy with pathology at wide
variance with what was to be expected from physical examination
during life. The post-mortem findings in these cases included ca-
tarrhal, ulcerative, hemorrhagic, suppurative, laryngo-tracheo-bron-
chitis, fibroid bronchitis, peribronchial infiltration and pneumonia,
pneumonias of both types, pulmonary suppuration, gangrene, atelec-
tasis, emphysema, and edema and will be completely dealt with in
laboratory reports.
It is to be recorded that no deaths in our soldiers were preceded
by more distressing s^anptoms than in these cases, which, for some-
times as long as two weeks, slowly developed asphyxia from hyper-
secretion and exudation, and finally literally drowned in a flooded
respiratory tract. Gas contact causing skin burns was frequent and
aggravated the seriousness of inhalation cases. Two inhalation cases
developed attacks typical of bronchital asthma, including the pres-
ence of eosinophilia. They denied ever having had asthmatic attacks
previously.
Mumq)S. — This was an annoyingly common disease : orchitis fre-
quent. One case of submaxillary mumps occurred without parotid
involvement. There were no fatalities or unusual complications.
TiiherculosU. — Xo deaths from this disease came to autopsy. Old
lesions were frequently found. Active lesions were infrequent, but
cases were frequently misdiagnosed as such, the confusion arriving
from residual influenzal changes and alterations of pulmonary struc-
ture by gas inhalation. The X-ray department has an interesting
comparison to report of extreme value in the diagnosis of chest con-
ditions in soldiers by military or civilian practitioners during and
after the period of demobilization.
Surgical. — When the unit arrived at its destination the operating
pavilion was not completed ; the windows and skylights had not been
fitted : the plumbing had not been started ; the adjoining X-ray room
was not finished. In spite of these facts, three weeks after the arrival
of the unit the first operation was performed in a completed oper-
ating room. The room was spacious, well lighted, excellently heated,
and the water supply ample. Immediately adjoining the operating
room, on one side, was the X-ray department, and on the other side
the sterilizing room, the sterilizing plant being entirely satisfactory.
An office for the chief surgeon, a dressing room for the surgeons, a
splint room, a room for making dressings, and a large room used for
a dispensary and plaster work, completed the operating pavilion.
There was never occasion for running more than three operating
tables at one time ; two tables were used for clean cases and the third
for infected cases. Fifteen of the 21 wards were occupied by surgical
cases, and in each ward, with the exception of the fracture wards,
there Avere 56 beds. At one time when there were 2,413 patients in the
hospital it was necessary to occupy 10 wards of an adjoining hospital
A. E. F. BASE HOSPITALS. 1931
to which no unit had as yet been assigned. Two wards were used
exclu.sively for compound fractures, 25 Balkan frames were placed
in each of these wards, and in each of the other wards 4 Balkan
frames were placed for emerofency. The wards were cheerful, airy,
well lighted, and heated. Adjoining each ward was an office, diet
kitchen, wash room, toilet, ward-master's room, and linen closet.
Upon the arrival of trains the more seriously wounded were im-
mediately sorted out and transferred to the wards; the transportation
of the wounded from the hospital tram to the hospital was speedily
carried out. Every surgical case was dressed immediately upon its
arrival in the ward and those requiring operative procedures were
operated on at once.
All bed cases were dressed in the wards ; the beds were not supplied
with rollers, nor was there a dressing room sufficiently large adjoin-
ing each ward to which the cases could be taken for dressing. With
strictest econom}' and by washing and resterilizing all gauze and
bandages there was never any serious shortage of supplies.
Traumatic head cases and traumatic abdominal cases were con-
spicuous by their absence. Many cases of gas bacillus infection re-
quired further debridement, drainage, or immediate amputation.
Bull's and French polyvalent sera were routinely used in these in-
fections. The chest cases were an interesting group of cases: those
associated with foreign bodies, extensive hemothorax, and adhesions
were operated upon. The blood or blood clot was washed out, adhe-
sions freed, the foreign body removed, and the incision closed with-
out drainage, with gratifying results.
In cases of empyema after free drainage Dakin-Carrel treatment
gave excellent results. Practically all compound fractures were treated
in Thomas splints swung on Balkan frames. The Dakin-Carrel tech-
nique gave excellent results; dichloramine-T and paste were tried,
but the results of cases treated by these antiseptics were not as good
as the cases treated with Dakin-Carrel. Fractures involving the
femur were, of course, a most serious group of cases, but not so much
so as gunshot wounds involving the knee joint; the results of these
latter cases were not encouraging. Many knee-joint injuries treated
at the front where the joint had been penetrated, the capsule sewed,
and a Carrel-Dakin tube placed down to the capsule arrived at the
base hospital badly infected. Free drainage in these cases was em-
ployed; in many cases the joint was widely opened, the patella re-
moved, the joint dressed in an acutely flexed position, giving access
with Dakin's fluid to all parts of the joint. Results were discourag-
ing; in a large majority of the cases amputation had to be resorted to.
Peripheral nerve injuries were a frequent complication of gunshot
wounds and fractures of the extremities; aneurism was not an in-
frequent complication or sequelax. The most frequent indications
for amputation were uncontrollable gas infection, streptococcus in-
fection, repeated secondary hemorrhage fi'om large vessels, and irrep-
arable joint injury. The guillotine operation was satisfactory^, but not
as satisfactory as an amputation leaving a long anterior flap, which
was sewed back to the skin about the stump. The result of secondary
closure of these stumps following the treatment with Carrel-Dakin
technique was entirely satisfactory. Every patient who had an ampu-
tation w^as transfused at the time of amputation.
1932 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The greater majority of foreign bodies were removed in the fluoro-
scopic room ; the Avork was facilitated by the Excellent localization by
the roentgenologist. The Strumpell method and the Hertz compass
were both used, with uniformly good results.
The ultimate result of gunshot injuries to the spinal cord was not
unlike that of civil surgery — unsatisfactory. A percentage of cases
had been catheterized before reaching the base hospital, with the
inevitable resulting cj^stitis. The secondary closure of wounds was
most successful. With the cooperation of the laboratory in examina-
tion of smears and cultures, there were but few failures to obtain
primary union after closure.
Ether was used for operations more extensively than anj^ other
anesthetic; the supply of nitrous oxide and oxygen was limited.
Novocaine was employed for removal of some foreign bodies, a few
secondary closures, and other occasional operations. Savariaud's
method of anesthesia was used in over 500 cases and was most satis-
factory ; there were no harmful results in any case. It was used exten-
sively for painful dressings and as a preliminary to a general
anesthetic. The mixture used was 1 to 2 parts chloroform, 5 parts
ethyl chloride, and 15 parts ether. A piece of flannel bandage folded
5 thicknesses was saturated with this mixture, placed over the patient's
nose and mouth, a cone-shaped mask made of oiled silk was then
placed over the face and held tightly by a turn of the rubber bandage ;
a small amount of air was allowed through an aperture in the apex
of the cone. The duration of the anesthetic, given as mentioned,
average from 10 to 12 minutes.
The question of administration of an anesthetic was handled in
exactly the same manner as in the average civilian hospital, always
keeping in mind the grave changes to which a patient is subjected in
taking a general anesthetic. Utmost precaution was taken by the
entire surgical staff to be sure the patient could take an anesthetic
with safety and careful selection of the anesthetic to be taken. All
ward surgeons were held responsible for conditions prior to anesthesia
and also for the condition of the patient while being transferred
from the operation pavilion to the ward.
The anesthetics were administered by trained anesthetists, one
dentist and two nurses, but always under the supervision of a medical
officer detailed for that position. Most major operations were per-
formed under ether anesthesia; thoracotomies and head operations
were done, as a rule, with a tube passed into the trachea and the ether
given by Blair's apparatus made by the De Yilbiss Co. Practically
all minor operations and secondary closures of wounds were done
under nitrous oxide and ether, given through a Gwathmey machine.
As a result of a very close cooperation between the surgeons and
the anesthetist, together with the careful examination of a patient
before giving him an anesthetic, the judicious choosing of the anes-
thesia, and avoiding any slightest danger to the patient, there has not
been a case on record in this hospital where death could be attributed
to anesthesia.
Plaster work was greatly facilitated by the use of the Hawley
table. In many cases of fracture, after the acute infection had sub-
sided, the fragments could be far better held in apposition by the
use of a well-molded plaster of Paris cast than by the continued use
of a Thomas splint. During the treatment of the acute infection and
A. E. F. BASE HOSPITALS. 1933
while using Dakin-Carrel technique in cases of fractures or extensive
injuries to the soft parts the Thomas splints for arm and leg were
invaluable. The Hodgkin splint was but seldom employed. From
August 8, 1918, until November 11, 1918, 507 operations were per-
formed; from August 8, 1918, until Januarv 1, 1919, 668 operations
were performed.
Ophthalmological department.— Early in August about 30 cases of
severely gassed cases were received directlv from the front. All with
body burns, all with more or less lung 'involvement, and all with
severe eye symptoms— discharge lachrvmation, photophobia. A few
showed distinct superficial corneal haziness. The majority showed
no apparent physical changes in the cornea. All corneal cases cleared
up within a week. The discharge, lachrvmation, and photophobia
persisted for a couple of months. Except' those who died from lung
affection all finally became well with no perceptible interference with
vision. Treatment— Sol. Ac. Boric. Sol. Dionin which for a time
seemed to give good results. Later Ung. Ox. Flav. appeared to be
most effective.
Gas cases received later, and generally after a period in other hos-
pitals, seemed to improve more rapidly with Ung. Ox. Flav than
anything else, although Dionin also had a good effect. Argvrol amis
never used.
Radiologic department. —There has been, perhaps, no one pha'^e of
war radiology which has attained such a field of usefulness as has
bedside radiologj', with the possible exception of localizations of
foreign bodies. Even the refinement and simplification of localiza-
tion and removal of foreign bodies as developed bv war necessities
has to a great extent fulfilled its usefulness when the war has ended,
but the development of bedside examination has opened a vast field
for radiology, hitherto a closed book. It is largely as an expression
of appreciation of the value of the Army bedside unit that I am
presenting this report. During the last three months, which repre-
sents the actual time this hospital has been doinff active service we
have examined a few more than 150 cases at the b^edside. '
The examinations have been radiographic, with and without the
intensifying screen and fluoroscopic, for fractures, foreiffn bodies, and
pulmonary conditions of those patients who could not be transported
to the laboratory. One is often called upon to exercise every bit of
ingenuity he possesses to secure two views to determine position.
Stereoscopic studies have assisted many a time. With the aid of
Bowen plate holders, and by marking the horizontal slidino- bar on
the tube carnage, the required shift can readily be made. *
Radioscopic studies with the Dessane bonnet fluoroscope have been
made for fracture position, foreign bodies and pulinonarv conditions.
I have found one method for examination of pulmonarv conditions
very valuable. We have had a number of patients who require
radiologic studies to determine the presence of fluid, empyema, hemo-
thorax, broncho-pneumonia, lobar pneumonia, pericardial effusions,
pulmonary abscess, subphrenic abscess, or foreign bodies. Many of
these patients were either too sick to be moved or even turned lipon
their sides, or else by reason of being splinted and slung in Balkan
frames, and other fearfully and wonderfully contrived devices, could
not be moved. By the use of font stilts, which, when placed under the
legs of the bed, raise the bed 12 inches, 1 can drop the tube beneath
1934 REPOET OF THE SUEGEOX GENERAL OF THE ARMY.
the bed, and, fluoroscoping through the mattress, secure very satis-
factory information.
The bed springs of the reguLation bed do not interfere materially with
the study, due to the fact that, being some distance from the screen and
a greater distance from the screen than the tissues to be examined, the
mesh shadow is very much exaggerated, and but few of the lines of
the spring intercept vision. I found the average ward bed spring
cast a shadow which placed the spring shadows 20 centimeters apart
on the screen. In the case of a search for foreign bodies a slight
shift of the tube will shift the shadows of the spring. By this
method the patient is not at all disturbed, nor is the position of the
fractured limb disturbed. Where the Balkan frame is being used,
the frame, which is lashed to the bed, is lifted with the bed, and rests
with the legs of the bed on the stilts.
Our hospital being of the barrack type, it is necessary to carry the
bedside unit from ward to ward. This is readily accomplished by
suspending- the unit b}' the handles on a litter made of timbers of
sufficient strength and fastened together by two crosspieces. The one
we used was made in a few minutes by one of the men. It consists
of two timbers 2 by 3 inches, 5 feet long and set 16 inches apart,
being held together by two crosspieces 30 inches apart.
Conclusion. — A bedside examination by this method affords:
1. Easy access to entire torso and limbs, fluoroscopicall3\
2. Patients can be examined who would otherwise not be available.
3. No risk to ver}^ sick pulmonary cases.
Sanitation. — Up to the time of arrival of the hospital staff in
Nantes, little had been done along the line of sanitation; all efforts
had been extended toward completing the hospital buildings and
roads. July 19, 1918, a detailed inspection of the hospital and sur-
rounding grounds was made. Later, with the sanitary officer of
Base Hospital No. 11, another general inspection was made, this time
covering the entire Grand Blottereau. In these reports upon these
inspections emf)hasis was laid on numerous breeding places for flies
and mosquitoes ; it was recommended that immediate steps be taken
to *' clean up the camp."
In addition to clearing out the underbrush, making the destruction
of breedmg places for tiies possible, an energetic campaign for de-
stroying the fl}^ was carried on. All kitchens and mess halls, the
operating room, laborator}^ and morgue were screened, 3 per cent
formalin solution sweetened with molasses placed in every building,
10 per cent formalin about all garbage cans, and the strictest atten-
tion paid to the general policing in and about the kitchens. An
epidemic of a mild type of diarrhea, affecting approximately a third
of the personnel, had caused the fly question to be brought into promi-
nence: this epidemic was investigated, but the true cause remained
undetermined. Bacteriological examination of the water showed
contamination in Avater from certain taps, while others were free;
samples of water from city taps were constantly free from contamina-
tion. However, only boiled water was used and signs were placed on
all taps forbidding the use of unboiled water. Later Lyster bags
were obtained and chlorinated water used for drinking purposes;
samples of water were taken from various taps weekly until all
samples were found to be colon free three successive weeks. After a
survey by the laboratory of Base Section No. 1, the water as piped
A. E. F. BASE HOSPITALS. 1935
to US from the city of Nantes was declared fit for drinking purposes
and chlorination discontinued October 7.
Larvte of anopheles and culex mosquitoes had been noted in the
pools and ditches about the hospital grounds; some of the pools to
the rear of the hospital grounds were at times blocked with larvse.
Because of the shortage of all kinds of oil, drainage was the chief
means of combating mosquitoes breeding. Oil was used sparingly
where drainage and filling in were found impossible.
Course taken hy fatients after received in hospital. — A litter case
arrives in ambulance, is lifted out by a team from squad 1, carried
into receiving ward, and placed on the floor. Here he shows his
field envelope and records, Forms 55 A, made out by a member of
clerical force, who returns all papers to him. He is then carried
opposite receiving officer at desk in rear of ward, has throat exam-
ination, records inspected by receiving officer, and is assigned to
ward — surgical, medical, observation, or isolation, as the case may
be. Ward number is noted on Forms 55. The original and his other
records are returned to him and the noncommissioned officer in
charge of squad 3 directs litter team to carry him to the ward indi-
cated. At the ward he is immediately seen by a medical officer;
has a bath, wound dressing and inspection, medication and food as
indicated; frequently cases are admitted demanding immediate op-
erative measures and are therefore prepared at once and sent to
ojDerating room. One blanket and empty litter are returned by the
same team to squad 1 to be placed in empty ambulance for return
to train. Pajamas, splints. Carrel tubes, bathrobes, and slippers
with which the patient arrives are noted by assistant to receiving
officer in order that proper return may be made to central depot
later. VValking and sitting patients are assisted to benches, have
Forms 55A made out ; have throat inspection ; are passed upon by
receiving officer; are assigned to ward; are passed on to batlihouse,
undress, discharge clothing to salvage heap, turn over valuables,
which later go to safe in adjutant's office and receive receipt for
same; go to medical officer for inspection for skin and venereal dis-
eases, etc.; draw towels, have bath, dry themselves, receive pajamas,
bathrobes and slippers (for ward wear), and records which non-
commissioned officer took from them in the undressing room. Hot
coffee and light lunch is given them, and they are then conducted to
their ward with all their records by a member of squad 4. Because of
the fact that patients are required to go from the bathhouse to wards
in mucld}^ streets and unsheltered walks they wear their own shoes in
lieu thereof. In order to maintain proper records in base house each
ward is charged with pajamas, bathrobe, etc., as they are issued to
patients, and accumulated supplies in wards are later turned in to
medical supply office for credit. If communicable disease is found,
the patient is sent to proper ward for isolation, or in doubtful cases
is admitted to observation ward, where immediate study of the con-
dition is started, or where he is held pending the development of
his case. The clothing of walking patients is put in bags, tagged
with their names, and sent to sterilizer. Walking cases with dress-
ings receive baths if justified in the opini(m of the medical officer
stationed in bath house. If their dressings become wet it is of only
a brief duration, because of immediate primary dressing so soon as
patient arrives at the ward. Medical officers in bathhouse may also
1936 REPORT OF THE SURGEON GENERAL OF THE ARMY.
direct shaving of axillary and pubic hairs on account of pediculi.
Cases are admitted as casuals from morning- sick calls, neighboring-
detachments, and organizations in the same though less formal man-
ner. Occasionally emergencies require admission to take place in
the ward itself. Duplicate Forms 55A go to registrar's office and
frcm there are initiated the reports emanating from that place.
AV. BASE HOSPITAL NO. 4 0.
In June. 1917, the organization of Base Hospital No. 40 was
authorized by the Surgeon General. Lexington, Ky., was the home^
and the Good Samaritan Hospital, of that place, its parent institu-
tion.
Its organization was placed in the hands of thei American Red
Cross Association, and was projected on the basis of 500 beds.
In December the director was instructed to change the organiza-
tion on the basis of a thousand beds, requiring 33 officers, 100 nurses,
5 civilian employees, and 200 enlisted men.
Late in December, 1917, the organization of Base Hospital No. 40
had been completed, and was so reported by the Red Cross, and
turned over to the Surgeon General's Office as read}^ for foreign
service.
About April 1 all officers were ordered to Camp Taylor and as-
signed to duty at the base hospital.
On June 18, 1918, the officers and enlisted personnel entrained
for Camp Mills by' special train, arriving there on June 20, and on
July 5 embarked from Hoboken for overseas. The nurses and civil-
ian employees were not in the convo3\ they leaving on the Olyni'piG
July 12, arriving at Southampton Jul}^ 19. Those on the Scotian
reached Glasgow on July 17; those on the Louisville, Liverpool,
July 17, the convoy being split off the coast of Ireland, some ships
going to Glasgow and some to Liverpool. From Glasgow by train
to Southampton to the rest camp, arriving July 19. and at Liver-
pool the 26 officers were sent to Knotty Ash Camp. The nurses were
sent from Southampton dock to Satisbury Court, only 6 miles, by
trucks, reaching the place July 20, 1918, the officers and men at the
rest camp Avent on the 2d, and the officers from Liverpool arriving
on the 30th. The unit was scattered, and at no time has the organ-
ization functioned as a whole, and as an organization Base Hospital
No. 40 has done but little work.
The hospital was first opened for admission of patients on Sep-
tember 27, 1918, 125 cases being admitted on that date. Between
September 27 and October 4, 1918, 312 medical cases were received
and cared for in the manor house and tents; these cases came from
ships arriving at Southampton and are reported in detail on a sep-
arate sheet. Most were influenza cases and complications of the
same, and in the number were 48 cases of pneumonia, the type not
determined, as the laboratory had not been established.
Since October 18, 1918, 988 cases have been admitted to the hos-
pital, and of the recent admissions have been a number of surgical
patients, they having passed through a number of hospitals before
reaching this one; and of the pneumonia cases, up to date, there
have been 108, with 13 deaths, one of which spinal meningitis was a
complication.
A. E. F. BASE HOSPITALS. 1937
December 31 the hospital has a reported bed capacity of 800; 1,000
patients could be cared for in an emergency. Total number of pa-
tients in hospital this date, 574.
X. BASE HOSPITAL NO. 41.
On February 26, 1918, Base Hospital Unit No. 41 was mobilized at
University, Va., the University of Virginia being the parent organ-
ization. On March 5 mobilization was completed and departure
taken to Camp Sevier, S. C, with 149 enlisted men.
Arrived at Camp Sevier following day and temporarily stationed
at division isolation camp. After being in quarantine for about two
weeks the organization moved to the base hospital for intensive train-
ing. We were stationed at the base hospital for about three months,
and it was there, under the guidance of the " old detachment," that
we were schooled and trained to be able to operate our own hospital.
On June 18, after completion of our preliminary training, the unit
proceeded from Camp Sevier to Camp Mills, with 35 officers and
223 enlisted men.
On August 12 the hospital was placed in readiness for the recep-
tion of patients, and the first convoy of wounded reached the hospital
on August 16.
General care of fatients. — Dressing teams, operating teams, and
wards were organized to receive the patients by the heads of the sur-
gical and medical services. The executive head planned expansion
of the hospital, which, from the ground it covered, seemed unlimited.
It is safe to say that when Base 41 was notified that it was to be
one of the largest hospitals around Paris it could be scarcely be-
lieved b}'' many of its personnel. Yet when this was realized by final
expansion to 2.807 beds, it rather was to be expected that another
expansion would follow.
During those trying days in the month of October when the hos-
pital was expanding to its limit, when everyone was taxed to his ut-
most, the corps men threw their strength and willing spirit into the
care of the patients, and many developed remarkable skill and judg-
ment in handling wounds and became very proficient as dressing
assistants. In the care of the patients too much credit can not be
given the corps and nursing staff of the unit for the earnest, untiring,
and conscientious application to their duty, which have won for them
a very promient place in the history of Xo. 41.
All of these patients with the exception of 200 in ward 21 were
walking cases, and were placed under the charge of a sergeant of the
corps. A classification and duty roster was kept of all walking pa-
tients, and every man capable of work, whether light or heavy, was
given some duty to perform. At one time the staff of patients uti-
lized by the hospital numbered 800, and were selected from patients
who were almost well, or whose wounds or illnesses made them un-
fit for further duty at the front. In this number there were many
men valuable in hospital management, such as cooks, stenographers,
etc.
To facilitate the better handling of so large a number of ambula-
torj'^ cases, a central dressing station was established in ward 22.
There the patients under charge of a noncommissioned officer were
1938 REPORT OF THE SURGEON GENERAL OF THE ARMY.
passed through and dressed daily by an efficient nursing staff and
corps men, assisting the surgeon. Several hundred wounded were
examined and dressed in this station daily.
Report of the surgical section. — On August 16, 1918, the first con-
voy of patients was received in Base Hospital 41.
This convoy consisted of 137 patients from the front and arrived
at 11.50 p. m., giving the personnel their first opportunity to put into
operation the machinery they had been carefully preparing.
It was no small task for doctors, nurses, and corps men, unused to
handling wounded men in such large numbers, to care for this con-
voy, but satisfactory treatment was administered to these wounded
soldiers in a surprisingly short time.
As the convoys continuously came in till the signing of the armi-
stice our machinery seemed to work more and more smoothly, and
the 700 patients that arrived in the course of about 40 hours on one
occasion were handled in a very satisfactory and expeditious manner.
From August 16 to October 7 Base Hospital 41 acted as an evacua-
tion hospital, receiving patients directly from the front. Only first-
aid treatment had been administered to these, patients, and it was
necessary for us to pass each patient through a dressing station.
A sufficient number of medical officers, nurses, and corps men were
always assigned to this dressing station to care for the work without
loss of time.
The patients were brought from the bathing station direct to this
dressing station by litter squads of corps men. Here the wounds
were carefully inspected and the further distribution of each patient
determined. Those requiring operation were sent to the operating
room, and most of them were sent through the X-ray rooms to
localize foreign bodies or determine the presence or absence of a
fracture. In this dressing room many early cases of gas bacillus
infection were discovered and the case hurried to the operating
room. Here also it was determined whether the patient had received
tetanus antitoxin or not. If he had not received a dose, one was
always given.
Adjacent to the operating room was prepared a shock room where
patients suffering from shock were given the usual preoperative
treatment.
Blood transfusions were frequently resorted to with great success
in cases where hemorrhage had complicated gunshot wounds.
In order to handle the large convoys of surgical cases it was neces-
sary to divide the surgical staff into operating teams. Each team at
first consisted of an operating surgeon, an assistant, a nurse, and
anesthetist, having eight-hour periods of duty. Later, when the
convoys became larger, more work accumulated on the wards, and
with the epidemic of influenza at its height it became necessary to
reorganize these teams, and the surgeons operated with nurses and
many times corps men assisting.
To use medical officers as anesthetists was not possible on account
of the amount of operative and postoperative work. Among the
nursing personnel were exceptionally good anesthetists, but not quite
enough to take care of large convoys. This difficulty was overcome
by training corps men to give anesthesia. Within a surprisingly
short time four corps men were developed into good anesthetists.
A. E. F. BASE HOSPITALS. 1939
We found that for many reasons nitrous oxide-oxj^gen anesthesia
Avas preferable to any otlier in a large amount of our surger}^, and we
always had two administering machines in readiness. Ether, how-
ever, was used as the routine anesthesia. Local anesthesia was used
many times in removing superficial foreign bodies.
During the maximum crisis the ward could not accommodate all
fractures of the long bones, and most of the other wards contained a
few such fractures. Our fractures of the long bones were treated
for the most part by suspension and extension in a Thomas or
Hodgen splint attached by pulleys to an overhead Balkan frame.
We also found it desirable to group all thorax cases in order that
<;fRcers of the medical section could more easily see these cases in
consultation with the surgeons.
At no time during the activities of Base Hospital 41 did we lack
for any essential equipment. Due to the combined efforts of the
Army and Red Cross there Avere always in the supply room an ample
supply of surgical dressings of all kinds and every desirable kind of
orthopedic apparatus. The operating room was always supplied
with every necessary instrument, suture material, and apparatus.
The Avork of an evacuation hospital is harder than that of a base
hospital having the same number of patients, because the cases are
sent out of the evacuation hospitals as soon as they can travel and
their places are taken by new cases, which keeps the hospital filled
with freshly wounded, requiring daily painful, laborious dressings.
For very painful dressings we used a " cocktail " consisting of
ether, 2 drams; chloroform, 2 drams: and alboline, 4 drains. This
was administered a few minutes before starting the dressing and was
never objectionable to the patient, but on the contrary decreased the
jjain very much.
When, on ( )ctober T, Base Hospital 41 ceased to act as an evacuation
hospital and liecame a base hospital the number of patients rapidly
increased, but the work was less strenuous and more satisfactory be-
cause we could follow our cases till they were well on the way towanl
recovery.
At this time, however, the influenza had reached its height and
eight members of the surgical service were unfit for duty. AVe asked
for help, and the commanding officer of Base Hospital 85 sent us three
excellent officers, who helped us throughout the busiest period.
Due to the improved methods of treating wounds, we were able in
many instances to get wounds surgically clean in a very short time
and do a secondary suture, thereby saving the patient several weeks
of convalescence and the hospital many dressings and the personnel
much time.
Naturally in a base hospital there are always quite a number of con-
valescing patients who have contracted tendons, partial ankylosis
of joints, peripheral nerve injury, causing deformity, and to correct
these conditions an orthopedic out-patient department was estab-
lished. Here the i)atients reported every morning and received con-
trast baths, massage, and passive and active movements.
The residts of this orthopedic clinic Avere beyond expectation,
many conditions of deformity being absolutely corrected and others
so nuich improved that reconstruction in the States will be much
facilitated.
142367— 19— VOL 2 61
1940 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Medical section. — On the night of August 16, IDIS, our first convoy,
consisting of 137 patients, arrived. It Avas then seen that the vast
majority of the patients we were to receive wouUl l)e surgical, as they
were reaching us on hospital trains and by ambulances directly from
the dressing stations and evacuation hospitals in the zone of active
operations. Out of 38 oflicers we retained nine for the medical serv-
ice, including the chief, but within 10 days two of these were trans-
ferred to the surgical side. Whereas the medical admissions
amounted only to around 30 per cent, it was realized that ever}^ surgi-
cal case was potentially a medical one, and frequent and early medical
consultations were encouraged. Thus was developed the true coop-
erative spirit, and excellent teamwork was the result. Whenever a
patient on the surgical side developed a fever or symptoms which
could not be accounted for by the condition of his wound, a note was
immediately sent by the ward surgeon to the chief of the medical
service requesting him to see the case. Either he or his assistant con-
sultant would examine the patient, and if a medical condition had
developed it was treated by the medical staff. All cases of the wounds
of the chest with resulting hemothorax or pneumothorax, or both,
were seen every day conjointly, and definite signs of infection were
considered to be pain and tenderness over the affected chest, slight
fever, spitting of pure blood in some cases, and the appearance of
large moist rales. Frequent X-ray plates were made in all cases and
were fcund to be of inestimable value, interpreted as they Were by an
expert in this line of Avork.
There were 141 mustard-gas cases, most of them bad eyes, trachea,
and bronchi affected, and many in addition had extensive burns of
the skin. They were kept in bed on an average of three weeks, the
eyes frequently washed out with soda-bicarb, solution, the tracheitis
and bronchitis treated by inhalation of medicated steam, and the
burns dressed with boric-acid ointment. There were three fatalities,
one from edema of the lungs, due to ulcerative tracheitis and bron-
chilitis, and two frOm broncho-pneumonia due to the streptococcus
hemolyticus. A sequella in some cases was a fibrosis of the lungs,
which was verified and often diagnosed by the X-ray plate. An
X-ray plate was made on each case before being finally disposed of.
Another sequella in a few cases was effort syndrome.
In-ftuenza. — September 20, 1918, a convoy of convalescent and
active cases of influenza arrived, and September 23 we began to have
our first cases of this disease among the personnel.
During this epidemic the corpsmen were inspected twice daily.
Any showing irritation of the eyes or throat were separated from
the others and a throat culture taken. If any subjective symptoms
were present they were sent to the influenza ward. They were moved
out of tents into sleeping quarters in a well-constructed building with
ample room space. Lectures Avere given emphasizing the importance
of personal hygiene, sleep, open Avindows during the night, coughing
into a handkerchief or the left hand rather than in a neighbor's face,
and of reporting at '* sick call "' on the slightest manifestation of
feeling beloAv par. The danger of cross infections was also explained
to them and the importance of Avearing the gauze mask Avhen Avorking
among the cases of influenza and pneumonia.
Out of 200 corpsmen 100 had influenza, and in 8 broncho-pneu-
monia was a complication. The largest number oft' duty at any one
A. E. F. BASE HOSPITALS. 1941
time AA'as 40. on Octol)er 3. The numlier of fatalities was two: one'
was due to the streptococcus hemolvticus. and a hmg- puncture after
death in the other showed the micrococcus catarrhalis. Out of 3S
officers 15 had influenza, and broncho-pneumonia followed in five of
these. One officer died, due to the streptccoccus hemolyticus infec-
tion.
Out of 100 nurses 50 had influenza, and in 8 fibrous or serofibrinous
pleurisy was a complication. One had a streptococcus hemolyticus
broncho-pneumonia. There were no fatalities among these.
This vast difference in the percentage of serious complications in
this disease among the personnel demonstrates very forcibly tlie im-
portance of getting these cases in bed early — that is. as soon as there
Avere any symptoms referable to the air passages or throat. The nurse
being constantly at work when on duty would naturally feel tlie
effect of the disease sooner than those who worked more or less spas-
modically and would report at sick call at once. We believe that
contact is the large factor in the spread of this epidemic disease^
whereas close and damp qiuirters and careless personal hygiene pre-
dispose to it by lowering the resistance of the body.
As far as possible all cases of influenza were placed in a ward to
themselves, or each bed was screened at the* sides. The treatment
consisted of rest in bed. warmth, and initial purge, forced fluids,
liquid and soft diets, cleansing of the throat and nostrils several
times a day, and codeine for frequent and severe cougli. ]SIany of the
ordinaiy employed drugs were used. Ijut -none seemed to have any
specific action. The good results that followed were probably due to
the diaphoresis produced. The total number of cases of influenza
and broncho-pneumonia and the mortality rate will be stated later.
Pneumonia usually follows an attack of influenza between two to
eight days from the onset of the disease, though sometimes it is
delayed for two Aveeks or more. Therefore, no case in an epidemic
of influenza, three-day fever, or what-not, should be allowed to make
any exertion until the danger period is passed. In the very acute
cases of hemorrhagic pneumonia little or nothing can be done to stay
the progress of the disease after it has started. In these cases there
is ])ractically no air space in the lungs and the patient dies by drown-
ing from the hemorrhagic exudate in the lungs and bronchi.
In many cases there is found an older lobular pneumonia with
more recent hemorrhagic pneumonia superimposed. Here again after
the secondary process has started there is little hope of recovery.
Then attention must also be directed to the prevention of this com-
plication.
This complication of hemorrhagic pneumonia is invariably due to
the hemolytic streptococcus. There is evidence to lead one to think
that this is probably a direct extension process. "When the process
can be traced it usually seems to start in the central portions of the
lung, spreading to the periphery along the bronchial tubes. Throat
cultures show that in an epidemic of this kind practically all in-
fluenza cases show a predominance of hemolytic streptococcus in the
throats. Of 20 cases cultured in one day in this organization every
one showed streptococcus hemolyticus in abundance. Some wore
beginninir and some were convalescent. One one case terminated
fatallv.
1942 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Brotieho-pneumonia.—M the same time the cases of influenza
were cropi)ing up, the streptococ-us liemolvticus made its appear-
ance, and it was ahuost universal. It acccnmted for ahnost all of
the deaths from broncho-pneumonia. During September. October,
and November 19 of the 23 deaths from that disease were shown by
cultures to be due to this germ. One patient with broncho-
pneumonia was transferred to us from another hospital and lived
only SIX hours after arrival. Two of the fatal cases of broncho-
pneumonia showed on autopsy old tuberculous lesions in the lungs,
and another showed chronic endocarditis.
The general measures employed in the treatment were early digi-
talization, physical and mental rest, with as few physical examina-
tions as possible, forced fluids, liquid diet, and enema at least every
other day, and the bed was placed at or near an open window. We
had no lobar pneumonias, hence we used no serum. We treated
the pneumonia and didn't aspirate unless there were evidences of suf-
ficient accumulation of fluid to cause disturbance by pressure. All
of the cases were severely toxic, and the heart at autopsy showed no
evidences of dilatation in any of its chambers. Venesection was em-
ployed in several cases, with apparently no beneficial results.
The main factors foi* recovery appeared to be obtaining the cases
sufficiently early to begin active treatment and digitalization when
the temperature was elevated after the fourth day. and good body
resistance not undermined by an infected wound, prolonged hospital-
ization, or exposure to wet or cold.
All the pneumonia cases were separated from the other patients
either by being placed in a reserved section of the ward or in the
cubicle. The officers, nurses, and attendants wore the gauze mask
and washed their hands frequently Avith soap and water and im-
mersed them in a lysol or cresol solution.
An X-ray plate was made on all suspicious cases of empyema and
on every case of broncho-penumonia that recovered before being
transferred or sent back to duty. Many cases suspicious of tubercu-
losis of the lungs were thus found to be due to an unrasolved pneu-
monic process or thickened pleura. A special hospital being main-
tained in the Paris district for contagious diseases, we were in-
structed to transfer all such immediately, and this order was carried
out.
y. HISTORY OF BASE HOSPITAL XO. 4 2.
Base Hospital 42 was organized under the ausi:)ices of the Ameri-
can Red Cross in the spring and early summer of 1917. The Uni-
versity of Maryland and College of Physicians and Surgeons was
the parent of this organization. The officers' personnel was. for the
most part, made up of graduates of this school. On or about April
1, 1918. the unit was mobilized at Camp Meade, Md.. for training.
The training was both medical and military. The military side
of the training consisted of drills, classes and lectures for instruction
in Army Regulations and Manual of Medical Department. This in-
struction was for both officers and enlisted personnel. In addition
to lectures and classes on medical subjects, the enlisted personnel was
assigned to ward work, operating work, etc., at the base hospital at
Camp Meade, Md. The nurses attached to the unit were assigned
to the different camps throughout the country.
A. E. F. BASE HOSPITALS. 1943
On June 20, 1918, Base Hospital 42 entrained at Admiral. Md.,
and proceeded to Camp Mills. Long Island, X. Y., stayed at the latter
camp until June 27, during which time there were various inspections
and arrangements made for proceeding oAerseas; reached Holjoken
June 27, hoarded ship, and Avent out to sea on the morning of June
28 at 9 a. m. In the convoy there Avere 12 other vessels besides an
armored cruiser. In the convoy Avas the ill-fated Justitki, which w as
attacked and sunk by a German submarine on her return trip. We
Avere aboard the British mail steamer Metagama. The trip over was
both interesting and pleasant, and. at 8.15 a. m. on July 10 landed
at Liverpool : immediately entrained here for Southampton and ar-
riA^ed at the latter place 7.15 p. m. and proceeded to rest camp. On
July 11, 1918, at 8 p. m., boarded a Channel boat called Viper and
proceeded to Cherbourg. "With us Avas Base Hos]3ital Xo. 25 and
314th Ammunition Train: landed in France at 9.30 a. m. on morning
of July 12. and from there hiked to a British rest camp (Xo. 2) just
outside the village of Tourlaville. Up early the next morning and
marched l)ack to Cherbourg. Boarded a train Avhicli Avas to take us
to our final destination. Ai-rived at Bazoilles sur Meuse (Vosges) on
the 15th of July. We found here a small American city, Avhich later
greAA' to be a large hospital center.
After this center Avas fully established there Avere eight base hos-
pitals located here. The location was A'ery advantageous, and it Avas
behind what Avas to be a future American line. The center Avas in a
valley in the foothills of the Vosges Mountains and situated directly
on a railroad. Almost immediately orders began to come through
sending officers and men to different places for duty. The teams as-
signed to Avork in other hospitals and other A'arious places of duty
were as follows :
Medical service. — At all times it was satisfactory, although when
great numbers of cases arrived it Avas found somewhat difficult to
handle them Avith a small staff. Aside from general medical cases,
pneumonias, Avith other acute respiratory cases, mumps, and measles,
were treated. Isolaticm facilities Avere excellent, and at no time did
Ave have any cross infections. The pneumonia Avards Avere Avell
equipped. Every patient Avas screened, and \'entilating arrangements
were excellent. The Avork of this department was of a high standard,
and each one Avorking in it serA'ed faithfully and well.
Z. BASE HOSPltAI. NO. 4?..
In accordance with an agreement Avitli the Surgeon General of the
Army a Eed Cross hospital of 500 beds, Avith a personnel of 24
officei's, 154 enlisted men, 65 female nurses, and 6 female civilian
enjployees was organized in the summer of 1917. The personnel
Avas largely recruited from Emory I'niversity of Atlanta, Ga. This
unit was consequentlv knoAvn as the Emor\' Unit, and was federalized
on August 30, 1917, as Base Hospital Xo.^43.
The command arrived at Camp Merritt, X. J., on June 4, 1918,
after an uneventful journey, and after a stay of nine days spent in
preparation for overseas duty. Avent ou board the steamship Olympic,
at Hoboken, X. J. The meclical sujiplies and the equipment for the
organization Avere at that time on the docks at Hoboken on arriAnng
and were left to be shipped at the first opportunity. The nurses and
1944 REPORT OF THE SURGEON GENERAL OF THE ARMY. 2^
civilian employees, whose equipment was not entirely complete, werel
likewise left in Xew York. Tlie unit sailed on June 14 with a full"
complement of officx^rs and men.
The commanding officer of Base Hospital Xo. 43, being the senior
medical officer on board the transport, was appointed by the com-
manding general, port of embarkation. Hoboken. X. J., as surgeon
of the boat. A hospital of 75 beds and an isolation section of 24
beds was established, the work being carried on by the personnel of
Base Hospital Xo. 43. Two sick calls were held daily for the 6.000
or more troops on board: also a daily i)hysical examination required
by the transport regulations. A total of 113 cases were handled
during the voj^age.
The unit docked at Southhampton. England, on the evening of
June 21, 1918. after an entirely uneventful voyage, and reembarked
on June 23. 1918, on the steamship Xirvarna for Havre, France, em-
barking at this port about noon of June 24. 1918. with the entire
personnel intact except for the Red Cross chaplain, who had not
been permitted to embark at Hoboken on account of a blanket order
covering the transportation of Red Cross chaplains to France.
On June 26, 1918, the command entrained at Havre for Blois,
France (par. 6. S. (). 173 headquarters base Section Xo. 4. American
Expeditionary Forces, dated June 26. 1918). arriving at Blois on
the evening of June 27, 1918.
On July 3, 1918. in compliance A^ith oral instructions from the
office of the chief surgeon. American Expeditionary P'orces, Base
Hospital Xo. 43. established itself at Blois. relieving Camp Hos-
pital Xo. 25.
July 6. 1918: Hospital train Xo. 51 arrived at al)out 5 o'clock a. m.,
this date, from Coulommiers with 314 patients from the front, classi-
fied as follows: Disease 71, venereal disease 1, war neurosis 3. gassed
124, gunshot wounds 84, and injuries 31. The hospital had received
no notice of this train due to a miscarriage of the telegraphic notices,
consequently there was delay in starting to unload the train.
August 12. 1918: The experience in the treatment of patients ad-
mitted to the hospital on account of gas infection of inhalation and
burns, consisting of some 285 cases, practically- all of these cases
having suffered from mustard gas or a combination of mustard
gas and phosgene, is as follows: The treatment is briefly, absolute
rest, occasional bleeding, and occasional administration of oxygen,
continuously if necessary, and the proper amount of stimulation. In
those gassed with weaker concentrations the symptoms come on
gradually, the danger lying chiefly in the complications which may
result, in the latter the treatment should be absolute rest, adminis-
tration of alkalies internally and the use of alkaline applications for
luustard gas burns and alkaline irrigations to correct the conjuncti-
vitis caused by this gas.
The effect on the heart has been very great in some cases. Our
experience has shown that digitalis is the best stimulant. To control
the cough and secure rest, small doses of morphine have not only had
no evil results, but have relieved these patients to a very marked
degree. Here oxygen may be used to an advantage in selected cases.
As a result of being gassed, quite a number of patients have shown
a hyposecretion of the thyroid, kidney changes that have persisted
over a number of weeks, cardiac changes, some of which appear to
A. E. F. BASE HOSPITALS. 1945
be permanent, lighting up of old tubercular lesions, and a peri-
bronchial infiltration.
All of these cases should be kept at rest for a month or six weeks,
after which the}' should have graduated exercises before they return
to active duty. This is absolutely necessary, because many cases
which, upon physical examination seem to have recovered, soon de-
velop heart murmurs after the very lightest exertion.
November 11, 1918: At a recent conference of officers, the neuro-
psychiatrist of this unit read a paper on the psychopathology of
" shell shock." in which it was stated that 10 per cent of hospital
admissions in the American Expeditionary Forces were psycho-
neuroses. Of these 60 per cent had been returned to duty. Experi-
ence has, proved that these cases, with rare exceptions, should be held
in field hospitals near the front for treatment. An interesting fact
was the extreme rare occurrence of psychoneuroses in wounded men.
No pcychoneuroses were observed in negro soldiers. In the series
of 100 cases at this hospital, a coarse tremor and emotional instability
were the most constant symptoms, whether the type was hysterical,
psychasthenic, or neurasthenic. Two cases of hysterical aphonia re-
covered spontaneously. War neuro.ses are looked upon not as ex-
pressions of conscious cowardice, but is a subconscious neurotic re-
treat. It was predicted that cessation of hostilities would result in
speedy recovery of most cases.
December 18. 1018: A paper on wound bacteriology was read by
the chief of the laboratory service in which the importance of early
culture of all wounds was emphasized. T^Hiile the enumeration of
the number of bacteria per microscopic field mav be accomplished by
the study of direct smears from the wound, this method does not
permit the accurate determination of the kind of bacteria present.
With reference to the prognosis of infected wounds it is much more
important to know the kind of bacteria than to know the number per
field. This is especially true of streptococcus hemolyticus, which is
by far the most important aerob found in war wounds. Peptone-
liver broth gives the highest percentage of positive cultures for the
streptococcus hemolyticus and also permits of the earliest diagnosis
of this organism.
The subject of gaseous gangrene deserves especial mention. While
the bacillus AVelchii is the organism found most frequently in this
condition (about 80 per cent), it is not the only cause of the disease.
It may be caused hy this organism associated with other organisms,
the vibrien septique association with other bacteria, the bacillus
oedematiens associated with other germs and. also, other combinations
of bacteria. The streptococcus plays an important role in gaseous
gangrene, especially when associated with one of the above organ-
isms. The term "' gaseous gangrene "' is a clinical definition and does
not imply that it is always caused by the same organism or asso-
ciation of oi-ganisms.
Moi-falify. — In the total series there were five deaths directly at-
tributable to the streptococcus hemolyticus infection.
1. A. B. — (xunshot wound, nudtiple. left arm. The severity of
injury necessitated amputation 1 inch beloAv the surgical neck of the
humerus at the evacuation hospital. Streptococcus hemolyticus was
isolated from the stump u])on arrival here, 10 days after amputation.
A blood culture was positive for this organism. Seven days later
1946 REPORT OF THE SURGEON GENERAL OF THE ARMY.
the patient developed a streptococcus meningitis, which proved fatal
on the fourtli day.
•2. J. K. — Gmishot wound, multiple (a) face through both rami
mandible, (b) left hand, penetrating, (e) left foot, perforating, (d)
right thigh, middle third, perforating. Patient recovered from ini-
tial shock. Wounds (a) and (h) and (d) improved rapidly.
Wound {(') showed on culture streptococcus hemolyticus. Two
weeks later a blood culture was positive for same organism. Patient
succumbed to septicenda 69 days after primary injury.
3. H. H. — -Gunshot wound, lacerating '' calf " left leg. Debride-
ment on arrival at this hospital eight days after injury. Culture
showed streptococcus hemolyticus. Amputation at lower third thigh
three days later on account of spreading infection. Patient died 7
days after amputation. 18 days after original injury, from septicemia,
complicated by acute nephritic.
4. S. J. — Gunshot wound, right buttock and left thigh. Debride-
ment both wounds. Streptococcus hemolyticus isolated from wound
in thigh. Blood cultures positive for same organism 10 days after
injury and 7 daj-s after debridement. Patient died of septicemia 35
days after being wounded.
5. A. A. — On arrival at this hospital, four days after injury, pa-
tient showed gunshot w^ound, perforating, left right, 5 centimeters
below knee, " S." Entrance, popliteal sjjace, 10 by 4 centimeters.
Exit, inner surface, knee, right. 5 by 5 centimeters. Debridement
both entrance and exit. " In good condition." Wound of entrance
successful!}^ closed by secondary suture 17 days after incurrence.
Wound of exit showed a streptococcus hemolyticus. Metastasis to
knee joint, which was opened and drained. No treatment was of
avail. Patient died of streptococcus hemolyticus septicemia exactly
four months after being wounded.
Smnmary and conclusions. — 1. In a series of 1,848 cultures made on
98.5 consecutive war wounds the streptococcus hemolyticus was iso-
lated in 24 per cent of wounds.
2. The clinical appearance of the wound gives no suggestion as to
the probable presence or absence of this organism.
3. The presence of this organism is the chief cause of the failure
of secondary suture. Therefore no wound showing a positive culture
of the streptococcus hemolyticus should be closed.
4. Other considerations being equal, the length of stay in the hos-
pital is practically twice as long as for wounds showing this organism,
as for those not showing it.
5. Dakin's solution is of value in clearing up these wounds, but its
action is much slower than in the same character of wounds not
showing the streptococcus hemolyticus.
BASE HOSPITAL NO. 44.
At a meeting of the staff at the Massachusetts Homeopathic Hos-
pital at Boston, held early in May, 1917, it was unanimously voted
that an offer to organize a base hospital in accordance with the speci-
fications and tables of organization of such institutions be sent to the
American Red Cross. The proposal was officially made by the
trustees of the hospital, and authorization to form a base hospital was
promised by the American Red Cross, provided that the sum of
A. E. F. — BASE HOSPITALS. 1947
$30,000 should be raised for the purchase of the equipment. During
the latter part of May a 10-days' intensive financial campaign closed
with the required amount largely oversubscribed, and the necessary
authorization to organize the base hospital was promptly received.
A connnissioned personnel of 22 medical officers was selected from a
list of 70 volunteers : a nurse corps of 05 graduate registered woman
nurses was chosen from a much larger number of applicants ; an en-
listed personnel of 153 men was enrolled from over 1,700 candidates;
and a nonenlisted personnel of 6 women secretaries was decided upon.
The complete equipment of a 500-bed hospital was purchased, and all
the details for preparing the organization for active service were
attended to.
During the fall and winter several members of the commissioned
personnel were called to active service to receive special training at
various camps and institutions.
Early in February, 1918, notification was received that the capacity
of the hospital was to be increased from 500 to 1,000 beds, and author-
ization soon followed to enlarge the commissioned personnel from 22
to 32 medical officers, the nurse corps from 65 to 100, and the enlisted
personnel from 153 to 200. The necessary additions were rapidly
made.
Mobilization of the original 153 members of the enlisted personnel
occurred on the lOtli of March at the hospital in Boston. The men
were outfitted at the armory in Charlestown, and arrived at Camp
Dix, N. J., on March 12, where they were quartered at the 303d Sani-
tary Train. Here they received intensive military training and in-
struction. On April 1 the organization was transferred to the Camp
Dix base hospital, and the •17 men completing the enlisted personnel
arrived on the 2d of the month. The men were given special training
in tlie different departments of the hospital.
The connnissioned persomiel was mobilized at Camp Dix durmg
the early part of April, and the officers were assigned to various duties
in the base hospital.
Liverpool was reached on July 17 after a smooth and uneventful
trip, and on tlie IStli the counnand entrained for Southampton, arriv-
ing there on the morning of the 19th. The trip across the channel
was made in the night of the 22d, and the rest camp at Havre was
reached on the morning of the 23d. The following morning the unit
began the final stage of the journey, by train, reaching its station,
Pougues-les-Eaux, France, on the 26tli.
As the buildings to be occupied by the hospital were in need of
many alterations, and no equipment had arrived, 28 officers and 150
enlisted men were transferred to ]Mesves for temporary duty on July
27, while the remaining members of the unit attended to the neces-
sary work at Pougues-les-Eaux. This detachment, with the ex-
ception of 10 enlisted men, returned on the 31st.
The work of preparing and equipping the buildings conq^rising
the hospital plant for the reception of patients was rapidly pushed,
and on August 10, 159 convalescent soldiers were received from
Mesxes, followed by other consignments at short intervals.
Two surgical teams, composed of three commissioned men each,
were sent to Mesves on August 15 for temporary duty, and three
other officers were called away for special work during the month.
1948 REPORT OF THE SURGEON GENER.VL OF THE ARMY,
Early in September orders were received to enlarge the capacity
of the hos])ital. and arrangements Avere at once made to care for
l.TnO patients. Every available space Avas utilized for beds and
cots, and the necessary adjustments in the personnel and working
plans of the institution were made to carry on the Avork at the emer-
gency capacity.
During the month of September several hundred patients Avere re-
ceiA'ed from Mesves, a large proportion of Avhom Avere convalescent
medical and surgical cases. Many sick and wounded officers were
assigned to this hospital for treatment, the policy of the staff at the
MesA'es center being to segregate the officers in this place. During
the same period the disability board acted upon a large number of
cases, ancl men were constantly being evacuated to duty, to the
Mesves-Bulcy couA'alescent camp, or to the other indicated hospitals.
The daily total of patients during the latter part of September was
about 900. Very little operatiA'e Avork Avas necessary, a fcAv ap-
pendectomies, hemorrhoidectomies, and herniotomies comprising
the bulk of the surgery undertaken by the department. The dental,
laboratory, and the eye, ear, nose, and throat departments did a large
amount of work during September, and the X-ray department com-
pleted its equipment and began its Avork late in the month.
The first hospital train to be assigned to this place arrived on the
2d of October, and 453 sick and Avounded men were received. Many
of these patients were in a serious condition, and several of them
died Avithin a few days. Another hospital train arriAed on the r)th,
and several assignments of men came from ^Nlesves during the suc-
ceeding days, bringing the daily totalof patients up to oA-er 1.700.
Early in October the widespread epidemic of influenza attacked
Pouges and about a third of the officers, nurses, and enlisted per-
sonnel were incapacitated.
While a considerable amount of stirgical Avork Avas done it was
iargelA' in the nature of secondary operations, removal of foreign
bodies, and ordinary emergency Avork. A vast number of dressings
Avere done, and all the departments of the hospital were taxed to
their capacity. The pneumonias Avere of a virulent tA'pe, and a large
proportion of the deaths occurring in the hospital were from this
cause.
After the signing of the armistice on the 11th of November the
number of patients arriA-ing at the hospital rapidly declined, and
the daih^ census quickh' derreased in size. In the latter part of
NoA'ember it was decided that the hospital plant at Pougues Avas
to be closed, and that Base Hospital No. 44 should occupy Unit Xo.
11 at the Mesves center.
Bl. BASE HOSPITAL NO. 4 6.
]May 24, 1917: Base hospital offer made by University of Oregon
Medical Department thi'ough American Red Cross.
January 2, 1918 : American Red Cross certified as to readiness of
hospital for actiA'e service.
April 5, 1918: Arrived at Camp LeAvis. AVash., for preliminary
traininir.
:N[ay^31. 1918: Left for Camp Merritt, X. J.
June 11, 1918: Sailed from Camp Merritt. X. J.
A. E. F. BASE HOSPITALS. 1949
June 25, 1918: Arrived Liverpool, England.
July 2, 1918: Arrived Bazoilles-sur-Meiise, Vosges.
July 23, 1918 : First patients received.
July 19, 1918: Three surgical teams, Xos. 77, 78. and 79, sent out.
November 25. 1918 : Three surgical teams, Nos. 77, 78. and 79, re-
turned.
January 19, 1919: All patients evacuated.
February G, 1919 : Reported to chief surgeon as ready for embarka-
tion orders.
llhtoi)j of operations, introduction.— 0\\ !Mav 21. 1917, the medi-
cal department of the University of Oregon offered to furnish the
personnel of a base hospital through the American Red Cross. The
enlistment of corps men and nurses was completed on July 28, 1917,
at which time a certification of the entire personnel was made to the
Red Cross at "Washington. After some difficulty in financing the hos-
pital, arrangements Avere carried out that the sum of $60,000 would
be furni^lied by the AA'ar Relief Committee of Benevolent and Protec-
tive Order of Elks. This offer was accepted by the president of the
university and the director of the unit.
On January 2, 1918, the American Red Cross formally certified to
the Surgeon General that the unit was complete in officers, nurses,
men. and equipment, and the official name was then given — United
States Army Base Hospital Xo. 46. Instructions came from the
Surgeon General early in January to prepare suitable quarters for
mobilizing and. on March 20. definite orders came to carr^^ this out.
April 5. 1918. the unit moved to Camp Lewis, reporting to the com-
manding general.
In December. 1917. orders were received to enlist 35 additional
nurses, making a total of 100. the strength required by a base hos-
l)ital of 1.000 beds. Shortly after arrival at Camp Lewis, orders
came to increase the enlisted personnel from 150 to 200. The order
also stated that sufficient officers would be attached later so that the
organization would have a personnel large enough to run a 1.000-
bed h()si)ital. At Cauqi LeAvis the officers and men were scattered
throughout the base hospital in order to get experience and training
for this work overseas. ^lay 31, 1918. the unit received orders and
departed for Camp Merritt. where it reported to the commanding
general, June 5, 1918.
The nurses who had been on duty at Camp Lewis and at other
camp.s and hospitals in the United States reported in Xew York
about the 4th of June, though they did not sail with the unit, leaving
Xew York on the Itli of July and arriving at our station July 15.
The tri]) over was uneventful. The unit arrived in Liverpool
June 25. at Southam))ton on the 2C)th. and left there on the 27th.
The Channel was crossed without incident, and we landed at Cher-
bourg, being the first Amei-ican organization to spend a day at the
Briti.sh rest camp nearby. The unit entrained on the 29th, and after
a circuitous trip through France, arrived at Bazoilles-sur-Meuse
July 2, where we took up tenqiorary quarters. On July 19 we
moved across the river to our permanent location and received our
first convoy July 23. We were the third hospital to arrive at this
center, whicli. in the next three Aveeks. received four other base hospi-
tals, so that the total capacity of the center at the time of the armis-
tice was about 13,000 patients. Our original capacity was 2.000 beds;
1950 REPORT OF THE SURGEON GENERAL OF THE ARMY.
1.000 in wards and 1.000 in tents. Later tliis was increased to 2,300
beds. Tlie hospital was laid out Avith three main rows of buildings
Avards holding 50 patients on each side of a center row of admin-
istrative buildings, mess halls, kitchens, etc. North of one of the
ward lines was a double row of tents. Each tent Avas composed of
three or four separate 14-bed sections joined together.
Our first patients were received July 23, a convoy of about 200.
Two days later Ave received the biggest convoy in our history— 52(>
patients m six hours. Our surgical department Avas not completelv
equipped until mid-August, so that our first patients were largely
gassed cases. AVork lightened up early in August, and our second
phase of activity nnmediately followed the St. Mihiel drive, and
up to about the 1st of XoA'ember the Avork Avas heavy. We reached
our maximum number of patients on October 19, Avhen IMi Avere
in tlie wards and tents. During the latter part of October many of
these patients Avere evacuated farther back in prepai-ation for the
later drive, Avhich Avas stopped by the armistice. From this date
until January 19, 1919, when we evacuated all our patients, work
Avas light and made up largely of influenza, bronchitis, gastroenteri-
tis, and pneumonia cases. On February G, 1919. Ave were reported
to the chief surgeon as being ready for"^ orders to port of embarka-
tion.
While we were actively functioning our work was largely that of
an evacuation hospital. This was mainly due to our advanced posi-
tion. Many patients came to us from field and camp hospitals, and,
if surgical cases, Avere evacuated farther back as soon as their Avounds
were m good enough condition to stand transportation. The medi-
cal cases were handled in the same Avay except that, as a rule, they
Avere kept for a longer period until convalescence Avas thoroughly
established. This constant infloAv and outfloAv of patients gave a
larger opportunity for brief study of the cases, but, on the other
hand, was unsatisfactory in that it Avas rarely possible to obtain
ideas as to the end results. This naturally increased the amount of
work and often rendered more difficult tlie proper attention to the
patients, because of occasional shortages of supplies. Eoughly. one-
quarter of the patients received here were returned to a duty "'status,
the balance being evacuated to base hospitals farther in theVear for
final treatment.
On arrival, we had a number of tents already in position, with
a maximum capacity of 1,000 patients. The tent service Avas' early
organized as an overfloAv from the wards proper, used either for
surgical cases which needed no further attention than dressings
Avhich are handled at the dressing station — and medical cases which
Avere convalescing. On tAvo occasions, Avhen the wards Avere nearly
full, convoys Avere sent direct to the tents, but in general the tent
service Avas used as a sort of a half-Avay station betAveen the hospi-
tal proper and either " duty " or evacuation to a neighboring con-
valescent camp, or by hospital or ordinary train to bases further
back. A separate staff handled the tents, a card index Avas kept of
each patient evacuated from the wards, and an effort made to
keep on these cards an approximate date when these patients Avould
be normally fit for duty or evacuation. After the 1st of Septem-
ber the bulk of the patients sent aAvay, either to duty or for further
treatment, went from the tents rather than from the wards. This
A. E. F, BASE HOSPITALS. 1951
separation, within the hospital, proved of great benefit in simplify-
ing the evacuation of patients. All motor transportation in this
center was pooled, which was of marked advantage in the reception
of convoys and the evacuation of patients.
Before our liospital received its first convoy, three surgical teams
were sent out and attached to some of the evacuation hospitals di-
rectly behind the Chateau-Thierry sector: later they were moved
down with these hospitals into the St. Mihiel and Argonne areas.
In these various areas they often worked under great pressure
with periods of inactivity between, corresponding closely to these
various drives. None of them returned to this hospital, however,
until after the armistice, so that during the period of real work
here, the hospital staff was short-handed. During September we
had the assistance of some temporarily attached officers, but the
full staff did not reassemble until early in November Avhen the
hardest part of the work Avas over. From the date of the armistice
until we closed the hospital in January, we took turns with the other
bases in this center in the reception of patients from troops operat-
ing in this vicinity.
Technical worl'. — Patients were admitted to the hospital through
a receiving ward, where their names and other data were first
taken. The walkiug cases were then undressed, examined, deloused
if necessary, bathed, given hospital clothes, and distributed to the
various wards according to diagnosis. The stretcher cases were
deloused, if their condition warranted, then taken to the wards;
those seriously wounded or ill Avere taken directly from the receiv-
ing ward to the ward assigned and there given baths and neces-
sary^ attention. In general, the same crcAv of personnel and exam-
ining officers handled all this work, so that very shortly after the
beginning of operations this system of admitting patients was
running smootldy and it was possible to run large convoys through
the various processes very rapidly and distribute them. The re-
ceiving ward was also used as an evacuating office and a system
of graphic charts or " clocks" was installed, so that we always knew
the exact nuuiber of patients in each Avard and no confustion re-
sulted if several convoys came in each day. In the early days of
the hospital an effort was made to divide the wards generally into
surgical and medical. It took some time to put this plan in oper-
ation, and quite often our best intended efforts along this line were
defeated because we never had advance notice as to what type, of
cases were coming to us by conA'oy. In fact, many conA'oys were
i-eceived without more than an hour's notice, and often we were
improperly advised as to the number of " stretcher " or " sitting "
cases, and as to whether the cases Avere medical, surgical, etc.
Rvrgical department. — This department did not function fully for
uearly a month after the opening of the hospital because of delay
in getting proper sup]')lies and equipuient. The surgical work car-
ried out here was decidedly varied. Up to December 13, 1918. 3.422
cases were received and 620 were operated on. The small number
of operations can be explained by the fact that outside of one con-
voy received early in October, evacuated directly from casualty clear-
ing station, all the surgical cases received had been operated on by
some of the uiobilf\ evacuation, or field hospitals farther front. An-
other reason was the order received that only emergency operations
1952 REPORT OF THE SURGEON GENERAL OF THE ARMY.
should 1)6 done, and that conditions such as hernia, hcMnorrhoids.
etc., should be sent back. Th>> mortality on this service was 2!S, or 8
per cent. AA"e had 23 iras bacillus infections, with 4 deaths. The fol-
lowing major amputations were performed: Arm. 7: leg. 2; thigh. 2.
The vast majority of the surgical cases followed gunshot wounds^
which were nearly all debrided b?fore admission. Many of these
arrived with Dakin tubes or were treated by Dakin soluti(m here;
the end results of this treatment, when properly carried out, wtre
most satisfactory. Among th&se gunshot-wound cases were naturally
included a c(msiderable number of fractures; at one time we had
three wards practically full of such c ases, and were fairly well sup-
plied Avith the necessary splints and apparatus to give them prop r
treatment.
This hospital was designated by the center as the one to receive
the neurosurgical cases. Among these were 15 fractures of the skull
and 15 other head-wound cases which were operated on, with 1
death; 7 cases of spinal-cord injury, all of whom died; some 45
nerA'e injuries, mainly ulnar, nuisculospiral, median, and sciatic.
Medical department. — Up to December 13, 1918, this service re-
ceived 4,479 patients, with 95 deaths, or 2.1 per cent; 88 of these
were fi-om pneumonia. During July and early August the medical
cases were very largely gas poisoning. From the end of September,
for about five weeks, influenza and gastroenteritis were the predomi-
nating causrs, and in the last six weeks the admissions more nearly
followed those in camps in the States. Most of our gas-poisoning
cases (480) were due to mustard gas; a small number of these died
of a. resulting broncho-pneumonia. AVe had 1,040 cases of influenza
in the same period, with 135 cases of broncho-pneumonia and 38
lobar pneumonia, and 6 complicating empyema.
Our pneumonia mortality, including complications, Avas 50 per
cent. Many of the cases of influenza developed a later broncho-
pneumonia. This condition differed from that seen in ordinary
home practice in that its symptoms were mainly high fever, rather
slow pulse, and marked prostration; physical signs were very unre-
liable, usually only a few rales Avith very little change in percussion
note or breath sounds until the temperature began to drop by Ij'sis
and resolution started. These physical signs and symptoms also
held in the more severe cases where autopsy would show, instead of
the diagnosis of acute bronchitis being correct that a true broncho-
pneumonia was present. Patches of consolidation would be found
more or less centrally in the lobes in places almost ( oalescent or si-at-
tered throughout all lobes. We believe that the type of pneumonia
seen here in October and November was entirely different from the
type normally seen in civil practice and also different from the type
which was so prevalent throughout the camps in the United States
during the winter of 1917-18. The bacteriology differed also in
that the streptococcus and pneumococcus were only occasionally
found. During August we had a fev.- (8) cases of typhoid and para-
typhoid and other cases which our later experience caused us to con-
sider as being these two eliseases, thougli not proven bacteriologically.
About the time of the armistice and from tlien on until closing the
hospital we had several more cases of typhoid, but the medical staff
had learned to suspect all cases entering the hospital with diagnosis
of influenza, N. Y. D., etc., as typhoid, if they ran a temperature
A. E. F. BASE HOSPITALS. 1953
for more than five or six days witlioiit chest symptoms; early blood
and stool cultures were taken and so positive diagnoses were made.
These cases we did not follow through, as they were evacuated to an-
other hospital in our center.
This hospital was not scheduled to receive contagious diseases, but
it was thought best to establish early an isolation tent where sus-
picious cases could be held for observation. A separate ward was
also opened exclusively for pneumonia cases, which facilitated the
handling and comfort of the patients. The cubicle system was used
here and also during the fall while the influenza epidemic was at its
height. An etfort was made to isolate by cubicle all the influenza
patients and thei'eby prevent tlie spread throughout the wards, It is
believed that this was of material value.
Cl. BASE HOSPITAL XO. 4T.
On December 5, 1917, the unit was ordered to Camp Fremont for
mobilization.
Orders came to move to Camp Greenleaf, Ga.. on March 2, 1918,
after four months at Camp Fremont. The unit arrived safely at
Camp Greenleaf (Camp Forest) for further training. The unit be-
came a'l.OOO-bed hospital and the personnel was enlarged propor-
tionately.
At Fort Oglethorpe (Camp Greenleaf) various officers were as-
signed to the medical officers* training camp for military instruction.
The enlisted personnel were drilled in tent pitching, litter drill,
first aid, and marching. The nurses had been sent to New York
(Plotel Irving) to await orders for embarkation.
The organization left Camp Greenleaf for Camp Crane, Allen-
town, on June 1, 1918.
On July 5 the unit left Camp Crane, and on July 8 sailed from
Hoboken, landing at Brest July 15.
About 12 days were spent at a rest camp under very trying con-
ditions. Dysentery was prevalent; no laboratory facilities were
available, so the type was midetermined. Respiratory disease was
prevalent but not very serious, mainly bronchitis or possibly a mild
form of influenza.
General description of hos'pital. — As above mentioned, the center
was composed of 10 hospital units (seven of which were complete
and in use). Base Hospital No. 47 was first on the scene and
pioneer in the organization of the center. Our unit consisted of
concrete and brick buildings distributed in five parallel rows sep-
arated by roadways.
These buildings were flanked on either side by 10 ward buildings
of 50-bed capacity each, and these in turn each reinforced by emer-
gency 8-tent units. All heated by stoves and electrically lighted.
Flanking these, in turn, were on one side nurses' quarters and
kitchen, on the officers* (|uarters and kitchen and medical supply
buildings. Enlisted men's quarters were near the garage. Later
this group of buildings was reinforced by a Red Cross hut erected
near the laboratory.
General schfTne, for receiving patients. — Varying from a few hours
to days in advance, center headquarters, would receive word of a
1954 REPORT OF THE SURGEON GENERAL OF THE ARMY.
convoy, especially after a big drive. The center would then appor-
tion this convoy among the various hospitals, depending upon vacan-
cies and types of cases. As we were the first in operation we re-
ceived all the cases in the first few convoys, running at full blast
about 2,000 patients. There was a general tendency toward sending
certain types of cases to certain units, but Base Hospital No. 47 on
the whole received all types. The hospital train would be backed
up on a siding near the hospital and all patients were carried directly
to the receiving ward and there serious cases were immediately sent
to the wards. All other cases were stripped, bathed, and then sent
to the wards. All clothing w^as deloused by steam under pressure.
Assignment to wards was made by the registrar and his assistants.
Oui- nurses in tt.<^ meantime had arrived at Blois and were on
duty with a base nospital there. They returned to us on September
4, 1918. About two weeks later our first convoy of about 500 patients
arrived- — a large number of them stretcher cases.
Chronological resume of inork in American Expeditionai^
Forces —
July 15, 1918 : Arrival at Brest.
August 1, 1918: Arrival at Beaune.
September 4, 1918 : Arrival of nurses at Beaune.
September 15, 1918 : First convoy.
September 15 to December 15, 1918 (approximate) : Period of
active surgical and medical work.
January 1, 1919: Orders received to get ready to be relieved by
Evacuation Hospital 22 preparatory for return to the United States.
February 18. 1919 : Left Beaune.
February 21, 1919: Arrived in embarkation area, billeted at
Gorges, near Nantes.
Fractures of the humerus were treated with the straight Thomas
splint. Our arm splints were too short, so that we had to resort to
the leg splint.
Influenza. — These cases were characterized by extreme exhaustion,
a shy cyanosis, a low temperature (101) usually falling by lysis.
The pulmonic second sound was invariably weak in the severe cases.
Tlie fatal cases were usually those who had been transported a long
distance. In these cases poor breath sounds were characteristic from
the outset. Many of the influenza cases went on to a lobular, or lobar
pneumonia, but a great number recovered without complications.
All modern methods of isolation and disinfection were used to coun-
teract the spread of this disease (see under " Pneumococcus pneu-
monia"). The sputum in these cases was not at all characteristic —
it varied anywhere from a frothy mucopurulent to blood-tinged
sputum. In only a few cases did careful bacteriological examination
reveal influenza bacilli.
Pneumococcus pneumonia. — These cases were quite prevalent, but
the mortality was low. The type of organism in cases studied early
was usually group 4 (often hemolytic streptococcus) or group 2.
Empyema complicated about 11 per cent of the cases, either pneu-
mococcus or streptococcus. An occasional mastoiditis occurred as a
complication.
The treatment of these respiratory infections consisted first in
prophylaxis — all cases and ward attendants (including nurses and
doctors) were masked. Large sheets were strung up between beds
A. E. F. BASE HOSPITALS. 1955
as a further protection against droplet infection. We had the pleas-
ure of having had as a medical consultant an ardent enthusiast of
the face mask. Large doses of digitalis were given routinely, even
to the extent of a pulse dropping below 60. Very few opiates were
used; if necessary chloral was used with caution, or opium. Bro-
mides proved of value in only a few cases.
Dysentery. — There were a few cases of amfjebic dysentery and no
cases of bacillary dysentery.
Typhoid fever. — There were three cases of t^^phoid, one of whom
also had pneumonia, with a positive pneumococcus blood cidture.
One case died of a perforation.
Gas cases. — For respiratory affections isolation and rest were used.
Contact with influenza or pneumonia cases were closely avoided.
Several of these cases, however, went on to broncho-pneumonia and
finally succumbed. Gas burns were of all degrees and were com-
plicated by tracheitis, bronchitis, myocarditis, or a nephritis (usually
transient). Some brownish pigmentation of the skin was noted
following healing of the burned area. The cases with m^'ocarditis
invariably had a slow pulse. (Not a rapid one, as the books led us to
believe.)
The mortality on the medical service reached approximately 100
cases, the causes in order of frequency being: Influenza pneumonia,
pneumococcus pneumonia, typhoid, meningitis (1 meningococcus,
I Welch bacillus).
Xew Years of 1919 brought us a telegram ordering our early relief
by Evacuation Hospital :22 as preparatory for our return to the
United States. Four days later we were in the embarkation area
in a pretty town of old Brittany — Gorges. Our nurses went on to
St. Nazaire, then Brest, and soon embarked for home.
Dl. BASE HOSPITAL XO. 4 8.
In August, 1917, an active campaign to raise funds to equip the
metropolitan base hospital was instituted. In all about $110,000 was
raised from man}^ hundreds of contributors, directly or indirectly,
and dul}' deposited with an agent designated by the New York
County Red Cross Chapter.
A few of the officers of Base Hospital No. 48 Avere in the United
States service prior to February 1, 1918, but the great majority went
into the service in March and "^ April, 1918. On March G, 19i8, 145
uniformed recruits were mobilized at the National Service Club,
opposite the Pennsjdvania Station, New York City. They left
shortly after 1 p. m. and reached United States General Hospital
A^o. 2, Fort IMcHenry, near Baltimore, the same evening.
June 20, 1918: Base Hospital No. 48, consisting of 11 officers and
204 enlisted men. left Fort ]McHenrv at 10.27 a. in. and arrived at
Camp Mills, Long Island, N. Y., at 8!30 p. m.
June 21 to Jul}' 4: Spent in attending to the nmnerous details
incident to overseas departure. Left the station at Camp ]Mills at
II a. m. and boarded the H. M. S. Aquitania at 3.30 p. m. the same
day, July 4, 1918.
July 5 to 12 : Our ship, the largest commercial liner in service, left
New York City Pier 53 at 3.21 p. m., July 5. The voyage consumed
less than seven days and was uneventful. Reached the Bar Light
142367— 19— VOL 2 62
1956 REPORT OF THE SURGEON GENERAL OF THE ARMY.
at Liverpool at 11.45 a. m., July 12, and at 2.45 p. lu. commenced to
land troops.
July 13 : About 8 a. m. our unit was collected together once more
and marched to a rest camp about 3 miles from the dock at South-
ampton. Then we marched back again and boarded the steamship
Caeserca at 7.30 p. m. for the sail across the Channel. This was
smooth and uneventful.
July 14: Xo. J^S appropriately do^-ked at Havre on Bastile Day.
After mess the march was started for the American Rest Camp Xo. 1
at Sanvic, 4 miles out of Havre.
July 15 to 16 : En route on train to Roanne, Loire. AVe left at
11.45 p. m. July 15 and arrived at Roanne at 11.30 a. m. July 18.
July 18 to 24 was happily spent in Roanne. where we took over
Hospitals Tern pora ire 84 and 06. On the afternoon of July 23 it
became known that orders had arrived detaching the greater part of
Base Hospital 48 to Mars liospital center. At 11.40 p. m. July 24,
31 officers and 183 enlisted men left on the train for Mare.
July 25 : The detachment of Base Hospital No. 48 reached the
]Mars hospital center at 5 p. m. and were assigned to section 1 of
the hospital center.
August 20 : One hundred nurses arrived, with six civilian em-
ployees.
November 11 to Januar}^ 15 represents an easy period in the work of
Base Hospital 48 in common with other organizations in this center.
January 10, 1919, Evacuation Hospital No. 37, with 21 officers and
222 enlisted men, came in at 2 p. m. This organization is to take over
the property ancl quarters of Base Hospital 48.
January 15 : Telegram dated Tours, January 13, 1919, to com-
manding officer, hospital center, Mars-sur-Allier, " Confirming tele-
phone conversation. Base Hospitals 48, 14, and 35 will cease func-
tioning as hospitals on Januarv 15, and will close their records as of
that date. (Signed) McCaw."
Statistical data of Base Hosfital J^8. — The registrar of Base Hos-
j)ital 48 reports the total admissions to that unit from July 29, 1918-,
to January 15, 1919, were 4,822 cases. Of this number, 2,960 were
surgical and 1,862 medical. The deaths numbered 85, being a trifle
under 2 per cent of the total admissions. The admissions by months
are as follows:
Julv, 1918 9
August, 1918 1,828
September, 1918 332
October, 1918 1,744
November, 1918 601
December, 1918 280'
Jaiuiarv, 1919 28
4, 822
El. BASE HOSPITAL NO. 50.
United States Army Base Hospital No. 50 is the University of
^Vashington, Seattle, Wash., unit of the American National Red
Cross.
On June 1, 1918, Base Hospital No. 50 was made a 1,000-bed hos-
pital and the enlisted personnel increased to 200. On June 15, 1918,
A. E, F. BASE HOSPITALS. 1957
physical examinations Avere scheduled, and out of approximately 250
men not attached to the unit 200 were selected for overseas duty; the
remainder were transferred by general order to base hospital, Camp
Fremont. On July 2. 1918. orders were received to depart from
Camp Fremont. Camp was struck on morning of July 4, 1918. and
personnel and equipment left via the Southern Pacific and arri^•ed
at Camp Merritt. X. J.. July 10, 1918, at 11 a. m. The unit remained
at Camp Merritt from July 10 to 13, where it was fullv equip]3ed
for overseas. The unit departed from Camp Merritt, N. j., morning
of July 13, 1918, with 199 men and 10 officers, and arrived at Pier 29,
Anchor Line, Brooklyn, and boarded H. M. S. Karmala. There
were about 16 ships in the convoy. The Karmala departed from
New York Harbor morning of July 14, 1918, and continued with
the convoy until about noon of July 16, when she broke down and
was obliged to put in at Halifax (Xova Scotia) Harbor, where she
arrived morning of July 17. and where she remained until July 20,
when she dej^arted with another convoy, consisting of about 22 ships.
On July 30, 1918, one of the battle' cruisers with the convoy had
an encounter with two submarines, the engagement lasting 15 min-
utes. It was afterwards reported that both of the submarines had
been sunk.
The ship arrived at Liverpool. England, on the afternoon of July
31, 1918, and the unit inarched to Knotty Ash, arriving there at
1 a. m., August 1. 1918, and departed at 8 a. m., same morning for
Southampton, arriving at that point 7 p. m. Left Southampton at
noon, August 2, boarding unknown steamer, arriving at Cherbourg,
France, 7 a. m., August 3. Left Cherbourg 2.15 p. m., August 3,'
1918, by train, through Orleans, arriving at Xevers 6 p. m., August
6, 1918. Arrived at Mesves August 6 and marched to hospital
morning of August 7, 1918. We were a^sioned to unit Xo. 5. :Mesves
hospital center, and were the third unit to arrive at the center.
The first assignment of patients arrived August 15, 1918, via hos-
pital train, and numbered 315. On Augiist 21, 1918, the second
assignment arrived, also via hospital train, and amounted to 685
patients. Since then this hospital has been receiving and evacuating
patients continuously. ^
Base Hospital Xo. 50 ceased to function as a hospital at midnight,
February 19, 1919. at which time all remaining patients were taken
over by Base Hospital Xo. 54.
AdmiHKirnifi to Vuitpil Stntc-^ Anini Iiaf<e lIoHpital No. 50. Augmt 16, 1918,
to Fehrvary 19. 1919.
Medif-al primary admissions 3,733
Battle surj^ery primary admissions 1, 732
Other siirjiery primary admissions l' 550
Other admissions witliin Mesves center ' 354
Total of admissions made to Base Hospital No. .50 7,399
Fl. BASE HOSPITAL XO. 51.
(Justice Hospital Group.)
Base Hospital No. 51 first showed signs of actual existence on
April 10, 1918, when a detachment of 200 enlisted men were sent
1958 KEPORT OF THE SUEGEON GENERAL, OF THE ARMY.
from recruit section. Battalion Xo. 14, Camp Greenleaf, Ga., to base
b>s]iitiil. Camp Wheeler, Ga., for a course of training leading to
later overseas activities.
At Camp Wheeler, Base Hospital No. 51 was properly mobilized,
obtaining the full quota of officers and enlisted men and 10 of the
nurses.
Late in May the overseas hopes of our unit were suddenly dulled
when 150 enlisted men were taken from us in favor of Base Hospital
No. 67. Substitutes were not provided until July 10, when replace-
ment was obtained with a detachment of high-class men from Bat-
talion Xo. 15, Camp Greenleaf. Ga.
On July 29, 1918, the entire personnel of officers and enlisted men
entrained from Camp Upton, N. Y., arriving on the afternoon of
July 31, 1918, and on the 8th of August we departed for Hoboken.
At 8 a. m. Friday, the 9th of August, we embarked for overseas
service. On Friday, August 16. 1918, we docked at Southampton.
On August 17 we disembarked and marched to a rest camp in the
outskirts of Southampton.
On Sunday afternoon. August 18. 1918, we reembarked on the
/St. George (channel boat) and arrived in the harbor of Cherbourg,
France, on tlie morning of August 19. 1918.
We di=em]iarked and marched to Eest Camp Xo. 1, Base Section
No. 5. about 4 miles from Cherbourg.
On August 22 our orders to move arrived. We marched to Cher-
bourg- in the evening and entrained at 9 p. m. : destination, Rimau-
court (Haute Marne).
August 24 : In the morning we passed through Saviers, Troyes,
and Bar Suraube. arriving at Chaumont about noon. In the middle
of the afternoon we reached Rimaucourt. We were settled in wooden
barracks by night.
August 27: Entrained at 9 a. m. : destination. Justice Hospital
group, Toul. Department Meurthe-et-Moselle. We arrived at Toul
at 9 p. m. We marched to the Justice Hospital group and were
guests overnight at Evacuation Hospital No. 3.
The chief surgeon, Maj. Gen. Ireland, and his assistant. Col. Walter
D. McCaw, paid us an official visit at 4 p. m., September 3. ' A few
days later Secretary of War Baker and his staff made a hurried in-
spection of Base Hos])ital Xo. 51.
September 5, 1918 : The openino- day of our career in the American
Expeditionary Forces. First patients admitted.
Our first evacuation, September 8. For 72 hours there was no
sleep in Base Hospital Xo. 51. neither on the part of the administra-
tion nor of the profession. Operating teams worked constantly on
the St. ]Mihiel admission, and we felt ourselves plunged 100 per cent
into the activities of the American Expeditionary Forces.
The month of September proved to h^ a surgical month. A
greater percentage of the 3.628 admissions were surgical.
During October the numlier of surgical admissions gradually de-
creased toward the end of the month and it was soon observed we
were slated to be a medical hospital. As Base Hospital No. 51 did
not operate contagious wards, the majority of medical admissions
were of respiratory nature, although the early admissions involved
several cases of dysentery. The medical service was enabled to op-
erate under a classified system which divided the medical building
A. E. F. BASE HOSPITALS. 1950
into wards as follows: Pneumonia, convalescent pneumonia, influ-
enza, tuberculosis, observation, and general medical wards. In all
wards respirator}^ cases were treated cubicles were installed.
During the month of November. 1018. the medical service was grad-
ually' increased until the medical-surgical admission ratio stood three
to one. The signing of the armistice on November 11 threw us into
a new frenzy of work. Post-armistice conditions involved the empty-
ing of many field and evacuation hospitals above us and we were
soon running on liigh tension.
By the end of November we had completed our fortieth eA'acuation
and had admitted a total of 8,037 patients out of the grand total of
12,505 for our entire ex])erience in the American Expeditionary
Forces. (See Appendix E. Table 1.)
Post-armistice acfivitws. — A new type of patient was now incor-
porated into our admission, viz. repatriated prisoners of war. These
patients came to us from Alsace-Lorraine and Conflans district. On
the whole they had received reasonal^le treatment. Their greatest
complaints covered the following points: {a) All valuables had l)een
taken from them and {b) general shortage of food.
A word must be said here concerning the enemy prisoners of war
who had been admitted as patients in Base Hospital No. 51. Dur-
ing the period of their convalescence and preceding their evacuation,
German prisoners proved to be of inestimable value in performing
the heavy drudgery that is peculiar to all hospitals. Heavy sanitary
work and grave digging was their specialty, and during the drives
they produced amazing results, A permanent guard of ^Medical De-
partment men h.ad been detailed to guard the Germans. The treat-
ment under their hands was above reproach. The sergeant in charge
made it a point to work the Germans 100 per cent and to feed them
and care for them accordingly.
The 3"ear 1918 Avas brought to a close with but one death in the en-
tire personnel of the hospital. During the year there had been
9,528 admissions and 250 deaths.
February, 1919: Up to the present time our unit had functioned
as an advance base hospital of the evacuation type and had always
received patients by ambulance and evacuated them by train. The
first patients to arrive by train reached this hospital center on Feb-
ruary 1. 1919. It was a new step in our career and gave us the first
hint that for once we had functioned as a base hospital.
After midnight, on the early morning of September 12, 1918, all
were simultaneously wakened by the opening of the great drive of
St. Mihiel. At 7.30 a. m. came orders telling us to send at 8 a. m.
40 nurses to help out more needy hospitals. Then a second order
followed to send forward 4 surgical nurses as special operating teams.
With those left at Brest, and two ill in Base Hospital No. 51 from
the hardships of travel, the active nursing force was now reduced
to the chief nurse. 42 nurses, and a dietitian.
In the late afternoon the wounded began to arrive, and into the
night, lines of ambulances, in pouring rain and almost impenetrable
darkness, ( rawled to our doors and were unloaded on stretchers into
wards and corridors, met always by physiciaus and nurses, the most
needy going directly to the surgery, where again nurses were readv
for their part of the work or for any work necessary to be performed.
Because of the rain there was less danger from Hun planes. We
1960 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
caiKlle lio:ht in tke ^vlu•ds and this made it easier to see to work,
cricity Avas beino- installed, but when the " alerte " sounded, elec-
liad ci
Elect]
tricity was cut off at Toul ; then admissions, operations, and nursing
proceeded bv candle lioht only.
On the night of the 14th of September a steady stream of our
wounded poured into the hospital tluouoh the receiving vrard, pre-
operative wards, and surgery, all except those brought in for imme-
diate transfer to surgery being now served with hot chocolate or
coffee and cigarettes, as these boys were not only wounded, but weary,
hungry, and cold. For four terrible days and nights this work went
on unceasingly; the wounded who could be moved being evacuated
to bases farther back to make room for those who continued to come
IP, until the wards were overflowing.
At midnight, March 31. 1919. Base Hospital Xo. 51 ceased to oper-
ate. More than 12.500 patients were cared for by the nurses at Base
Hospital Xo. 51 in addition to work done h\ them in five other
evacuation hospitals.
Gl. BASE HOSPITAL XO. .j2.
Base Hospital Xo. 52 (authorized complement 35 officers, 200 men,
100 nurses) was organized pursuant to instructions of the Surgeon
General, United States Army, at Camp Gordon. Atlanta, Ga., Jime,
1918. July 5, 1918, the organization, consisting of 34 officers and
145 men (no nurses), left Camp Gordon for service in France.
Arrived at Camp Merritt, X. J., July 7, 1918. At Camp Merritt,
X. J., 56 men were received and 3 were transferred to hospital.
Sailed from Brooklyn. July 14, 1918 (embarked flie day before), on
transport Karmala. The latter being unable to keep up with the
large convoy in which she was sailing was at 1 p. m. July 16, 1918,
directed to proceed alone to Halifax to join another convoy. Arrived
at Halifax 11 a. m. July IT, and departed Avith a large convoy 8 a. m.
July 20. Arrived at Liverpool July 31, being convoyed by a cruiser
throughout and destroyers at both ends of the voyage. Stoppecl the
night of July 31-August 1 in a British rest camp near Liverpool
and proceeded by rail at 9.40 a. m. August 1, to Southampton.
Arrived at American rest camp, Southampton. 5 p. m. August 1 and
remained until 2 p. m. August 2. Sailed August 2 from Southamp-
ton to Cherbourg on the transport Ahoarth. Disembarked at Cher-
bourg 7 a. m. August 3 and marched to British rest camp near by.
Entrained at Cherbourg 9 p. m. August 5 for Rimauoonrt, Haute
Marne, at which place the organization arrived for station and duty
7 a. m. August 8, 1918. At Rimaucoiirt iios])!tal center a group of
five hospitals was under construction ; Base Hospital Xo. 52 occupied
section B of this groui), as it was the one of the group most nearly
completed, lacking, however, when occupied much essential con-
struction.
The first patients arrived by rail. American Hospital Train Xo.
59, from hospitals in the vicinity of Toul at 11.07 p. m. September
14, 1918. These were medical cases, except few slightly wounded,
501, about 300 being able to walk.
September 24, 19i8 : The first evacuation of patients was effected
this date — ^20 class A (duty) men sent by rail to Is-Sur-Tille for
disposition b}^ the regulating officer at that place.
A. E. F. BASE HOSPITALS. 1961
The first female nur.-es arrived (for temporary duty) this date,
10 from Base Hospital Xo. 68 and 15 from Base Hospital Xo. 53.
September 27, 1018 : The fir.-t (except class A) patients were evacu-
ated: 111 sitting and 76 lying cases were entrained on American
Hospital Train Xo. 51 destined for Bordeaux.
On October l;j, 1918. 91 nurses. Base HospUal Xo. 52. arrived for
duty. Others followed later to a total of 101.
The continuing heavy evacuations from the front compelled the
utilization of the crisis expansion ( marquee tents accommodating 11
patients each), thereby bringing the hospital capacity to 2,150.
BetAveen Septeml^er 1, 1918, and January 23, 1919,'Base Hospital
X"©. 52 admitted 6,388 patients, tabulated as follows :
War wounds (iuclufling 2.260 gassed cases) 3,327
Other surgical conditions 933
Medical cases 2, 128
Total deaths (1.096 per cent) 70
Base Hospital Xo. 52 had ceased to function at midnight January
22, 1919. and awaited orders to return home.
HI. BASE HOSPITAL NO. 5 3.
Base Hospital Xo. 53, which was organized at Camp Greenleaf,
Chickamauga Park, on April 10, 1918, was one of the first so-called
Army units, being composed of officers, nurses, and enlisted men
assigned through the Surgeon General's office. On April 11 the en-
listed personnel of somewhat less than 200 was ordered to Camp Han-
cock, Ga. During the weeks following their arrival the enlisted men
were assigned to wards, office duties, etc., in connection with the base
hospital at this camp, in order that they might become familiar with
the machinery of a base hospital. At the same time many hours were
devoted to various drills and hikes. Men and officers alike were given
a course in gas instruction. On July 5 orders came to report to Camp
Merritt, X. J., for overseas service. The command left Camp Han-
cock on July 8; arrived at this embarkation camp on July 10. On
July 13 the command took a small river boat from Alpine Landing,
X. J., to Brooklyn, Avhere 7 officers and 178 enlisted men, 1 having
deserted at Camj) Merritt, boarded the transport Kariiuda.
The balance of the officers returned to Xew York and embarked on
the steamship Baltic. Both transports were in the same large convoy
and sailed the following day, July 14. Owing to some trouble with
the machinery the Kannala was forced to put in at Halifax about the
third day out, remaining in harbor for three days: she then joined
another convoy bound for England. The medical officers on board
the Bcdtic reached Liverpool on July 27, and remaining on board that
night entrained early the next morning for Southampton, where they
went to the first American rest camp. Two days later they left
Southampton on the steamship Duchess of Argyle and landed at
Cherbourg the following morning, where they went to an English
rest camp in a suburb called Touraville. Here they received orders
to entrain for our permanent station at Langres, Haute-Marne,
France, geographically in the advanced section. They reached Lan-
gres on the 3d of August.
The seven officers and enlisted men previously mentioned arrived
at Liverpool on July 31. From here they went to a training camp at
1962 KEPOET OF THE SURGEON GENERAL OF THE ARMY.
Knotty Ash, leaving there on August 1 for Southampton, which place
they reached the same day. Two days later they embarked for Cher-
bourg, remaining there until the afternoon of August 5, when they
entrained for Langres.
At 4 a. m., September 16, our first convoy, consisting of 440 pa-
tients, arrived from the St. Mihiel front. Most of these were medical
cases suffering from influenza and pneumonia. They were cared for
by the nurses of Base Hospital No. 55, temporarily assigned here.
The nurses of Base Hospital No. 53 reported for duty at 7 o'clock
tliat morning, September IG, having left New York just 14 days
previously on the steamship Aquitania.
The officers of Evacuation Hospital No. 18 arrived on September
25 and opened the adjoining Type A hospital under the administra-
tion of No. 53. As their wards were filled with gas cases, a large
number of which were severely burned, many of them being tem-
porarily blind and absolutely helpless, it became necessary for some
of our nurses to be sent to help in caring for these men. Numerous
cases of pneumonia developed and in most instances proved fatal.
On January 13 the officers and men of Base Hospital No. 88 were
elsewhere and its place taken by Base Hospital No. 88. who likewise
drew upon us for a number of nurses. This left us at times quite
short of nurses.
On January 13 the officers and men of Base Hospital No. 88 were
ordered to Savenay and their patients and buildings were taken over
by Base Hospital No. 53. On January 22 the convalescent camp was
closed and the personnel attached to this organization. On February
6 the commanding officer of the center left, under orders, to report for
duty at Kerhuon. The remaining officers and enlisted men of the
center were at the same time attached to Base Hopsita] No. 53.
From the 16th of September until the 2d of December we received,
ever}- few days, convoys, varying in number from 100 to 600 patients,
the majority of which were medical cases. Since the 2d of December
we have been receiving men, brought in by ambulance from the divi-
sions stationed in the vicinity and from camp hospitals under orders
to evacuate. As will be seen in the statistical report, we received
5,560 patients in convoys up to the 2d of December and 350 patients
from casual sources.
October was an unusually cold month, and as our stoves had been
held up en route, we were at times far from comfortable. The nurses
on night duty were the ones who suffered the most, owing to the fact
that, for many nights, there was no oil to burn in the small and
inadequate cooking stoves or lanterns. It Avas not even possible to
fill a hot-water bottle or make a hot drink for those sick men. When
the stoves finally did arrive, they came without much of the necessary
piping, and thus proving more of an aggravation than a comfort.
The greatest event in our career as a unit took place in the Red
Cross hut on Sunday, ISIarch 9, On that day the mayor of Langres,
by vote of the council, presented Base Hospital No. 53 with the coat
of arms of the town in recognition of its work here. The speeches
were translated from English to French and from French to Eng-
lish before the decoration was tied on the flag.
Surgical Team No. 136 : Pursuant to Special Orders, No. 22, head-
quarters, hosiDital center, A. P. O., 714, dated October 12, 1918, Oper-
ating Team No. 136 left Base Hospital No. 53 at Langres the morn-
A. E. F. BASE HOSPITALS. 1963
ing of October 13. Reaching Soiiillv that day, they reported for duty
with Evacuation Hospital Xo. 7.
They arrived at Vaiennes on the morning of October 14 and re-
ported to commanding officer of Field Hospital Xo. 162. Two days
were spent in search for a mobile hospital, Xo. 6. which was sup-
posedly stationed at Apremont. October 16 : Between the villages of
Cheppy and Varennes. That same afternoon. October 16, began the
arrival of patients — men who wei'e in such a severe state of shock
that they were unable to continue their trip to the rear. With these
cases operative measures were out of the question, and energetic
treatment in the shock ward was resorted to. Many not responding
to treatment died bOon after arrival.
On October 22 the neighboring villages Avere bombed twice, but
the mobile unit reuuiined intact. The following day the surgeons
were shaken up while operating at noon, and again that night the
bombs fell not far from the tents. The nurses arranged, on the
ground, a large white cross of bed sheets, which the Boche must
have seen and respected, for during the following weeks there were
no more bombs dropped in that vicinity.
Later, as the activity of the front increased. Mobile Xo. 6 accepted
all types of wounded, and the hospital was kept full practically the
entire time. Six surgical teams were kept constantly busy day and
night. The results of the work were at this time far more satis-
factory because the men were received within a few hours after
having been wounded.
On Xovember 1. 1918. the last big drive began. The barrage
started shortly after uiidnight and the firing continued on into the
afternoon. Mobile Xo. 6 was left from 20 to 30 kilometers in the
rear. The great congestion of traffic along all the roads made the
transportation of the wounded a difficult problem, and as a result
many of the wounds were from three to four days old before the
patients reached the operating room. As the result of this inevitable
delay in operation main- cases of gas-])acillus infection were received.
Following the signing of the armistice, the work of this mobile unit
practically ceased, with the exception of an occasional case sent in
from a near-by hospital.
Surgical Team Xo. 136 returned to their former station with Base
Hospital Xo. 53 on Xovember 26.
We received our first large convoy of wounded on October 13. Our
surgical staff then consisted of five men. The entire surgical side was
full of badly wounded and large numbers were on the medical side.
Every wound was dressed as soon as the patient was made com-
fortable, no matter how trivial the wound or how recentl}'^ it had
been dressed. This Avas a standing order for all the ward surgeons.
By adhering strictly to this rule, three gas-bacillus cases were found
in one small convoy on one night and three lives saved that would
otherwise, probably, have been lost had the dressings been allowed
to go until morning.
The Avound that gave us the most concern was the gunshot wound
of the knee joint that was infected and discharging large amounts
of pus. This type of wound was drained in CA-ery conceivable way
known to surgery, but in the majority of cases Avithout any beneficial
result; the patient finally Avas obliged to undergo an amputation
after his resistance had been lowered by absorption for seA'eral weeks
1964 REPORT OF THE SURGEON GEjSTERAL OF THE AEafy,
from his infected joint. We finally^came to the conchision that in
tliis type of case where there was definite infection of the joint cavity
with a pnrnlent discharge, nothinj^ was to be trained by procrastina-
tion, and the patient was given the best chance by an early amputa-
tion.
l'. BASE HOSPITAL NO. 54.
September 6. 1918 : Arrived Mesves hospital center. 38 officers. 199
men.
September 9. 1918: Epidemic of influenza and broncho-pneumonia
broke out ; 14 of personnel admitted to hospital this day. In 11 days 4
officers and 40 enlisted men sick. Epidemic lasted about three weeks.
Preliminary report of 266 cases of broncho-pneumonia observed in
United States Base Hospital No. 54, Mesves hospital center. Septem-
ber 11 to October 25, 1918.
Statistics.
Pa-
tients.
Deaths.
Cases
266
98
Soldiers
252
Qft
Nurses
14 ">
Number of cases of typhoid fever 73
Number of cases of paratyphoid fever 3
Total number of eases of typhoid and paratyphoid fever 76
Number of cases proved by laboratory culture 53
Number of cases clinically positive, but imconfirmed by culture 23
Total number of cases of typhoid or paratyphoid fever developing in this
center - 21
Total number of cases of typhoid or paratyphoid fever developing outside
this center 55
Mortality (11.8 per cent) 9
Etiology. — Typhoid or paratyphoid fever in the vaccinated must
be due to (1) poor vaccine, (2) slips in technique of administration,
or (3) overwhelming infection.
Owing to the fact that relatively few cases of typhoid and para-
typhoid fever have been discovered in this center, althouglt careful
search had been made, the first of these possible causes hardly seems
worthy of consideration. On the other hand, in wholesale vaccina-
tion as practiced in the Army camp, it would not be surprising if cer-
tain individuals lost part of their dosage, either through faulty syr-
inges, leakage about the site of inoculation, or intentional expressage
of the vaccine by the soldier. Thus protection would be below the
average. Perhaps also the time interval between inoculations had
been such that the maximum of protection was not obtained. Com-
bined with this, overwhelming infection against Avhich prophylactic
injections are not absolute protection, seems to be the most likely cause
of the typhoid and paratyphoid fever among our patients. It is a
reasonable supposition that since the beginning of the war gross
typhoid pollution of the soil and water along the battle front and
far in the rear must have taken place, even though no previous pollu-
A. E. F. BASE HOSPITALS. ^ 1965
tion existed. Avhich is extremely doubtful. Careful inquiry reyealed
the fact that 73 cases out of 76 had received their full course of three
inoculations, most of them within a year. (Several had had a pre-
vious typhoid fever and a few had received more than one series of
three inoculations.) In three cases the data are now known. The vac-
cine had been administered in many different Army camps, and at
times a course of inoculations begim in one camp had been completed
at a second, showing that special pains were taken to give each soldier
his complete course of three inoculations. Xearly all of the cases who
contracted the disease at the front drank water from any source what-
ever. (Distances from the supplies, together with the speed and con-
fusion of the advances, were undoubtedl}^ the cause of not securing a
safe water supply.) Those cases developing typhoid fever in this
center were mostly ambulatory and acknowledged that they drank tap
water in the center or in neighboring towns, drank wine in wine shops,
or ate raw fruit or vegetables. There is one apparent instance of con-
tact infection which existed in the 316th Infantry, of which 12 cases
came to this center. These soldiers were all in about the same stage of
the disease and must have acquired their disease from the same source
of infection.
Complications.
Case.
Per
cent.
1. Perforation ] 3
2. Hemorrhage, intestinal 7
3. Phlebitis 2
4. Otitis media 2
o. Psyehosis 1
6. Brbncho-pncumonia '. 7
7. Ruptured rectus muscles 2
8. Relapses 5
3.9
9.2
2.6
2.6
1.3
9.2
2.6
6.5
The presence of only two instances of complicating otitis media
was attributed to the care of the mouth and throat.
Management of cases. — Two adjoining wards were set apart for the
diagnosis and treatment of typhoid and paratyphoid fever. The first
was used as a receiving ward, into which were sent the suspected
cases and those who were classified as " clinically typhoid fever," the
two groups being segregated at either end of the ward. The second
ward was occupied entirely by those who were proved by cultural
methods to be either cases of typhoid or paratyphoid fever. Although
there were two cases of parathyphoid A and one case of paratyphoid
B treated in the same ward with the tj'phoid-fever patients yet no
cross infection of any kind took place. Orderlies for tlie ward were
provided from the list of convalescent patients and rendered most
excellent service. General care, diet, and treatment were the same in
both wards, and all precautions in regard to sterilizing dishes, bed-
pans, urinals, and linen were identical. Stools and urines were mixed
with equal quantities of 2 per cent cresol solution, and after standing
half an hour were carried respectively to the incinerator and the
latrine. Dishes were boiled each time after use in G. I. cans, as also
were bedpans and urinals in separate cans. Linen was soaked for
one-half hour in 2 per cent cresol solution and sent to the laundr}'.
The diet was a fairly liberal one, prepared in the hospital kitchen
1966 EEPOET OF THE SURGEON GENERAL, OF THE ARMY.
and delivered to the ward diet kitcliens. Three to five meals were
served during the day, with added liquid nourishment at night to
some cases. The diet consisted of strained cereals and cereal gruels,
creamed vegetable soups, boiled rice, boiled macaroni, tapioca, corn-
starch, soft-cooked eggs, chopped chicken, soft toast, tea, coffee,
cocoa. This diet, although limited in variety, proved altogetlier ade-
quate, and convalescence in nearly eveiy instance Avas prompt and
uninterrupted. Cases with serious distention were very rare.
Sponges were given every few hours if the temperature equaled
102.5. After each meal the mouth was carefully cleansed. Abdomi-
nal distention, rarely more than moderate, was controlled by enemas
and rectal tube. Hexamethylenamin grs. X, T. I. D., was routine in
all proved cases. Digitalis tincture in one-half to 1 dram doses three
to six times a day was used as cardiac stimulant when needed. Abso-
lute rest and morphine were sufficient to control hemorrhages.
Jl. BASE HOSPITAL NO. 55.
Base Hospital No. 55 was organized May 31, 1918, at Camp Green-
leaf, Ga., from Company 4, recruit section, hospital group. The per-
sonnel consisted of 2 officers and 238 enlisted men.
June 11, 1918 : This entire organization was broken up and dis-
tributed among eight other hospitals then forming.
June 16, 1918: Base Hospital Xo. 55 was reorganized with 30 en-
listed men.
August 22, 1918 : Base Hospital No. 55 left Camp Greenleaf en
route to port of embarkation. New Jersey, with 29 officers and 202
enlisted men.
August 24, 1918: Arrived at Camp Merritt. N. J., and assigned
to barracks.
August 29, 1918: Left Camp Merritt, N. J., for overseas service
per order No. 85, Headquarters Camp Merritt. N. J., August 28,
1918, on U. S. S. FUttsburg.
August 30, 1918: Left New York under convoy. The convoy pro-
ceeded south by southwest until off the latitude of Virginia, when a
small convoy from Newport News, Va., joined. The crossing occu-
pied 12 daj's, and for several days heavy seas were encountered.
September 12, 1918 : Arrived at Brest, France. Debarked about
4 p. m., and marched to rest camp, Pontanezen Barracks, about 4
miles from the port. Assigned to quarters in pyramidal tents just out-
side the barracks wall. Within three days cases of influenza began
to appear among the men on duty in the hospital, and from them
the diseases were transmitted to others. Anticipating the exact
chronological order of events, it may be said here that this was the
beginning of an epidemic of influenza from which a large propor-
tion of the men sickened, particularly during the hard journeys to
their ultimate station. It made of the organization a disseminator
of the disease on its way into the interior of France, and eventually
led to the death of two men of the detachment from pneumonia.
September 19, 1918: Left Pontanezen Barracks. Brest, France,
en route to Mesves-sur-Loire (Nievre), per Special Orders. No. 252,
Headquarters Base Section No. 5, Services of Supply, September 13,
September 23, 1918 : Arrived at Mesves-sur-Loire.
A. E, F. BASE HOSPITALS. 1967
September 25, 1918: Left Mesves-siir-Loire (Nievre) en route to
Toil], France.
September 28. 1918: Arrived at Toul, France, Justice hospital
group and assigned to Tliouvenot annex. Toul, to establish a base
hospital. The organization proceeded at once to take possession of
the area, establish the mess, and begin the preparation and equip-
ment of the buildings for the reception of the patients. The area
was located on the Strasburg-Paris road, al)out a mile west of Toul,
and separated from the central hospitals of the Justice group about
a mile cross-country and about 2 miles hy road.
October 1, 1918: The hospital formally opened for the reception
of patients, taking upon its records 31 patients from its own detai h-
ment, the aftermath of the exposure to influenza in Brest and the
hardships of the journey to this station. The St. Mihiel drive had
just ended, and the central hospitals of the group were crowded with
wounded and the inflowing cases of respiratory diseases. To relieve
this condition Base Hospital Xo. 55 began at once to receive con-
valescent patients from these hospitals until, on the 9th, about 900
patients were in the hospital.
October 16, 1918 : The entire stream of the admissions to the
Justice hospital group was turned into Base Hospital No. 55, and in
two days over 400 patients liad been admitted, and the hospital was
filled to its capacity of about 1,200 beds, — of which were in Ameri-
can hospital ward tents, pitched for that purpose.
Xovember 1. 1918: About this time intimations were sent out of
Tin approaching drive by French and American forces in the sector
north of Toul and Xancy. We were ordered to provide for all avail-
able beds and increase capacity to the utmost. Eleven American
ward tents had already been set up. Eleven double-walled French
tents (type Henry) were obtained and set up on the parade. Eleven
hundi-ed American beds and 500 cots, with all necessary equipment,
held in readiness to set up in emergency space in halls and all unoc-
cupied space. The emergency capacity was reported as 1,600 beds.
It is a matter of history that the projected drive never took place,
beins: anticipated bv the signing of the armistice on November 11,
1918.
March 25, 1919 : This date marks the end of the active hospital
service of Base Hospital Xo. 55. During the past month or more
our evacuations have been steadily greater than our admissions, so
there remained only about 100 patients for final and complete
evacuation. Orders for tliis arrived in the morning, and hy 5 p. m.
of this date every patient outside of our own personnel had been
removed to other hospitals of this group.
March 31, 1919 : Base Ho.spital No. 55 ceased to function as a,
hospital on this date.
Kl. BASE HOSPITAL NO. 58.
Mobilized at Camp Grant, Rockford, 111., on or about June 3,
1918. Xo records on hand to show exact date or authority. Ceased
to fimction per verbal orders hospital center A. P. O. 919. January
25, 1919, per letter chief surgeon's office A. E. F. to hospital center.
A. P. O. 919, dated January ll, 1919.
1968 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Respiratory and contagious disca-^es. — Every effort Avas made to
give instructions to officers in professional subjects. Clinics were
held in the center, which officei's attended from the various units.
Anto])sies were held on cases of interest which were also attended
by the officers. Daily lectures on pertinent topics by mcuibers of
the various hospital staffs. Following steps were taken to separate
cases into disease groups in the unit: All patients masked upon ad-
mittance and continue to wear mask as long as sick in hospital.
Cubicle system installed in all wards. Upon admittance to re-
ceiving ward, patients given thorough examination, those with
normal temperatures given bath, clean clothes, and assigned to
wards designated to receive their type of disease. Those running
a temperature placed temporarily in wards set aside as " receiving
wards," bathed, given clean clothes, and examined by a "team of
surgeons," given thorough examination and cases diagnosed, after
which they were transferred to certain designated wards set aside
lor such cases. All clothing from incoming patients promptly de-
loused. By this method we had practically no cross infection in
our wards. Also kept the wards practically free from vermin.
General cotnments of interest. — Entire organization left Camp
Grant, 111., August 16, 1918, arrived Camp Upton, X. Y., August
18, 1918. Left Camp Upton (36 officers and 191: enlisted men)
August 23, 1918, embarked on Transport No. 246 at New York,
same date, arrived Bordeaux September 4, 1918 — ^Rest Camp Xo. 1.
Left Rest Camp No. 1, Bordeaux, September 8, 1918, arrived Rimau-
court, Haute Marne, September 12, 1918 (36 officers and 193 en-
listed men). Occupied quarters being used temporarily by Evac-
uation Hospital No. 11, section A, hospital center.
Bed report to eliicf surgeon, showing growth of hospital.
Beds.
Sept. 16 500
Sept. 2.5 1,000'
Oct. 6 1, 500
Oct. 17 1, 700
Nov. 11 1,900
Hospital ceased to function January 26, 1919. On September 20,
1918. we received our first train load of patients; total. 358. On
October 6, 1918, 86 nurses of Armj^ Nurse Corps reported for duty.
Ll. BASE HOSPITAL XO. 5 9.
The hospital left Camp Shelby on August 28, arriving at Camp
Stuart, Newport News. Va., August 31. Equipment completed at
this point for the 38 officers and 204 enlisted men. Embarked on the
U. S. S. Madanmska in dock at Norfolk. Va., September 6, 1918, and
sailed September 8, the personnel having been diminished by one
officer being taken off board and left behind on account of illness.
Base Hospital No. 59 was in charge of troops en voyage. There
were no fatalities and no epidemics on board: rigid inspection of
mess and of troops was made, and rules of sanitation were thoroughly
enforced. A submarine attack was experienced at 7 ]). m. September
20, when 20 hours out of Brest, a depth bomb barrage put down by
accompanying destroyers being credited with destruction of the
A. E. F. BASE HOSPITALS. 1969
U-boat. Arrived at Brest September 21, debarking same day, going
into qiiai'ters at Pontanezen Barracks. During stay at this post the
personnel was utilized in the camp hospital, in camp sanitation, and
as medical officers in various organizations encamped near by. there
existing at the time a severe epidemic of influenza, Avith the addition
of new cases upon the arrival of each convoy. Leaving Brest Sep-
tember 29, Base Hospital Xo. 59 arrived at Rimaucourt hospital
center, Rimaucourt, Haute-Marne. on October 1.
The nurses of Base Hospital Xo. 59, 100 in number, were mobilized
at Hotel Irving. Xew York, X. Y, They sailed on transport OrfJrina
September 9, 1918. landing in Liverpool. England, on September 21,
going by way of Southampton and Havre to Rimaucourt. arriving
there Sejitember 27.
ITpon arrival at Rimaucourt center nurses Avere assigned to duty
in Base Hospitals Xos. 52 and 58. the nurses for those oriranizations
not having arrived. Septemljer 28, 50 nurses were detached and
sent for temporary duty with Base Hospital Xo. 83 at Revigny. Of
the 50 remaining at Rimaucourt, 13 shortly after arrival suffered an
attack of influenza. 3 developing pneumonia. recoAery ensuing in each
instance. On October 10 the 50 nurses moAed to quarters in Base
Hospital Xo. 59 and Avere assigned to duty Avith the organization.
During the Aveek beginning October 13 the 26 wards, containing
1,250 beds, were filled, and it became necessary to erect tents.
SeA-enty-five of the marquee type, Avith a capacity of 1.250, were put
up. It might be said that only patients not considered seriously ill,
Avithout feAer, Avere quartered in these tents, and when serious illness
developed such a case Avould be transferred to a Avard and a con-
A'alescent sent to the tent in his place. The total capacity of hos-
pital, Avards, and tents, Avas 2,500 ; the greatest number in hospital at
one time was 1,G60. At first cots alone were aA^ailable. for some of
which ticks filled with straw, for the remaining blankets alone, one
under and tAvo OAer patient, could be provided. As fast as available
these Avere replaced with beds, mattresses, and, v\ith the installation of
laundry plant, sheets. Until the installation of the center laundry,
toAvels and such sheets as it was necessary to use Avere boiled in mess
boilers and sterilized in the steam disinfecter. With the erection of
the laundry plant all ])eds for patients were kept supplied with clean
bed linen. During October the supply of stoves Avas meager, one
for each ward, Avhich. Avith scarcity of coal and character of wood,
made the heating of Avards but poor. During Xovember and Decem-
ber. Avith the arrival of more stoA'es, three Avere allotted to each ward,
giving all comfortal)]e Avaimth.
Cases treated may be divided into gas, pneumonia, influenza, rheu-
matic, and enteric: (1) Gas, with pneumonia, bronchitis, enteritis,
and burns; (2) influenza of difi^erent types and all complications : (3)
enteric cases ; (4) arthritic.
Eight hundred and four gas cases Avere admitted to the hospital,
and of these, mustard predominated: second, phosgene: tliird, both
mustard and phosgene ; and fourth, chlorine gas. Of these, eight gas
cases had pneumonia on admission. The larger number of deaths
Avere from secondary infection, in each case bronchial pneumonia
being the sequel of gas. Practically all gas cases were susceptible to
attacks of acute bronchitis, often resulting in subacute or chronic
1970 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
I
les 1
re, I
conditions, which did not improve in this climate. All of these cases
have an nnprodiictive conoh, occasional slight rise in temperature,
and few or many rales at the base of both lungs on deep inspiration
or on coughing. A large percentage of gas cases were from time to
time attacked Avith acute enteritis. These cases Avere carefully
studied and the laboratory reports were negative, both as to an
identical organism or to typhoid or parayphoid, and the condition
must be considered as one of the direct effects of gas upon the gastro-
intestinal tract. Burns from mustard gas complicated many of these
cases and ranged from slight burns to those of great severity. The
most frequent location being about the scrotum, in the bend of the
knee, the elbow, and in the axilla, where the gas could be best re-
tained and where moisture added to the burn. Conjunctivitis was
another severe complication which occurred in many cases, but these
cases rapidly improved when treated with constant care: cold com-
presses of boric acid solution and with an instillation of 15 per cent
argvrol three times daily. The most marked and constant effect of
gas was the effort syndrome or D, A. H. This feature was present
with all forms of gas and continued throughout the entire time as
such i:)atients were in the hospital. These patients apparently upon
inspection, showed nothing abnormal, but when allowed freedom and
the slightest exercise, attacks of this D. A. H. was always apparent.
None of these patients who showed an effort syndrome were ever
classified to be returned to duty from this hospital, it being the
opinion of the medical officer in charge that such cases showing
tremor, dyspnoea, sweating, and tachycardia needed further treat-
ment and they were evacuated to that end.
Influenza of many types was noted here with complications. Many
terminated in bronchial pneumonia, while quite a few serious in-
volvements w^ere noted. A few otitis-medias and quite a large per
cent with nervous involvements were treated. Of the gastrointestinal
ty^pe, w^e saw but few. Enteritis w^as often a periodic condition here
and its epidemiology' Avas never demonstrated. All possible precau-
tions were taken and every focus of infection was considered ; that is,
food, cleanliness in handling it, cleansing of mess kits, supervision
of the diet, and endeavoring to determine its origin. Arthritis cases
came to' this hospital in numbers, and were probably due in most
cases to exposure. Most of these cases under rest, warmth, and proper
food made uncomplicated recovery.
Ml. BASE HOSPITAL XO. (K).
Surgical Section No. 1 was organized in North Dakota. This
personnel was ordered to Camp Jackson, S. C, for duty with Base
Hospital No. 60. The equipment of the section, which had been
collected and purchased by the individual members of the personnel
from private subscriptions of North Dakota citizens, and through
cooperation of the Bismarck Hospital, was eventuallv transferred
to Base Hospital No. 60.
During the period of mobilization at the base hospital at Camp
Jackson the personnel was gradually acquired from the staff of
the base hospital at Camp Jackson and from the Medical Corps of
the Ai-my Avho Avere ordered to the organization by the Surgeon
•General's Office and reported at intervals. The officers were placed
A. E. F. BASE HOSPITALS. 1971
on duty in the various wards and departments of the base hospital
at Camp Jackson, where they received under the direction of the
commanding officer of that institution the training necessary to
fit them for their duties with Base Hospital No. 60.
The journey to Brest, via Camp Stewart, Va., was accomplished
without incident, and upon arrival at Brest, September 3, 1918, we
were quartered at Pontenazen Barracks. After a week's sojourn
the organization was ordered to hospital center, A. P. O, No. 731,
at Bazoilles-sur-Meuse, where they arrived September 15, 1918.
The following two weeks were spent in policing the grounds and
placing the buildings at their disposal in readiness for the reception
of patients. During this period two operating teams were sent
to Evacuation Hospital No. 114, at Fleury-sur-Aire. These teams
departed on September 24, 1918. The first convoy of patients
arrived on October 5, 1918, and consisted of 177 sick "and wounded.
At this time the complement of nurses had not arrived, and 46
nurses were detailed for duty with Base Hospital No. 60. It was
during the succeeding several weeks that we were most actively
engaged, and the services rendered by these casual nurses was of
an inestimable value. On October 16, 1918, our own nurses arrived,
and they were heartily welcomed. On November 1, Operating
Team No. 163, which had seen very active service at Evacuation
Hospital No. 114, was relieved by another team, and on November
10, Team No. 164 was replaced by another team. On March 31,
1919, all the patients in the hospital were evacuated to other hospi-
tals in the center, records were closed, and preparations were made
for return to the United States.
During the epidemic infiuenza was prevalent and highly con-
tagious, requiring energetic measures in all wards along the line of
early recognition and prompt isolation in order to prevent its rapid
spread in the hospital. Serious complications were few with the
exception of pneumonia, 39 of the 40 cases of pneimionia treated
followed influenza and adhered to the peculiar type characterized
by the following features: Gradual onset, profound prostration,
marked cyanosis, massive lung involvement, extremely low leucocy
to count, and any one of the types of pneumococci in the sputum.
There were 9 fatal cases in which autopsy showed a broncho-
pneumonia with a decided coalescence and an excess of fluid in the
lung tissue. Culture from these lungs usually showed a pneumococ-
cus together with Pfeiffers bacillus. Little response to treatment
was noted.
November, 1918 : Thirteen pneumonia cases were treated, most of
them being of the frank lobar type and quite different from the
pneumonias seen the preceding month. Occasional sporadic cases of
meningitis, diphtheria, and mumps appeared, but there was no evi-
dence to suggest an epidemic of these diseases.
December, 1918: During the month of December, 1918, as in the
months immediately preceding, pneumonia Avas the most serious dis-
ease encountered by the medical service and was responsible for prac-
tically the entire mortality. There were 30 cases of this disease
treated, with 7 deaths, a mortality of 23.3 per cent. The lobar va-
riety prevailed and there was a notable tendency toward empyema, 2
of the fatal cases showing this complication as a contributing cause
of death. Where fluid appeared aspiration was instituted promptly
142367— 19— VOL 2 Ca
1972 KEPOET OF THE SURGEON GENERAL. OF THE ARMY.
with a view to preventing excessive pressure, but rib resection was
reserved until the patient's condition seemed to warrant the opera-
tion,
January, 1919 : Admissions on the medical service for the month
of January, 1919, included a considerable number of transfers from
other hospitals preparing to close. Pneumonia continued to be the
most serious disease and was responsible for most of the mortality.
There were 34 cases treated, with 4 deaths. The type known as
coalescing broncho-pneumonia, previously described, was prevalent
and extremely fatal. Two fatal cases of this disease developed in
patients under treatment for typhoid and in whom the lesions of tho
latter were found at autopsy.
Typhoid. — Sixteen cases of typhoid appeared and ran a fairly
typical course. Positive blood cultures were rarely obtained, the
diagnosis resting on the clinical history together with the finding of
B. typhosus in stool cultures. The two deaths in this series were due
to a complicating coalescing broncho-pneumonia.
Nl. BASE HOSPITAL NO. 61.
Base Hospital No. 61 was formed at Camp Greenleaf, Fort Ogle-
thorpe. Ga., on June 5, 1918. The unit received orders to proceed to
Camp Lee, Va. The command reached this place on June 30, 1918.
On August 16 orders were received to send this organization, con-
sisting of 35 officers and 200 enlisted men, to Newport News, Va.,
for embarkation. The usual inspections and transportation facili-
ties were arranged and on August 21 the personnel of Base Hos-
pital No. 61. with full field equipment for extended field service,
marched to City Point.
The command reached Newport News after spending the night on
the river steamer Mohjach at 6 a. m.. August 22. The organization
immediately embarked on the steamship Lutetia. In Hampton Roads
we were joined by five other troopships convoyed by one battle
cruiser, two destroyers, and two submarine chasers.
On September 3", at 3.30 in the afternoon, we boarded lighters in
the harbor of Brest. At 5 o'clock we landed and proceeded in forma-
tion to the rest camp at Pontanazen Barracks. Here we remained
one week, when we received orders to proceed to Beaune, Cote d'Or.
The troops train arrived at Beaune at 5 o'clock in the morning of
September 13. On September 30 we reported to the chief surgeon's
office, American Expeditionary Forces, that we were readv to func-
tion as a base hospital. Our first patients arrived on October 5.
This "convoy" (hospital train) of patients arrived about 8.30 p. m.,
on the evening of October 5, 1918, with 404 patients. The second
one arrived at 12.30 a. m., October 6, 1918, with 232 cases, making
a total of 636 cases (classified as one conyoy in our records) which
were received between darkness and daylight that same night. Of
these cases 438 were surgical. On October 9 we received another con-
voy of 145 cases. The morning report October 10 showed the 10 gen-
eral surgical wards of 50 beds each, 500 in all, contained but 3 empty
beds, with 22 patients in the genitourinary ward and 32 in the eye,
ear. nose, and throat ward, making a total of 551 surgical cases. We
had thus more than half filled our hospital with surgical cases during
the first four days of our operation.
A. E. F. BASE HOSPITALS. 1973
Our capacity was then increased to 1,600 beds. On the 13th day of
October we received our fourth " convo}- " and the morning report the
following: day showed that one of our surgical patients had died and
87 had sufficiently recovered to be sent to the convalescent camp, still
leaving us with 593 surgical cases. This condition of affairs con-
tinued, about two "convoys" arriving weekly until on October 31,
1918, we reached the high-water mark of 1,190 patients with 1,115
surgical cases.
We received in all 18 " convoys," the last December 11, 1918, which
brought us to a total of 2,403 admissions up to that time; of these
1,513 were surgical.
Our results in blood transfusion were excellent. Early in the
period of our hospital life, our corps men had been grouped for use
as donors and we were never short volunteers when blood was needed
to help the wounded soldier. When blood was needed for wounded
German prisoners, convalescent Germans were grouped and blood
taken from them to supply the needs of their comrades. A startling
recovery was obtained following transfusion in a demonstrated case
of hemolytic streptococcemia. We used transfusion with very grati-
fying results in badly exanguirated and shocked cases, frequently
as a preliminary to amputation or other operation. We employed
the citrated blood method.
On the morning of Januarj^ 31, 1919, a telegram was received from
the chief surgeon's office, American Expeditionary Forces, which
stated that Base Hospital No. 61 was to be returned to the United
States. Before midnight the same day we had evacuated 79 remain-
ing patients to Base Hospital No, 77 of this center, and disposed of
our extra equipment and dental outfit.
On March 6, orders were received to send one officer and nine
nurses of Base Hospital No. 61 to La Baule for embarkation to the
United States. Paragraph 2 of this order directed 11 officers and
173 enlisted men to proceed without delay to the same point. This,
however, was later changed to read "Reserve embarkation camp,
Montoir," in so far as affected officers and enlisted men.
On November 11, the day the armistice was signed, we had a total
of 1,346 cases. 1,071 of which were surgical. One month later there
were 734 patients, 484 of which were surgical. There was little
variation from this number until January 19, 1919, when the num-
ber fell to 591 cases, of which 336 were surgical. One week later
the census dropped to less than 100 cases.
Remarks upon the instant effects of 'poisonous gases in toar-
fare. — There were 375 patients who suffered from the effects of gas
treated in the medical wards of this hospital.
During the early days our lack of familiarity with the various
types of gases resulted in the fact that of the 175 cases the nature of
the gas was undetermined. Since the evidences of mustard gas are so
distinct it is probable that nearly all of these were phosgene. Thirty-
three others suffered from phosgene poisoning. One hundred and
twenty-six were mustard gas cases, four had inhaled a mixture of
gases, and one claimed to be suffering from arsene poisoning. One
confusing element in diagnosis was the fact that soldiers in battle
were constantly subjected to the inhalation of gases from high ex-
plosives, and failed to recognize the fact that they had been gassed
until they had become sick and could not describe the odor. Nearlr
1974 REPORT OF THE SURGEON GENERAL OF THE ARMY. ^
all our early cases came from the Meiise front. Later trains brought
various types from various places. One large convoy from the
Argonne, nearly all of the 89th Division, were mostly mustard gas
cases with predominating respiratory symptoms.
There were only three deaths among these gas patients. One was
by accidental electrocution, and gassing probably had nothing to
do with his death. Of the other two patients who died, both had
been exposed to Mustard gas.
Fifty-two complications developed among our gassed patients, of
which six certainly and probably were not related to the gassing.
These coniplications were: Neuralgia, jaundice, sinusitis, recurrent
appendicitis, recurrent nephritis, and myocarditis. Including the
doubtful cases this leaves us a total of 46 patients with complica-
tions. Of these one occurred in a mixed gas case and showed dis-
ordered action of the heart, and* one in the doubtful arsene case
(also D. A. H.). Of 8 in the 41 phosgene series, 6 had disordered
action of the heart (2 persistent weakness, probably D. A. H., 1
D. A. H. with neurosis), 1 persistent enteritis arid 1 persistent
cough. Among the 154 mustard gas patients 29 showed complica-
tions. There were 9 broncho-pneumonias (1 died), 3 influenzas (1
of which was followed by broncho-pneumonia), 3 persistent coughs,
1 bronchitis (death), 2 bronchiectases, 5 persistent hoarseness, 2
persistent diarrheas, and 5 with severe persistent photophobia and
blethrospasms. Among the 175 undetermined gas cases, there were
23 complications, six of D. A. H., 2 persistent gastritis, 2 gastro-
enteritis, 3 psychoses, 2 neuralgias, 1 influenza, 1 broncho-pneu-
monia, 1 influenza followed by broncho-pneumonia and frontal
sinusitis.
Ol. BASE HOSPITAL NO. 6 2.
Base Hospital No. 62 was organized at Camp Greenleaf, Chicka-
mauga Park, Ga., June 13, 1918. The detachment consisted of 131
enlisted men. The organization remained at Camp Greenleaf until
June 29, having spent two weeks in intensive training ; it then pro-
ceeded to Camp Upton, Long Island, N. Y., arriving in the morn-
ing of July 1, 1918. After clearing a tract of ground, tents were
pitched and training continued. A selected number of the men were
given special ward duty training in the Camp Upton Base Hospital.
The organization, then consisting of 37 officers and 199 enlisted
men, left Camp Upton on August 29, 1918. bound for port of em-
barkation, Hoboken, N. J., where they boarded the transport North-
em Pacific for overseas.
On August 31, 1918, the organization sailed for Brest, France,
where it arrived on the afternoon of September 7, 1918. On Sep-
tember 8, 1918, all went ashore and marched to a rest camp at Pon-
tanezan Barracks, where eight days were spent awaiting further
orders, after which the officers and enlisted personnel proceeded to
Hospital Center, A. P. O. 780, Mars-sur-Allier, arriving in a drench-
ing rain at 2 a. m., September 19, 1918, after spending three days
en route.
At midnight, February 11, 1919, Base Hospital No. 62 closed its
records and ceased to function as a hospital, having treated 3,631
I
A. E. F. — BASE HOSPITALS. 1975
cases, 1,303 of which were returned to duty, 2,294 were transferred to
convalescent camps, and 31 died.
Of this number 3,232 were medical, of which 100 were pneumonia,
730 were influenza, 10 typhoid fever, and 3 meningitis; the remainder
consisted of misceilaneous diseases of lesser importance. Three hun-
dred and ninety-nine of the total were surgical and 212 venereal.
The records show that there have been no venereal diseases in the
organization. The records also show that there were no deaths in the
organization.
PI. BASE HOSPITAL NO. 63.
Base Hospital No. (53 was first designated as such on June 7, 1918,
at Camp Greenleaf, Cliickamauga Park, being formed from Com-
pany No. 8, recruit section, hospital group at that camp. When first
designated. Base Hospital No. 63 consisted of 2 officers and 188
enlisted men. After many changes in personnel of officers and en-
listed men, the hospital unit was transferred to Camp McClellan,
Ala., for further mobilization on June 30, 1918. It then consisted
of 1 officer and 113 enlisted men.
After arriving at Camp ]McClellan, on June 1, 1918, the unit
began at once to enlarge to its full strength required for overseas
service. On June 1, 1918, 1 officers were assigned for duty, making
a total of 5 officers. On July 27, 1918, 8 more officers were assigned
t-o duty, and on July 2, 1918, 62 enlisted men were transferred from
Motor Company No. 11, Camp Greenleaf, Ga. This brought the
total strength of the unit to 23 officers and 200 enlisted men.
On August 19, 1918, the unit, comprising 33 officers and 215 en-
listed men, left Camp McClellan for overseas service. Arrived at
Camp Merritt on August 21, 1918. Embarking August 28, arrived
at Brest, France, on the evening of September 7, 1918. Debarked
on the morning of the 8th and immediately proceeded to Pontanezen
Barracks to await further orders. Remained at Pontanezen Bar-
racks until September 12, 1918, on which date the unit proceeded
under ordei^s to Caen (Calvados), France. Arrived at Caen at mid-
night on September 13, 1918.
The building to be occupied and to be used as a hospital was a
famous old monastery built by William the Conqueror, called the
Lycee. Immediate steps were at once taken to prepare this hospital
for the receiving -of patients. By the end of September the hospital
had progressed enough that 300 or 400 patients could have been
handled.
On October 20, 1918, the first officers were sent away on detached
service when three were ordered to the camp hospital at Cosne-
Nievre, four to the Base Hospital at Pruniers and four to Base Hos-
pital No. 27 at Angers. On November 21, 1918, 80 enlisted men were
transferred to the camp hospital at Brest for duty. It was evident
then that no patients would be received. A few days later orders
were received to abandon the hospital at once.
On December 15, 1918, orders were received for the unit to pro-
ceed to Chateauroux (Inder), to relieve Base Hospital No. 9 at that
station. The unit left Caen under orders on January 2, 1919, and
arrived at Chateauroux on January 3 at midnight. On January' 14,
1019, Base Hospital No. G3 relieved Base Hospital No. 9, and assumed
operations of the military hospital at that place. At this time the
1976 REPORT OF THE SURGEON GENERAL OF THE ARMY.
hospital AA-as a well -organized establishment, making a specialty of
orthopedic cases. Sixty-three, therefore, carried on the work begun
by nine. From the time Base Hospital No. 9 ceased to fimction as
a hos])ital until March 5. the date they left this station for return to
the United States, it had been called on to assist in various ways in
the operation of the hospital.
The laboratory here handled all work for the surrounding base
and camp hospitals. Many interesting cases were diagnosed, both
in the X-ray and laboratory portion of the hospital. The many
plates on hand here are the proof of this statement. No serious epi-
demics were encountered wliile this hospital functioned at Chateau-
roux.
Patients were continually evacuated so that there were only 200
left when orders were received to abandon the hospital as soon as
possible, and that Base Hospital No. 63 would be skeletonized and
returned to the United States. On March 21, 1919, Base Hospital
No. 63 ceased to function as a hospital.
Ql. BASE HOSPITAL NO. 64.
This detachment left Camp Greenleaf for Camp Sevier June 28,
1918. At this station the personnel was increased by the addition
of 33 officers and 85 enlisted men.
Activities at inohilization point. — All officers and enlisted men
were assigned for instruction to base hospital, Camp Sevier, and a
regular schedule of instruction for enlisted men instituted in sanitary
drill. Mason's Handbook, and gas-mask drill. Intensive training
was conducted along these lines for one month. During this period
20 enlisted men Avere transferred to the limited service battalion at
that station as physically unfit for service overseas on recommenda-
tion of a board of medical officers appointed for the purpose.
The organization, consisting of 34 officers and 205 enlisted men,
left Camp Sevier August 19, 1918. Arrived at Camp Merritt, N. J..
August 21, 1918. Three officers joined for ^wty at this station. De-
parted from port of embarkation, Hoboken, N. J., on steamer Belgic^
White Star Line, September 1, 1918. Arrived at Liverpool, Eng-
land, September 13, 1918. Voyage imeventful. Arrived Winchester
Rest Camp, England, September 14, 1918. Arrived Southampton,
England, September 16, 1918. Arrived Cherbourg, France, Septem-
ber 17, 1918. Arrived hospital center, Rimaucourt, Haute-Marne,
France, September 21, 1918. Assigned to present location at this
station.
Resume of work in the American Expeditionary Forces. — Hospital
began to operate on October 4, 1918, receiving 545 patients on that
date, consisting of 128 gassed, 217 gunshot wound, and 146 general
medical cases. Maximum number of patients in hospital, 1,612, was
reached October 21, 1918, consisting of gassed, 1.069; gunshot wound,
300 ; general medical, 243. On November 11, 1918, the crisis expan-
sion was increased to 2,500 beds, which had been gradually accom-
plished by the erection of marquee tents in the field adjoining the
hospital on the northeast.
The following is a condensed classification of the patients treated
during the period covered by this report :
A. E. F. BASE HOSPITALS. 1977
1. Total number of patients from Oct. 4 to Dec. 31, 1918 2, 810
2. Average daily number of patients treated 662
3. Lari^est number of cases treated in one week 1, 713
4. Smallest number of cases treated in one week 181
5. Gunshot wounds 334
The large number of gassed cases is explained by the fact that in
line with the general policy of specialization of this center this hos-
pital had been designated by order of headquarters hospital center,
Kimaucourt, as the hospital for the reception of all gassed cases.
Gas-contact cases. — Local symptoms were present, as pain and
inflammation, varying in nature, intensity, and degree, depending
on their extent. Constitutional symptoms are present likewise. In
all gas-contact cases of any severity we had to deal with more or
less shock. Patient show^s a thready pulse, subnormal temperature,
and shallow resp)iration. The patient may die without showing
any reaction, but usually, unless the burn is extensively severe, there
is a reaction, followed by a severe fever, with a tendency to con-
gestion of the internal organs, which fact is never to be lost sight
of. There follows in many cases vomiting, diarrhea, hemoglobin-
uria, and often enlargement of the lymphoid tissue throughout
the body. Extensive blood changes may occur, which may be
enumerated as follows: (1) Polycythemia, which is due both to
venous stasis and loss of blood plaques; (2) leucocy tosis ; (3) in-
crease of blood plaques; (i) a tendency to clot. ■ This clotting
tendency may be the cause of damage to various organs and struc-
tures; and this, along with the general alterations in the blood,
causes injury and impairment of the functions of the excretory or-
gans, usually seen to 3, mild or severe degree in every case. Along
with these changes in the blood we must always keep in mind the
loss of the power of throwing off from the body excretory products
in proportion to the extent of the area burned, the formations of
toxins at the burned site, their absorption into the sj^stem already
reduced in its excretory power. Thus we have fraudulent accumu-
lation of waste products, augmented by toxins from the burned
area, in a system with decreased eliminative facilities, and in a sys-
tem going through the thralls of shock. In addition, another fac-
tor makes itself felt, viz, the disintegration of the red blood cells
brought about by the reactionary high temperature, and these prod-
ucts of corpuscular degeneration may cause irritation or throm-
bosis of the kidneys or other viscera. This makes up quite a com-
plex problem and not a question of burn per se. Burns of any de-
gree are not simple, as one may believe, but one must always have
in mind the complications and sequelas. In all burns of the head
one must be on the lookout for inflammations of the brain ; in chest
burns, lung inflammation; and in abdojninal burns, be scrutiniz-
ingly careful of abdominal inflammation. The usual burn compli-'
cations are considered as damage to the lung, kidneys, and stom-
ach. Danger of burns depend on extent, degree, and situation.
The outlook for the patient with a burn of a large area superficially
is much worse than with a small, deep area. Clinically and bac-
teriologically all burns are sterile during the first few hours follow-
ing the receipt of the burn, then they become bacteriologically in-
fected as soon as the skin begins to slough and become necrotic, and
smears taken from the burned areas show saproph;yi;es and cocci,
1978 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
SO we will think of practically all bums as infected wounds at some
period during their course.
This hasty review of burns as a general question brings us up
to the consideration of mustard-gas burns, so termed. These are
the result of the vesicant action of dichlorethyl sulphide, conunonly
known as mustard gas. It exerts its irritant action as a vapor in
low concentration in the air or by direct contact from splashes of
the liquid. It is an oily liquid, used in shells and scattered from
them on the ground, where it slowly evaporates. This not only
exposes those in the immediate vicinity of the shell burst, but may
also affect those who go over the contaminated ground later. The
fluid may be scattered on clothing, shell casings, rifles, etc., and
thus become effective through direct contamination of the skin.
No irritant effect is felt at first, whatever the concentration may
be, but after a delay of two to six hours or even up to two or three
days, the skin begins to react with a progressive inflammation that
may react in blistering and in local necrosis.
Skin areas inrolved. — The face alone seems to be in a class by itself
in escaping vesicant or escharotis action. The areas most severely
involved are the axillae, penis, scrotum, perineum, inner surface of
the thighs, the flexor surfaces of the joints and buttocks. Where the
skin is damp with perspiration as axillae, perineum, and flexor sur-
faces, the burns are the most frequent and severe, for there is a reso-
lution of the gas brought about by the action of the moisture. No
part of the body, however, is exempt from its action. The dried
liquid clings to clothing and thus it continues to exert its irritant
action. The burns range in degree from first to second and third,
some cases showing simply first degree bums M'ith red erythematous,
sunburned reaction of the skin. There may be excoriation of the
skin, or the skin may be retained while the erythema gradually fades,
being displaced by a brown staining or bronzing. The early burns
appear, as a rule, in 12 hours, and these are usually severe, present-
ing the appearance of large erythematous patches covered with large
bullae, which contain a serous, sero-purulent material. The contents
of these bullae are impregnated with the irritant and if the blisters
are opened allowing the contents to come in contact with one's skin,
you in turn will suffer from itching and burning of the involved
bathed areas, therefore in opening the bullae it is advisable to make
use of a hyperdermic needle, withdrawing the contents.
Treatment of all contact burns which produced the best results here
•were the following: (1) Alkaline solution (sodium bicarbonate);
(2) dusting powder; (3) ambrine, applied with brush or atomizer.
Ambrine gave the best result.
Gas inhalation cases. — All of these cases before reaching us had
.gone through the initial symptoms, such as watering of eyes, choking
sensation, tightness of chest, coughing, nausea, and vomiting, and
upon arrival here complained of cough, shortness of breath, tightness
of chest, loss of voice, blindness (temporary) at times, and general
weakness.
After a period of five or six hours an acute edema may develop
insidiously in the lungs. It may progress so rapidly as to be a menace
to life itself. Aeration of blood is seriously interfered with due
to the fact that air sacs are filled with fluid o"r burst from excessive
coughing. The blood itself is concentrated by the loss of serum, so
A. E. F. BASE HOSPITALS. 1979
that red corpuscles may even rise to a count of eight or nine million
to the cubic millimeter. The characteristics brought out in these
cases were, a rise of temperature, in a large percentage of cases upon
the least exertion ; a general weakness that persisted ; and a contrast
was noted between gas inhalation cases and those wounded by shell-
fire, in as much as the gassed cases, having lost all their fighting
spirit, never had any desire to return to the firing line.
The treatment that was instituted in these cases varied. "We first
tried alkalinization, with only fair results. Treatment became more
symptomatic, as absolute rest, expectorants, and sedatives — a ques-
tion of time really being the necessary element, so far as recovery was
concerned.
Summary of gas cases. — 1. Kinds: {a) Dichlorethyl sulphide, (&)
chlorine, {c) phosgene.
2. Over 95 per cent of our cases were dichlorethyl sulphide.
3. Gas contact cases were of all stages, first, second, and third
degree burns. About 60 per cent second degree, 30 per cent first de-
gree, and 10 per cent third degree. A very small percentage of these
bums when healed broke down again. In a majority of cases, for
weeks following recovery from burns, these cases presented a typical
erythema after a warm bath.
4. Final results as regards {a) gas contact cases ; (6) gas inhalation
cases; (<?) conjunctivitis (chemical cases)- time alone will tell. It
may be that the burns will cause a contraction of the skin; the pul-
monary irritation predispose to tuberculosis or set up an old latent
tuberculosis; the chemical conjunctivitis tend toward impairment of
vision.
Respiratory cases. — Under this heading we include the following
diseases: Bronchitis, pneumonia, pleurisy, and pulmonary tubercu-
losis. The total number of cases being 150.
Bronchitis cases constituted about one-third the total, 25 per cent
of these followed gas inhalation. Pneumonia cases numbered 44.
These cases were not kept in our hospital, but were transferred to
Base Hospital No. 52, which hospital received all pneumonia cases
of the center.
Rl. BASE HOSPITAL NO. 65.
The organization of Base Hospital No. 65 was authorized by the
Surgeon General in the late fall of 1917 as a casual organization.
The nucleus of a professional staff was soon formed from the physi-
cians of the State of North Carolina, and this was gradually added to
until the completed quota was attained.
Base Hospital No. 65 was ordered mobilized at Fort McPherson,
Ga., in March, 1918. For the first two weeks at Fort McPherson
the enlisted personnel was attached to Army General Hospital No. 6.
The entire authorized quota of enlisted men was not filled until
May, 1918.
On August 9, 1918, Base Hospital No. 65 was ordered to Camp
Upton, N. Y.
On August 29, at 4 p. m.. Base Hospital No. 65 left Camp Upton
for Hoboken, N. J., and by noon was aboard steamship Kroonland.
The trip across was devoid of incident, and Base Hospital No. 65
landed in France the afternoon of September 13, 1918. From this
1980 REPORT or THE SURGEON GENERAL OF THE ARMY.
date until September 16, 1918, the organization was in Camp Pon-
tanezen. Brest. Orders then came that the unit would proceed to
Kerhuon hospital, 4 miles from Brest, and prepare it for the recep-
tion of patients.
The history of Base Hospital Xo. 65 from September 16, 1918, to
the present date (Mar. 31, 1919) is the history of Kerhuon hospital
center, for Base Hospital No. 65 is the only base hospital that has ever
functioned at Kerhuon hospital center.
The hospital center at Kerhuon was planned for service as an em-
barkation hosi^ital to receive patients from the American Expedi-
tionary Forces for evacuation to the United States. The construction
of the hospital was to be completed by September 15, 1918, but at that
time only about 50 per cent of the buildings were under roof.
On September 16, 1918, Base Hospital Xo. 65 was ordered from
Camp Pontanezen to prepare the hospital for the reception of patients.
The hospital unit found enough buildings for shelter, but was sub-
sisted b}" means of temporary kitchens, with field ranges, as no cook-
ing facilities had been provided at that time in the hospital develop-
ment.
On September 20, however, the epidemic of influenza-pneumonia
among the American troops debarked at Brest began to assume alarm-
ing proportions, so that all the available hospital beds in Camp Hos-
pital No. 33, Navy Base Hospitals Nos. 1 and 5 were occupied. As it
became necessary to provide additional hospital accommodations for
the increasing number of patients debarked with the incoming troops
this hospital center was forced to receive the patients that could not
be accommodated in the other military hospitals at this base. On
September 25 a few convalescent patients from the other hospitals
of the base were evacuated to this center for the purpose of increasing
the space for more seriously sick in the established hospitals. The
admissions of cases evacuated from other hospitals continued for some
days until it became necessary to admit patients directly from trans-
ports. Within 10 days from the time of our first admission 2,000
patients suffering from influenza and pneumonia were in the wards
of this hospital.
Only about one-half of the buildings were covered with tar paper,
and none of the windows had been fitted with glass. The windows
were covered, as rapidly as construction force could work, with
oiled cotton cloth, which afforded suitable protection, until the supply
was exhausted, when burlaps and other fabrics had to be substituted
for windowpanes. As stoves were not available for heating, the
wards were cold and damp from the constant rains, and this consti-
tuted one of the most serious sources of discomfort, as well as of
actual danger, for the constantly wet condition of the personnel
speedily led to an alarming increase in the personnel sick rate at a
time when the services of all were imperatively needed. Fortunately,
an adequate supply of blankets, of excellent quality, and sufficient
beds and mattresses permited the patients to be kept warm and
comfortable enough. The shortage of mattresses was not a very
severe condition, as blankets could be substituted and all the patients
placed on beds.
As no system of walks or roads had been even projected, the con-
tinuous rains soon produced an almost impassable condition by reduc-
ing all lines of communication to pools of mud. It was under these
A. E. F. BASE HOSPITALS. 1981
conditions that stretcher hearers, hy day and night, carried to the
wards the continual stream of desperately ill men.
The strength of Base Hospital No. 65- at this time was 20 medical
officers, of whom only 12 were available as ward surgeons ; 100 nurses,
of whom from 15 to 25 per cent were on the sick list ; and 200 enlisted
men.
Approximately 3,300 patients suffering from influenza-pneumonia
were treated, of whom 569 died.
Other infectious diseases, such as measles, mumps, and scarlet
fever, were present among the patients at this time, and, as is usually
the case in epidemics of respiratory infections, meningitis of both
the epidemic cerebrospinal and pneumococcic types was frequently
encountered, 31 positive cases having been diagnosed during Sep-
tember and October.
By the 1st of November, 1918, the epidemic of influenza-pneumonia
had definitely subsided at this port. The hospital was thoroughly
cleaned, blankets disinfected, and preparations made for the recep-
tion of sick and wounded en route to the Uunted States. The first
hospital train from the forward areas was received October 26, 1918.
The vast majority of the patients arrived with very meager data,
and inadequately equipped for returning to the United States. Their
evacuation was imperative, however, for trains of patients were
arriving daily. For example, .1,592 patients were received from
hospital trains on November 21, 1918. Unquestionably, many cases
were evacuated to transports who should not have been transferred to
this center. Several base hospitals evacuated their patients '' en
bloc" to Kerhuon, where they arrived after a journey of three or
more days. Many of these cases were such as to render daily dress-
ings necessar}', and these were apparently not done on the hospital
trains. Nine thousand two hundred and fifty cases have been evac-
uated to the United States up to the present date (Jan. 14, 1919).
[March 31, 1919: From January 14, 1919, to the present date the
hospital center, Kerhuon, has continued to function almost purely as
an embarkation hospital, sending to the transports sick and wounded
received from other hospitals. These patients have arrived, either at
Brest or Kerhuon station in hospital trains, and have been conveyed
to the hospital, and subsequently to the boats by ambulance. The
movement of sick and wounded has progressed smoothly and no
special difficulties have been encountered. Of course the use of am-
bulances has been objectionable and could have been obviated by
running a spur track from the near-by railroad to the hospital
grounds.
SI. UNITED STATES AKMY BASE HOSPITAL NO. G7.
On the night of July 6, 1918, the organization left Camp Crane,
Allentown, en route to the port of embarkation, Hoboken, N. J., for
over-seas service, and sailed from that port on the transport Levia-
than early in the evening of July 8. The trip over was uneventful,
the weather lieing fair and the sea unusually smooth. Owing to the
fleet character of our ship no convoy was provided until within 36
hours of the French coast, when five United States destroyers ap-
peared on the horizon, and, coming closer, accompanied us into the
harbor of Brest. Landing was made in the afternoon of July 15,
and that night the unit went into encampment on plot 83, near Ponta-
1982 KEPORT OF THE SURGEON GENERAL, OF THE ARMY.
nezon Barracks. For a period of two weeks we remained at this
point under the most trying conditions.
Three days and two nights of travel brought us to Mesves, Depart-
ment of Nievre, in the late afternoon of August 1, and we took
possession of hospital building Unit No. 1. On arrival we were told
that there were already in the hospital more than GOO patients and
that another train was due within a few hours. It thus happened
that within the first 24 hours of our service we were compelled to
receive and give medical attention to 1.075 patients, consisting in the
main of wounded from the Chateau-Thierry drive. The hospital
buildings were about 90 per cent completed but the water had not
been turned on, there were no electric lights, and, of course, dressings
and appliances had to be sought from the quartermaster. By the
aid of lanterns and candles and with only such surgical instruments
as could be drawn from our first-aid belts, the staff worked through
that first night and day so industriously and so efficiently that at the
end of 24 hours every patient had received at least a thorough ex-
amination and dressing. To many of the staff that experience re-
mains as a nightmare ; the continuous service without sleep, without
adequate equipment, with no nurses and assisted only by corps men
who had never had any previous hospital training, the labor was
heavy and the nervous strain such as to wear out the strongest.
In the period of its existence, from August 1, 1918, to January 20,
1919, the hospital admitted 7,853 patients, and within that same time
there were but 80 deaths, a mortality percentage of only 1 per cent.
Tl. BASE HOSPITAL NO. 68.
Base Hospital No. 68 reported ready for service overseas on June
26. 1918, ancl received orders to proceecl to the port of embarkation on
July 2, 1918. Between that time and the 5th of July, sufficient per-
sonnel was transferred from the organization to reduce the number
of enlisted personnel to 200.
The transport sailed from Hoboken at 6.30 p. m. July 8, 1918,
being at sea until 1.30 p. m. July 15, 1918. Debarked at Brest,
France, at 11.30 p. m. same day. Marched to Pontanezen Barracks,
arriving at 2.30 a. m. and remained encamped until 4.30 a. m. July
22, when the organization entrained for hospital center, Mars-sur-
Allier, arriving at 6.15 p. m. on July 24, 1918.
On arrival at Mars, this organization first prepared the unit for
occupancy which was later occupied by Base Hospital No. 48. This
unit then prepared its own hospital, which it has occupied during its
service at the center. The hospital was formally opened on August
2. 1918, when the first hospital train arrived at the center. The first
death in this hospital occurred on August 4, 1918.
From this time on the hospital gradually increased its capacity
until early in October. It then took over another unit as an annex
and soon increai^ed its bed capacity to 3.500. with an emergency bed
capacity of 4,000. The annex was opened on October 12, 1918, and
on November 12, 1918, had a maximum bed capacity of 2,000. The
maximum number of patients was 1,834 on November 16, 1918, and
on December 4, 1918. the annex, with 1.197 patients, was transferred
to Base Hospital No. 123.
A. E. F. BASE HOSPITALS. 1983
During the period up to November 20, 1918, 7,021 patients were
admitted and treated at this hospital and 4.211 cases were evacuated,
the majority of which returned to duty. Up to this same date there
was a total of 98 deaths in this hospital, including civilian laborers.
On January 3, 1919, there arrived at this center a hospital train
carrying wounded German soldiers and the personnel of two German
hospitals, Nos. 28 and 129, taken over by the American troops after
November 11. at Arlon and Virton, Belgium, This unit received 83
patients and 74 personnel.
Januar}^ 4, 1919 : The last hospital train to arrive at this center
brought wounded, transferred from Base Hospital No, 17, Dijon;
Base Hospital No. 68 received 50 of these patients. On January 11,
1919, telegraphic instructions dated January 11, 1919, reached this
hospital, requesting that the commanding officer, Base Hospital No.
68, have other organizations in the hospital center take over patients
and equipment.
Ul, BASE HOSPITAL NO, 69,
United States Army Base Hospital No. 69 is a casual unit, the
mobilization of which at Camp Meade, Md., was in acordance with
Confidential Orders, No. 61, Headquarters, Southeastern Department,
under date of June 11, 1918, directing the commissioned and enlisted
personnel to proceed from Camp Greenleaf, Fort Oglethorpe, Ga.,
to Camp Meade, Md. At this period the personnel of Base Hospital
No. 69 consisted of 2 officers and 122 enlisted men.
The period of active mobilization existed from approximately June
30, the date of arrival at Camp Meade, to August 28, when, in com-
pliance with Special Orders, No. 231, Headquarters, Camp Meade,
Md., August 26, 1918. the fully mobilized organization, consisting of
35 officers and 199 enlisted men, entrained for the port of embarka-
tion. Hoboken, N. J. The organization arived at Hoboken August
29, 1918, and immediately embarked on the U. S. S. Susquehanna and
sailed for over-sea service on August 30, 1918, Arrived at Brest Sep-
tember 12, and were quartered at the Eest Camp at Pontanezen Bar-
racks from September 12 to 20, when, in accordance with Special
Orders, No. 251, paragi-aph No. 29, Headquarters, Base Section No.
5, Services of Supply, September 12. 1918, the organization was en-
trained for Savenay (Lor-Inferieure). Arrived at Savenay Sep-
tember 21 1918, reporting to the commanding officer, hospital center,
Savenay, for duty.
Assignment was made to take over the hospital plant then known
as Construction Unit No. 2. There were 46 wards in all, of the knock-
down wooden-barrack type. Of these, approximately two-tliirds
were completed, and the remainder were in advanced stages of con-
struction. None of the administrative buildings were fully com-
pleted; only one of the proposed set of the three officers' barracks
had been constructed, and none of the four sets of proposed nurses'
barracks had reached completion, although these were in advanced
stages of construction. The majority of the fully constructed wards
were already occupied by ambulatory patients. The main kitchen
and mess hall was not yet completed, three ranges being partly in-
stalled in the kitchen.
Base Hospital No. 69 immediately started functioning as an indi-
vidual unit, the records being carried by the registrar of Base Hos-
1984 REPORT OF THE SURGEON GENERAL OF THE ARMY.
pital No. 8, and 01113- ambulatory cases being admitted to the wards.
The receipt of tA-pewriters made it possible for tlic registrar's office
to take over all records of patients two days earlier. At this time
there were aj^proximately 1,500 patients in the hospital.
In mid October there were something over 1,100 j)atients on the
medical service, the organization of a 1.000-bed base hospital only
providing for 4 medical officers for this service, and some 400 or 500
on the surgical service. By mid November there were approximately
1,200 patients on the surgical service and 600 on the medical service
within the unit proper, with approximately the same proportions
obtaining in the adjoining unit, which was being conducted by this
hospital. This condition required a constant transfer of patients
from ward to ward, a ward being one day on the medical service
and probably on the same day emptied of medical cases and filled
with surgical. The problem of quarantine of the occasional cases
of acute contagious diseases which arose was also a difficult one.
Arriving at its present station on September 21, 1918, with 35 offi-
cers and 199 enlisted men, this organization had by March 1, 1919,
carried on its rolls for various terms of duty some 345 officers and
1,150 enlisted men. For the first month of its active service there
were no nurses available. From that time on the number of nurses
was always, prior to February 1, 1919, far below that prescribed
for military hospitals. For the first four months the highest pro-
portion achieved exceeded by ven' little 1 nurse to about 18 beds of
rated capacitj' , being for a considerable period approximately 1 nurse
to 47 patients. On February 1, 1919, approximately 75 per cent of
the officers, 100 per cent of the nurses, and 60 per cent of the enlisted
personnel had been on duty with this organization for less than two
weeks.
Base Hospital No. 8 having been ordered to prepare for return to
the United States and Base Hospital No. 88 having been ordered to
this center, the period between January 15 and January 31, 1919, was
largely occupied with the double process of transferring the con-
struction unit and patients of Base Hospital No. 69 to Base Hospital
No. 88 and of taking over by Base Hospital No. 69 of the construc-
tion unit and patients of Base Hospital No. 8. Since midnight, Janu-
ary 31, 1919, Base Hospital No. 69 has operated in the unit centering
around the ficole Normale, which had been occupied for some 18
months by Base Hospital No. 8.
VI. BASE HOSPITAL NO. 71.
This unit left Camp Greenleaf, Chickamauga Park, Ga., August
17, 1918, at 4.30 p. m., en route to Camp Beauregard, La., in compli-
ance with paragraph 17, Special Order No. 224, Headquarters, Camp
Greenleaf, Chickamauga Park, Ga., dated August 7, 1918, arriving
at Camp Beauregard, La., at 9 a. m., August 19, 1918. Organization
attached to Base Hospital, Camp Beauregard, La., as part of hos-
Ijital group, that station.
Organization left hospital group, Camp Beauregard, La., at 9.30
a. m., October 26, 1918, en route to Camp Upton, Yaphank, Long
Island, N. Y., in compliance with paragraph 1. Special Order 78,
Headquarters Camp Beauregard, La., dated October 24, 1918.
A. E. F. BASE HOSPITALS. 1985
October 29 : Organization arrived at Camp Upton, N. Y., at 3.30
p. m.
Xovember 10: Organization left Camp Upton, N. Y., at 3 a, m.,
en route to Pier No. 97, New York. Boarded steamship Errvpress of
Asia at 11 a. m. for service with the American Expeditionary Forces,
France.
November 12 : Steamship Empress of Asia left dock at New York
at 4.30 p. m., en route to France. Base Hospital No. 71 debarked
from steamship Empress of Asia, Brest, France, reporting to com-
manding officer Pontanezen Barracks, at 4 p. m., November 22, 1918,
and assigned to plot No. 87. Command left pier at about 5 p. m.,
en route to plot No. 87, by marching a distance of approximately 3^
miles, establishing camp, awaiting assignment to station in the
American Expeditionary Forces.
November 29: Organization, consisting of 33 officers and 194 en-
listed men, left camp, plot No. 87, in two sections at 1 a. m. and 9.30
a. m., en route to Pau (Bassens-Pyrenees), France.
Patients treated during the month of December 26
Patients discharged to duty 19
Patients remaining in liospital 7
Patients admitted from January 21 to 31 41
Patients discliarged or transferred 28
Patients remaining in hospital at end of month 434
Patients admitted during the month of February 103
Patients discharged or transferred 497
Patients remaining in hospital at end of month 40
Patients remaining in hospital from month of February 40
Patients admitted during the month of March 23
I'atients discharged or transferred during March 63
Wl. BASE HOSPITAL NO. 7 7.
June 14, 1918, 113 enlisted men, transferred to the organization,
arrived at base hospital, Camp Sherman, July 1, 1918. Eighty-seven
adidtional enlisted men Avere transferred from the enlisted personnel
of base hospital. Camp Sherman, bringing the enlisted personnel of
Base Hospital No. 77 up to full strength. On August 1, 34 officers,
representing 20 States, had reported for duty.
The organization was rapidly perfected. The enlisted men and
officers were prepared and equipped for overseas service, and the
organization left Camp Sherman, Ohio, with a full complement of
officers and men on August 27, 1918, en route to Camp Upton, Long
Island, N. Y. Left Camp Upton August 31, 1918, at 3 a. m., arriving
in New York at 7 a. m. Went on board steamship No. 222 {Baltic)
9.30 a. m. Left dock at New York September 1, 1918, at 10 a. m.
September 11, 1918, a large British convoy met the fleet, of which
the Baltic was a part, at 6 a. m. and conducted it safely to the harbor
of Liverpool September 13, 1918, at 7 a. m. Debarked from the Baltic
about 8 a. m. and entrained about 9 a. m., and proceeded by rail to
Southampton, arriving there at 8.30 p. m.
The first consignment of j^atients arrived October 12, 1918, and as
the nurses of this command had not yet arrived, the nursing and care
of the patients was done by the officers and enlisted men of the organi-
zation. The enlisted men did their work very well, indeed.
From October 12, 1918. the date of the arrival of the first patients,
to and including March 5, 1919, when Base Hospital No. 77 was or-
1986 REPORT OF THE SURGEON GENERAL OF THE ARMY.
dered to return to the United States, 3,789 patients were treated in the
wards of Base Hospital No. 77; 16 of that number died.
Duration of service, October 12, 1918, to March 6, 1919.
Number of patients treated in medical wards, 3,505.
During the first two months of the service the cases consisted
largely of influenza, bronchitis, and pneumonia, an epidemic of re-
spiratory disease being present throughout the entire American Expe-
ditionary Forces.
XI. BASE HOSPITAI^ NO. 7 8, TOUL, FRANCE,
Base Hospital No. 78, a casual unit, came into existence at Camp
Greenleaf, Ga., prior to June 1, 1918. On June 30, 137 enlisted men
and 1 officer, then comprising the unit, were transferred to Fort
McHenry, Md., for mobilization for overseas service and for a period
of training with General Hospital No. 2.
On August 27, 1918, the unit, consisting of 33 officers and 191 en-
listed men, entrained for Camp Merritt, N. J.; thence, after three
days, proceeded by early morning march to Alpin Landing and by
ferry to New York Harbor, where the ship Afwhises was boarded.
As part of a large convoy of transports with escorting destroyers, this
English transport sailed September 1, 1918. A northeast course was
pursued, and later a southeast course, landing Friday, September 13,
1918, at Liverpool, England. After four days at Knotty Ash rest
camp the organization traveled to Southampton by rail, passing
through Manchester, Sheffield, Leicester, and Oxford.
The English Channel was crossed at night, arriving at Havre
on the morning of September 20. Departing from Havre at 1
a. m. September 21, we traveled across country by tioop train. At
Chatillon-sur-Seine our orders were changed, so that instead of pro-
ceeding to Beaune, the original destination, we proceeded to Toul,
Meurthe-et-Moselle, arriving there September 23, 1918. Base Hos-
pital No. 78 became one of a group of eight base hospitals, making
up the Justice hospital group, located about Toul, the most advanced
base hospitals in the American Expeditionary Forces.
The first patient was admitted September 29, 1918. During the
months of September and October the activities were practically those
of an evacuation hospital. Evacuation of patients was facilitated by
the presence of a railhead immediately to the rear of the hospital.
This hospital was the surgical unit of the group, but with the
spread of influenza and other respiratory diseases it became necessary
to admit many such cases, the overflow from the other hospitals in
the group. After the armistice the surgical work was modified, and
we received only infected wounds and suppurating conditions; the
medical cases continued to be admitted in increasing numbers. This
arrangement continued until January 30, 1919, when this hospital
was designated to care for the genito-urinary cases of the group.
The hospital ceased to function as a base hospital at midnight March
31, 1919, and preparations were begun for return to the United States.
The almost constant din of artillery and sky illumination at night
soon became commonplace, and the air-raid alarms, which were fre-
quent, did not cause much excitement. No damage was ever done to
any buildings in this hospital group. The windoAvs and transoms
A. E. F. BASE HOSPITALS. 1987
were made light proof with a special black opaque paper, which was
very effective. The electric current was usually interrupted during
air raids or air-raid alarms, and the work in the wards was carried on
by candlelight.
Equipment was meager and difficult to obtain. The original
equipment requisitioned in the United States arrived at this station
in December, 1918, and was not needed at that time.
Operating teams were made up of three medical officers, an oper-
ator, an assistant, and an anesthetist. The schedule was so arranged
that not more than 12 hours' continuous service was required of a
team, night and day service alternating. A large part of the operat-
ing work was performed at night.
From September 29, 1918, to April 1, 1919, 3,205 cases were ad-
mitted to the surgical service, and 343 operations performed. There
were 25 deaths among the patients in the surgical service ; 12 of these
25 had been operated upon at this hospital. .
Although designated as a surgical unit, there has always been a
fairly large proportion of medical cases in this hospital, a total of
2,368, including gas and contagious cases, having been admitted.
Respiratory diseases predominated, and of these most were influenza,
pneumonia, and bronchitis.
The influenza-pneumonia types were very severe and left a high
mortality. Clinically these patients showed an overwhelming toxe-
mia and on post-morten examination all organs showed the effects of
an infection of high virulence and corresponding toxicity. Many of
these cases showed intestinal involvment and at autopsy hemorrhagic
changes in the intestines were found. There was a fair percentage
of enteritis, acute and chronic, which seemed to be due largely to
dietetic faults. These cases responded readily to proper feeding,
with little or no medication. Many influenza cases with abdominal
(intestinal) symptoms resembled appendicitis in the severity of pains
in the right lower abdomen.
Water supply in the buildings was limited to the first floor.
Disposal of wastes was by contract with French civilians, the col-
lection of feces and garbage Avas irregular, necessitating the building
of incinerators and digging of latrine pits.
The water supply to this hospital has never been adequate ; there
have been periods of 36 hours in which water has not been available
from the supply pipes, and the facilities for storing water have been
very meager, but were improved by obtaining two small water carts
from a salvage dump.
Yl. BASE HOSPITAL NO. SO.
Base Hospital No. 80 came into active existence June 25, 1918, as a
United States Army base hospital. The embryo unit, with its 5
officers and 119 enlisted men was virtually absorbed in the base hos-
pital at Camp Wheeler, although preserving its own identity and
forming its own records.
Besides the 119 enlisted men previously received from Fort Ogle-
thorpe, an additional 60 were sent on July 9 and incorporated with
the unit, and on September 4, 43 more men were ordered from Fort
Oglethorpe to complete the quota of 200, allowing for certain men
who had been transferred to the development battalion.
142367— 19— VOL 2 64
1988 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The unit received orders on September 10, and at noon September
12 left Camp Wheeler, arriving at Camp Upton on the 14th. Here we
remained for five days, completing the equipment of the enlisted men
and making final preparations. Leaving Upton at 2 o'clock in the
morning of the 19th of September, we were aboard the Agamemnon
at Hoboken at 10 a. m. and sailed at dusk on the 20th of September,
landing at Brest. Our journey across the Atlantic was without in-
cident. We were accompanied by another transport, the Anwrica.
The soldiers were kept on deck as much as possible, every attempt
was made to isolate respiratory cases, and strict cleanliness was en-
forced throughout the ship. Although there were about 1,000 cases
of influenza with many complicating pneumonias, we suceeded in
reaching Brest without a death, although one man succumbed the
day after our arrival. Our work was not finished, however, when our
boat was in port.
On Sunday, October 6 we received our orders to proceed to Beaune
(Cote d'Or) and left the same night, arriving at our destination the
evening of the 9th. Upon our arrival in Beaune, we found that we
were to occupy a nearly completed part of a center ultimately de-
signed to handle 20,000 patients. Of the 10 units which it was
originally planned to station at this center we were the fourth to
arrive. Our first work was to get in condition to take care of con-
valescent or slightly wounded patients. As the mattresses had not as
yet arrived, it was necessary to fill ticks with straw, draw blankets,
clean and equip wards, start a mess, and do all the thousand and one
things which must precede the care of patients. Having no nurses at
first, the corps men were obliged to learn many unfamiliar duties,
but when on October 19 our first patients arrived, these boys made
up by their energ^^ and enthusiasm much that they lacked in experi-
ence, so that these milder cases were Avell taken care of, until we re-
ceived more serious convoys and our own nurses were assigned. Be-
side the work connected with the actual operating of a hospital, it
was necessary to make labor details from the men, for the purpose of
laying wal]?;s through the deep mud, transporting the supplies and
other work.
From the time at which the first patients were received until about
the 1st of January, 1919, the hospital worked at practically full ca-
pacity, the crisis expansion tents being used continuously. Our
work gradually diminished from this time. The last patients were
admitted on February 18, and on February 22, all patients remaining
were transferred to Base Hospital 77, preparatory to our departure
to the hospital center at Mars-Sur-Allier, Department Nievre.
On February 21, we left Beaune, arriving at Mars-Sur-Allier on
the following day. We were assigned to Unit No. 1, formerly oc-
cupied by Base Hospital 48 and Evacuation Hospital No. 37.
The variety of cases treated by the medical staff consisted of the
usual run of medical work, viz. Gas (by inhalation), influenza,
pneumonia, diarrhea, rheumatism, nephritis, neurosis, pulmonary
tuberculosis, measles, mumps, scarlet fever, diphtheria, and cerebro-
spinal meningitis. During the period from October 19, 1918, to
February 18, 1919, 2,479 cases were treated by the medical service.
The cubical and mask system of handling all respiratory cases as
well as contagious cases was installed as soon as we began receiving
A. E. F. BASE HOSPITALS. 1989
patients, and a great deal of credit must be given to this measure
for the good results obtained.
On March 27, 1919, in accordance with telegraphic orders, office
of the chief surgeon, American Expeditionary Forces, Base Hospital
No. 80 ceased to function as a base hospital. Upon this date, there
were in the organization, 10 commissioned officers, including the
commanding officer, 6 medical officers, 2 sanitary officers, and 1
quartermaster, and an enlisted personnel of 195 men.
Incidents and events of general interest. — Few great events inter-
fered with the serenity of our routine work. ' On Xovember 11. 1918,
our work was interrupted by extemporaneous processions of French
citizens, chiefly women and children, who carried the Tricolor of
France and our own Stars and Stripes through the streets of Base
Hospital Xo. 80. On this same date also, the prefecture of Cote d'Or
invited the commanding officers of the various units to his home,
where a celebration was held, at which telegrams were read from the
commanding generals of the various armies in the field. Base Hos-
pital Xo. 80 joined with the other units of the center to obsefve the
day in memory of Theodore Roosevelt.
Zl. BASE HOSPITAL, XO. SI,
The organization of United States Army Base Hospital Xo. 81
was authorized in letter from the Surgeon General of the Army,
Washington. D. C to the commandant medical officers' training
camp. Fort Riley, Kans., dated February 23, 1918. Pursuant to in-
structions from the War Department, dated June 1-1, 1918, Base
Hospital Xo. 81 was authorized to proceed to Camp Travis, Tex.,
for training at the base hospital at that camp.
Officers and enlisted personnel were assigned to duty at base hos-
pital Camp Travis, Tex., for training in various duties pertaining to
the Medical Department. The organization did not function as
separate imit until arrival overseas. Xo hospital equipment was
issued in the United States.
The organization left Camp Travis for port of embarkation
August 17 and arrived at Camp Merritt, X. J., August 20, 1918,
where it completed its overseas equipment and embarked on
the U. S. S. Leviathan August 28, and sailed from Xew York
August 31. Arrived in the port of Brest, France, September 7,
and disembarked September 8, and was assigned to Pontanazen
Barracks. Ordered to Le Mans, France, September 18, to receive
gas-drill instruction and were equipped with steel helmets and gas
masks. Left Le Mans for hospital center, Bazoilles-sur-Meuse
(Vosges), on September 22, 1918, and arrived at destination on Sep-
tember 25. Took over section 4 the same day and reported ready
to receive patients on September 30, receiving the first 283 patients
on October 5.
Medical and surgical equipment, instruments, dressings, sterilizing
plant, and drugs have all been ample. The small electric-light plant
has given excellent service. The heating plant for the operating
room was not sufficient in cold weather. This was remedied by put-
ting stoves in the operating room, carrying the chimney pipes out
through the windows.
Total patients admitted to hospital for period 1,899
Total medical conditions treated for period 1, 365
1990 REPORT OF THE SURGEON GENERAL OY THE ARMY.
Base Hospital Xo. 81 was closed March 31, 1919, and all patients
transferred. This hospital has handled in this center a total of
8,748 cases, 5,994 medical and 2,754 casuals.
Total patients admitted to hospital for period 764
Total medical conditions treated for period 437
A2. BASE HOSPITAL NO. 82.
Base Hospital No. 82, organized at Fort Riley, Kans., in com-
pliance with letter of instructions from the Surgeon General's Office
to the commanding officer medical officers' training camp, under date
of February 23. 1918.
July 17 : Left Fort Riley for Camp Crane, Allentown. Pa., ar-
riving July 19.
August 28 : Left Camp Crane for Hoboken.
August 31: Sailed for overseas service on troop- ship Leviathan
with 35 officers and 199 men.
September 8: Uneventful trip.
September 12: Xothing of importance except that the attack of
influenza which started on the boat has opened, and a very large
number of officers and men suffering from it.
September 19 : Arrived at Allerey after very uncomfortable though
interesting trip. Points touched : St. Brieic. Reunes, Laval. Le
Mans, Tours, Bourges, Xevers, Allerey. Took over hospital filled
with convalescent patients which was being operated at Base Hos-
pital Xo. 26-A.
September 25 : Left Allerey for Toul.
September 27: Arrived at Toul. Report to commanding officer
Justice group and assigned to American Red Cross Military Hospital
No. 114. located in Luxembourg Barracks, near Dommartin-les-Toul.
September 29 : Patients received.
The following figures give the number of patients admitted with
pneumonia and other respiratory infections :
October —
November.
December.
Acute
respira-
tory
infec- 1
tions.
1
Pneu-
monia.
483
464
278
128
6S
19
The high incidence of pneumonia during October illustrates the
severitv of the infections encountered at that time. The greater pro-
portion of the pneumonias were secondary to a previous respiratory
infection, such as influenza or bronchitis. Absolute figures on this
score are inaccurate, since the diagnosis of bronchitis on a field med-
ical card was in many instances only an evidence of a rush period at
a regimental infirmary — the first examination at the hospital showing
the presence of pneumonia.
During the three months covered by this report there was a
total of 212 pneumonias in the medical wards of the hospital. A
studv of this series presents several striking points. Pneumonias
A. E. F. BASE HOSPITALS. 1991
with classical signs were not the rule. Onsets with chill, pleural
pain, rapid breathing, and expiratory grunt were infrequently ob-
served. Kecovery was usually by lysis. Complications of the serous
membranes were rare. Broncho-pneumonias were frequent, combi-
nations of lobar and broncho-pneumonia more so. Of the broncho-
pneumonias, a group of early cases with coalescent broncho-pneu-
monia stand out as a pathological picture at variance with our pre-
vious conceptions of this disease. A common pathological observa-
tion was, " Consolidation not uniform ; has decidedly patchy ap-
pearance, caused by various elevations and degrees of color, ranging
froni red to gray, giving the impression of a coalescent lobular pneu-
monia." Mediastinal emphysema and subcutaneous emphysema of
the tissues of the neck and upper thorax, purulent bronchitides with
minute abscess formation, were encountered.
Histoinj of the surgical service, Base Hospital No. <?^.— The his-
tory of the surgical service of Base Hospital No. 82 begins with the
arrival of this organization at " L'Aisle Caserne de Luxembourg," at
Toul, on September 27, 1918.
The operating room and the wards had been well prepared, and
there was an abundance of dressings, splints, ether, and instruments.
We were able to begin work immediately without further requisi-
tions.
Twenty-two officers constituted the surgical staff at this time.
Fifteen of these officers were divided into five surgical teams con-
sisting of three officers each, and to each team there were assigned
two enlisted men. These teams were made available for detached
service with evacuation hospitals. Only two of them, however, were
called upon to leave the organization, and these went to Fleury sur
Aire for work with Evacuation Hospital No. 114, where they re-
mained until after the signing of the armistice.
On Sunday, September 29, 1918, at noon, the first patient was
admitted to the hospital, and patients continued to come in at the
rate of 200 a day until Friday at 4 p. m., when all wards were full
to overcrowding. A large part of the surgical cases were battle cas-
ualties, but many were minor conditions, such as hemorrhoids, flat
feet, sprains, etc. There was also a considerable number of hernias
and a few cases of acute appendicitis.
During the eight weeks that surgical cases were being admitted
to the hospital, 200 operations were performed, about equally divided
between primary and secondary. In addition to these there were
many fracture cases which required an anesthetic to permit of their
reduction.
B2. BASE HOSPITAL NO. 83.
The organization of Base Hospital No. 83 was begun at Fort
Riley, Kans., during the month of April, 1918. The pioneer mem-
bers consisted of a lieutenant, Quartermaster Corps, one medical
officer, and 50 enlisted men, who came to Camp Pike, Ark., early in
June. There our present commanding officer, 22 officers, and 150
enlisted men were added, completing the required personnel, except
for the officers who were to join the unit at the port of embarkation.
Entraining orders were received August 25, 1918, and the unit pro-
ceeded to Camp Upton, Yaphank, Long Island, arriving there at
1992 EEPOKT OF THE SURGEON GENERAL OF THE ARMY.
1 p. m. August 30, 1918. The following day the organization boarded
the White Star Liner Baltic for the journey overseas. The steamer
left Pier 59, North Eiver, 1 p. m. September 1, 1918, and arrived at
Liverpool, England, 10 a. m. September 13, 1918. The trip across
England was made by train that day, and the night was spent in a
rest (amp at Southampton. England. The following day an unsuc-
cessful attempt was made to cross the English Channel on a small
steamer, the Duchess of Argyle. On the night of September 15,
however, a sucessful passage was effected and Havre. P^rance,
reached earh^ the next morning. Three days were spent at Havre
in waiting for orders, and then the organization proceeded by rail
to Revign}", Meuse, where it united with Evacuation Hospital No. 15
on September 22, 1918.
On November 14, 1918, Base Hospital No. 83 assumed command
of the hospital at Eevigny.
The medical and surgical work was mostly that of an evacuation
hospital, in that a majority of tlie patients were evacuated as soon
as they were in condition to travel.
On March 8 the organization entrained for St. Nazaire for em-
barkation to the United States.
C2. BASE HOSPITAL NO. 84.
Base Hospital No. 84 was organized and mobilized at Camp Bowie,
Tex., during the summer of 1918. The enlisted personnel was drawn
from three groups of men, the first from Fort Eiler, Kans., the sec-
ond from Dallas, Tex., and the third from the base hospital. Camp
Bowie, Tex.
At 11 a. m. on August 25 the hospital, it having received its over-
seas orders, entrained for Camp Merritt. The train reached Hoboken
at 7.30 p. m. on August 29, and after a little delay was sent to Camp
Merritt, where it arrived at about 10 p. m.
Leaving Alpine Landing on a ferry boat crowded to the full with
various other troops, the organization was carried to the transport
Talthyhius, moored at the foot of West Fifty-seventh Street, New
York. Once aboard ship, nobody was allowed ashore. The ship
spent that afternoon and night at its mooring and on Sunday, Sep-
tember 1 pulled out into the North River, weighing anchor at 3 p. m.
for Liverpool.
Thirteen cases of measles and nine of mumps dcA'eloped on board,
and one man had his leg broken. The ship docked at Liverpool on
the morning of September 13, 1918. The various troop detachments
separated on the docks, and Base Hospital No. 84 made a short march
through the city to the railroad station and entrained for Southamp-
ton. The first section reached Southampton about midnight in a
downpour, which lasted almost without intermission throughout our
stay there. The men of the second train section arrived in camp
about 4 a. m. The following afternoon the hospital in a body was
marched to the Channel steamer and crossed to Havre. On Septem-
ber 16, 1918, at 4 p. m., we entrained again at Havre and began the
ride to Perigueux. We finally reached Perigueux, Dordogne, France,
at 3 p. m., September 18, 1918. Perigneux-Perigneuz, Department
Dordogne, France, is a city of approximately 40.000 inhabitants,
situated on the right bank of the Hie River. It is located about 70
A. E. F. ^BASE HOSPITALS. 1993
miles east of Bordeaux and 300 miles south of Paris (longitude, ap-
proximately, 1° east; latitude, approximately, 45° north).
Base Hospital No. 84 was located about 1 mile east of the city of
Perigueux, in the vicinity of St. George, a small village. The hos-
pital was type A (1,000 beds) and covered an approximate ground
area of 17 acres of rolling land on the south bank of the Hie River.
The water supply was derived from the municipal system of Peri-
gueux and is piped about 2 kilometers from the city to the hospital.
Sewage was disposed of through a system of concrete drains, con-
necting all buildings with an outfall sewer, which conducts the
liquid sewage through a septic tank, where any suspended matter is
precipitated by screening. The overflow is then partially purified
by chemical dosing and ejected into the Hie River.
On February 4, 1919, this hospital ceased to function as a hospital.
On October 18, 1918, the date of arrival of the first convoy of
patients, there were 7 wards of 50 beds each in use by the medical
service ; three were equipped with the " cubicle system," two of these
being used for acute respiratory cases (influenza) and the third for
pneumonia cases. Two wards received gassed and general medical
cases. One ward was set aside for contagious diseases. Later the
number of medical wards fluctuated as the proportion of medical
and surgical cases varied.
The influenza and pneumonia epidemic was of the usual severe
type, being at its height during the latter part of October and
Xovember. These cases were in the main from local camps, there
being from October 16, 1918, until January 1, 1919, about 282 cases
of influenza, and 79 cases of pneumonia (broncho-pneumonia, 54;
lobar pneumonia, 25).
Total number of diseases treated Oct. 18, 1918, to Feb. 5, 1919 891
Deaths .
LoDar pneumonia 5
Broncho-pneumonia (following influenza) 9
Total 14
Percentage of deaths in all medical cases 1. 5
Percentage of deaths in pneumonia cases 17. 7
D2. BASE HOSPITAL NO. S6.
Base Hospital No. 86 was stationed at Fort Riley, Ivans., June 10,
1918, to June 27, 1918. and the time was spent in bringing the records
up to date, establishing a retachment office, disciplining, training,
drilling, and clothing the men.
On June 27. 1918, the organization left Fort Riley, Kans., per
special order, Headquarters, Medical Officers' Training Camp, Fort
Riley, Kans., and proceeded to Camp Logan, Houston, Tex., arriving
there at 4 a. m., on June 28, 191 8. The organization was stationed at
Camp Logan from June 28, 1918,'to August 26, 1918, these two months
being spent in drilling, lecturing, and training the men to the greatest
extent in hospital work.
As the con mi and was to leave for overseas duty as soon as the en-
listed personnel was brought to its authorized strength, everything
possible was done to secure these men, and finall}- on August 22, 1918,
1994 REPORT OF THE SURGEON GENERAL OF THE ARMY.
after several telegraphic and written communications had passed back
and forth, 97 enlisted men, consisting of 96 privates and 1 corporal,
reported for duty from casual detachment. Fort Riley, Kans., bring-
ing the enlisted men to a strength of 192, several having been trans-
ferred from the command for various reasons which unfitted them
for overseas service.
August 26, 1918, the command entrained for Camp Upton, N. Y.,
per telegraphic instructions, Adjutant General's Office, dated August
23, 1918.
Left Camp Upton, N. Y., at 1.30 a. m., August 31, 1918. Embarked
on transport Baltic and left United States for American Expedi-
tionary Forces September 1, 1918, at 3 p. m.
Arrived at Liverpool, England, at 10 a. m., September 13, 1918, and'
departed for Southampton the same day, arriving at 7 p. m. Left
Southampton on steamer Nai^ragnnsett at 3 p. m., arriving at Havre
September 15, 1918. Left Havre September 17, 1918, arriving at
Mesves-Bulcy, France (Mesves hospital center), September 19, 1918,
at 1 p. m. The organization was assigned to Unit 10 at the hospital
center.
The first patients were received at the hospital on September 27,
1918. No nurses were assigned to tho unit except casual nurses, who
were attached for rations and quarters only and departed at different
times, leaving hospital with an average of 10 nurses during the month
of October, 1918.
October 20, 1918, buildings approximately 75 per cent complete,
water piped in, and lights installed, roads under construction, and
windows and doors being installed. Hospital filled with patients to
its full capacity.
During the period from September 27 to December 31, 1918, the
following admissions and evacuations took place:
Total admissions for September 303
Total admissions for October 2, 764
Total admissions for November 937
Total admissions for December 799
Grand total admissions 4,803
Total evacuations for September 8
Total evacuations for October 935
Total evacuations for November . 1, 222
Total evacuations for December 1, 551
Grant total evacuations 3, 716
Remaining hospital on December 31, 1918 1, 087
Making a daily admission of 48 and a daily evacuation of 37.
This hospital was selected to receive all patients suffering from
tuberculosis for the entire center. Tuberculosis patients in hospital
December 31, 1918, 38. Prevailing diseases for the period were in-
fluenza and pneumonia.
E2. BASE HOSPITAL NO. 87.
The organization of Base Hospital No. 87 was begun at Medical
Officers' Training Camp, Fort Eiley, Kans., in compliance to tele-
graphic instructions to commandant that camp about February 16,
1918, " to organize 10 base hospitals for overseas service."
A. E. F. BASE HOSPITALS. 1995
The officer in charge received notice by special order from head-
quarters, No. 145, Medical Officers' Training Camp, Fort Eiley,
Kans., to prepare his unit to move on June 26, 1918, for Camp Mac-
Arthur, Waco, Tex.
These preparations were made and the company left about 11 a. m.,
June 26, 1918,
This report is mainly rendered from memory, practically all com-
munication and records being destro^'ed in the fire when the Admin-
istration Building at this place burned July 24, 1918.
Orders were received for the unit to proceed to Camp Mills, X. Y.
Left Camp MacArthur, Tex., at 5 p. m., September 6, en route for
four days, arriving at Camp Mills, September 10.
Left Camp Mills at 5.45 a. m., arrived at Hoboken, N. J., at 12.30
p. m., and embarked at once on troopship 4^. Sailed on September 15,
at 1.30 p. m., for overseas with 36 officers and 200 men; all records
complete.
After sailing for 13 days, landed at Brest, France, on September
28, 1918. Many of the men were taken ill with influenza.
Debarked to rest camp, Pontanezen Barracks and remained for
seven days.
Organization left Brest on October 5, for Justice hospital group,
Toul, and arrived at 2 a. m. October 8, 1918. The following arrange-
ments were made : The Gas Hospital and Neurological Hospital No.
2 of this group be taken over complete, including personnel and prop-
erty, by Base Hospital No. 87, and continue under command of this or-
ganization. General Order No. 12, headquarters Justice hospital
group, October 8, 1918, was issued to that effect.
The bed capacity scheduled for gas section was 1,000 and of the
neurological section was TOO, making a total bed capacity of 1,700 for
Base Hospital No. 87 to begin with. Only about 1,100 beds were
available at first and these were filled on the 10th and 11th of Oc-
tober, 1918.
Four surgical teams were formed on the 11th of October for duty
as emergencies arise at the front.
The contemplated bed capacity for this hospital, including gas and
neurological sections, of 1,700, has, as yet, not been reached. Beds
are added and plans formulated each day to increase the bed capacity
up to 2,000 if possible. Cooking facilities are rather inadequate at
present.
Ninety-four gas cases were evacuated Sunday, November 17, for
Angers; 180 were evacuated to duty on November 18, 1918. Gas
cases represent about two-fifths of the total thus far, the remainder
being disease, mostly influenza, pneumonia, and others occasionally.
Influenza has filled the wards with more patients than any other
disease, and many cases of broncho-pneumonia follow.
The field and evacuation hospitals toward the front are evacuating
their remaining cases to us. Also on November 18 a bunch of British
prisoners returned by the Germans were taken in for recuperation.
December 30 finds this hospital admitting an average of 15. patients
per day. The gi-eatest trouble has been of late to evacuate the duty
cases. One hundred and ninety-four class D patients were evacuated
for return to the States on December 28. On hand, about 200 duty
cases; total on hand, 1,100.
1996 REPORT OF THE SURGEON GENERAL OF THE ARMY.
On April 1 Base Hospital 87 took over Base Hospital 82. Section
B was abandoned and the property checked up and turned in. Sec-
tion A was used for contagious work with four officers in charge.
Headquarters Avere moved to the administrative building of old Base
Hospital 82.
A]3ril 19 the group triage was abolished and Base Hospital 87 took
over the records and work formerly done by it.
April 21 preliminary orders to evacuate patients and cease to op-
erate as a hospital and prepare for return to the United States were
received. The officers and enlisted personnel of Base Hospital 55
were taken up for quarters and rations on this date, also.
On April 25 evacuations were made of States cases and cases ready
for duty within two months. On the hospital train for base port
were evacuated 20 enlisted men of B and C classifications who had
been attached to our detachment in our early days in the group. Gen-
eral preparations made for checking of property and completion of
records. Nurses of Base Hospitals 51 and 55 relieved from duty,
with orders to report for duty to their commanding officers.
In the first days of December the increase in the work compelled
a move to larger quarters in the same building. During this month
a survey of officers, nurses, and orderlies on duty in the wards was
made for streptococcus-hemolyticus carriers. Two hundred and six
were cultured. They showed a percentage of positives of 8.73. The
total number of reports rendered amounted to 1,292. Twenty-six
autopsies were done, 21 of them on cases of pneumonia.
An investigation of our records relative to the incidence of three-
day fever and influenza in our organization was made, revealing the
following facts and figures. An epidemic characterized by great
sudden prostration, general aching, pains, and fever for about three
days, broke out among the crew of the ship on which we sailed from
New York on September 15, 1918. It spread rapidly to the Army
men on board, attacking our organization September 23. Between
September 23 and September 30, embracmg the period in which we
landed at Brest, 7 of the 36 officers were attacked and 83 of the 200
enlisted men were sent to the hospital. The average number of days
sick of all these was three days. There was no mortality among the
officers. Eleven of the men had pneumonia following, five of whom
later died in other hospitals. Six of the officers and 11 men suffered
subsequent similar attacks at this station.
r2. BASE HOSPITAL NO. 88.
The preliminary mobilization of this unit took place at the med-
ical officers' training camp. Fort Riley, Kans.
One August 24, 1918, 150 enlisted men. Medical Department, were
transferred to the unit from Fort Riley, Kans., arriving at Camp
Dodge on August 25, 1918.
September 11, 1918, under telegraphic instructions. War Depart-
ment, dated September 7, 1918, and telegraphic request from the com-
manding general, port of embarkation, N. J., dated September 8,
1918. the unit, consisting of 30 officers and 196 men, left Camp Dodge
for Camp Upton, N. Y.
September 14, 1918, the unit reached Jersey City and were trans-
ferred by ferry to Long Island Railroad station, where they entrained
A. E. F. BASE HOSPITALS. 1997
for Camp Upton, arriving there about 3.30 p. m. and occupying bar-
racks assigned.
Epidemic influenza was present at Camp Upton at the time of the
unit's arrival tliere, several blocks of barracks being under quarantine,
and there was a progressive increase in the number of cases in the
camp during the succeeding four days. As a precaution against
infection the entire personnel of Base Hospital 88 was kept under
rigid restriction, and no cases of influenza cleveloped while at Camp
Upton.
September 18, 1918 : Orders were received for the entrainment of
the unit at Camp Upton terminal on special train V-3, leaving for
the port of embarkation on Thursday, September 19, 1918, at 3 a. m.
Arriving at pier No. 5, Hoboken, at 10 a. m., the unit went on board
transport No. <?, which proved to be the steamship America^ formerly
the Amerika^ of the Hamburg- American Steamship Co.
The voyage from Hoboken to Brest was marked by the outbreak
of a severe epidemic of influenza, there being at one time over 900
cases abroad ship. This organization assumed charge of the medical
work, and in addition looked after the running of the mess halls for
troops.
The number of cases of pneumonia which developed was large, and
up to the time of debarkation the number of deaths had been consid-
erable.
The Amenca made port September 29, 1918, but the organization
did not land until after the discharge of troops was completed, which
occurred October 1. It arrived at Pontenazen Barracks at 10.30 p. m.
on the above date, and was assigned to Plot 14, outside the walled
area.
The influenza epidemic at Pontenazen Barracks was at its height,
and this organization was immediately assigned to medical care of
the troop areas, and was also drawn upon for detacliments of officers
and soldiers to serve in the camp hospital at Pontenazen Barracks.
On October 7 the organization entrained at Brest for Langres,
Department of Haute-Marne, arriving at the above station at 1.30
a. m. October 11.
January 11, 1919, pursuant to orders, the organization turned over
patients and equipment to Base Hospital No. 53 and proceeded to
Savenay, Loire Inferieure, arriving there Thursday, Januarj'^ 16, 1919.
Base Hospital No. 88 was to occupy the buildings evacuated bv Base
Hospital No. 69.
G2. BASE HOSPITAL NO. 90.
The organization expected orders every day after the 1st of Sep-
tember, but various complications kept it at Fort Riley until the
epidemic of influenza made going impossible. Every available man
was needed there, even more than in Europe. After many orders to
move, onlv to have these same orders rescinded, we at last left camp
on Sunday, October 27, 1918.
At 9 p. m. on October 30 we disembarked from the train at Dumont
and marched to our quarters in Camp Merritt.
Several times our baggage was sent to the station, only to have it
returned. Each time our hearts sank a little lower, but finally, on
the morning of the 10th of November, we began our march to Alpine
1998 REPORT OF THE SURGEON" GENERAL, OF THE ARMY.
Landing, and at noon we were on board the finest ship in the trans-
port service, the Mauretania. The voyage was without incident, and
we landed at Liverpool one week later, November 17, 1918.
Leaving Liverpool that evening, we reached Winchester at 3 a. m.
on the following morning and spent the day in the rest camp at
Wynnal Downs. Early on the morning of the 19th we found our-
selves en route again, and it was only a few minutes' ride to South-
ampton, from which place we embarked for the trip across the channel. '
Havre, France, was reached at 11 p. m. Through the fog we
marched to Rest Camp No. 2, and here we stayed until ordered to
Commercy. Leaving Havre November 29, we made the journey in
48 hours.
H2. BASE HOSPITAL IsO. 91.
Base Hospital No. 91 was organized June 16, 1918, in recruit
section, hospital gi'oup. Camp Greenleaf, Ga., with 56 privates from
Camp Zachary Taylor, Ky. On this same day 28 of the men were
sent to General Hospital No. 14 Annex on detached service. A short
time before this organization was sent to Camp Gordon, Atlanta, Ga.
August 15, 1918, these men, in addition to a number of others, who
were sent to General Hospital No, 14 for training, were transferred to
General Hospital No. 14.
On or about the 1st of July the organization was moved from the
recruit section to the hospital group in Camp Greenleaf. While at
Camp Greenleaf the men were constantly drilled and given numerous
lectures and demonstrations on hospital routine.
As soon as it was learned that the organization was to go overseas,
arrangements were made to equip the officers and men according to
regulations. While making these preparations for overseas duty,
more enlisted men were assigned to the organization in order to have
the necessary strength of 202 men which was required before going
overseas.
Finallj^ orders were received and the organization, consisting of 26
officers and 201 enlisted men. left Camp Gordon on the evening of
October 31, 1918, for Camp Upton, N. Y., arriving there November
2, 1918.
Shortly after midnight, in the midst of a heavy storm, on Novem-
ber 9, 1918, the organization marched to the train which took them
to Long Island Depot at that place, A ferry was boarded, which
took them to pier 57, where the Mauretania was docked, and the men
and officers went aboard with hundreds of other troops. The Maure-
tania left the dock at 2.30 p. m.. November 10, 1918, just a short time
after the organization came on board. On November 11, 1918, a wire-
less was received that the armistice had been signed, and there was
considerable jollification on board the ship. We arrived oif the shores
of Liverpool on the evening of November 16, 1918, where the Maure-
tania anchored overnight, and on the morning of November 17, 1918,
finished the voyage to the docks at Liverpool, arriving there about
noon.
After disembarking the men were marched to the railway station
in Liverpool, where a train was boarded about 4.30 p. m., November
17, 1918, for Camp Wynnal Downs. Winchester, England. The train
arrived at Winchester, England, about 11 p. m., November 17, 1918,
and the men were marched to camp and assigned to quarters. On the
A. E, F. BASE HOSPITALS. 1999
afternoon of the 18th a number of men were marched through Win-
chester on a sight-seeing trip. On returning to the camp word was
received that the organization was to leave Winchester the next morn-
ing. Accordingly we left Camp Wynnal Downs the next morning in
time to catch the train leaving Winchester at 9.15 a. m., November 19,
for Southampton — about an hour's trip — where we got aboard the
U. S. S. Nopatten about 1 p. m., sailing for Havre, France, about
2.30 p. m., November 19, 1918, and arrived there at 11 p. m. that night.
About 7 o'clock the morning of November 20, 1918, disembarkation
took place, and the men were marched to Rest Camp No. 1, section B,
and were assigned to tents.
The organization remained at this camp until midnight, November
26, 1918, when all marched to the depot and left Havre early the
morning of November 27, 1918. for Commercy (Meuse) ; about 2.30
p. m., November 30, 1918, we arrived at Commercy (Meuse) and were
billeted in the Caserne " Oudinot," where Evacuation Hospital No. 13
was operating.
On December 6, 1918, Evacuation Hospital No. 13 was officially
taken over by Base Hospital No. 91, and in the meantime the men
had been set to work policing up the buildings which were to be
occupied by Base Hospital No. 91.
Patients continued coming in x^rj rapidly, and it was found neces-
sary to increase the bed capacity from time to time until January 24,
1918, the maximum was reached, when there were 1,458 patients in
the hospital. There was an evacuation each week of about 500
patients, but even then the patients came in much faster than
evacuated.
12. BASE HOSPITAL NO. 92.
On June 17, 1918, Base Hospital No. 92 was organized at Camp
Greenleaf, Ga., with lH: men.
On October 27, 1918, we entrained for Camp Merritt, N, J., and
late on the next afternoon of October 28, we arrived at this camp.
November 10, we marched 6 long miles to Alpine Landing. The steam-
ship Mauretania carried us overseas and we landed at Liverpool,
England, on November 17, 1918,
The next day we rode to Southampton and boarded the Omnipaton^
which took us across the calm Channel waters to the shores of France.
Havre was the name of the port, and we marched to Rest Camp
No. 1 on November 20, 1918. We, after three days' rest, took the
French troop train for Kerhuon, where we landed on November 25.
J2. BASE HOSPITAL NO. 'J 4.
Organized under authority of letter from overseas division, Sur-
geon General's office, through the commanding general, 34th Divi-
sion, Camp Cody, Deming, N. Mex., pursuant to paragraph 5,
Special Order 197, Headquarters 34th Division, Camp Cody, N. Mex.,
July 16, 1918, and paragraph 6, Special Order 204, Headquarters
34th Division, Camp Cody, N. Mex., July 23, 1918.
Departure of this unit was made on October 8, 1918, in compliance
with telegraphic instructions, headquarters, port of embarkation,
through the commanding officer. Camp Cody, N. Mex. On October
8, 1918, at 2.30 p. m. the detachment was entrained on a siding near
2000 REPORT OF THE SURGEO:sr GENERAL OF THE ARMY.
base hospital. Camp Cody, N. Mex., with eight cars, rationed and
fully equipped and started on the journey across the continent.
On October 10, the special arrived at the Union Station, Kansas
City, Mo. Left Kansas City about 11 a. m. Arrived in Santa Fe
yards about 2 miles from Fort Madison, Iowa, at 4 p. m. ; detrained,
hiked up to the station at Fort Madison, messed, and then entrained
for Chicago, 111. Left Chicago about 8.30 a. m. for Fort Wayne,
Ind., where we arrived about 1.30 p. m. Leaving Fort AVayne we
proceeded to Butfalo, N. Y., where we arrived about 8 p. m. on
the 11th. Here a delay of five or six hours was encountered, leav-
ing Bulfalo about 3 a. m. on the l-2th, over the Lackawana Railroad
for Elmira, X. Y., arriving there about 11 a. m. October 12. Ar-
rived at Scranton, Pa., about 5 p. m., leaving about 5.15 for Hobo-
ken, X. J., where we arrived about 11 p. m. October 12, 1918.
On the morning of the 13th the detachment was detrained and
boarded a ferryboat for Long Island City. We left Long Island
City on the Long Island Railroad for Camp LTpton, N. Y., where
we arrived about 3 p. m. On October 15, 1918, this unit was or-
dered to entrain for overseas by Confidential Order No. 450, part A,
Headquarters Camp Upton, X. Y., October 14, 1918, for port of
embarkation. Baggage was loaded on the train and the detach-
ment ready to move when a verbal communication was received from
port of embarkation, Hoboken, X. J., stating that movement of
Base Hospital Xo. 94 scheduled for October 16, had been canceled.
At 3 a. m. October 19, 1918, the detachment entrained via Long
Island Railroad for Long Island City. Arriving at Long Island
City about 6.30 a. m., we boarded a ferryboat and jfinally arrived
at our pier, where men were inspected and boarded the steamship
Wr/J?7ier Castle. We arrived at Liverpool. England, October 27,
with very good health condition, after a wet and rainy trip. Upon
landing in Liverpool, the detachment, in heavy marching order,
was sent to the Canadian cattle yards, and there entrained for
Southampton, England. The journey from Liverpool to Southamp-
ton was uneventful, except for the fact that the Red Cross at Liver-
pool and at Birmingham were in evidence with plenty of good hot
coffee and other things for the comfort and enjoyment of the de-
tachment. We arrived at Southampton, England, the following
day in a drizzling rain, about 7 a. m. On Xovember 2, 1918, we
receiA'ed orders to report at the Mono-Qvpen, a side-wheeler, for em-
barkation to France. We arrived at Havre after an uneventful
voyage across the Channel in a driving rainstorm. After several
days of rest at Havre, orders were received to entrain for Pruniers
(Loir-et-Cher) , where we arrived in a special train, after a series
of long delays, having taken 40 hours of train travel.
On Xovember 8, 1918, the detachment was assigned to the several
departments of the hospital which was unfinished and not ready for
occupancy. On Xovember 14, 1918, Hospital Train Xo. 64, contain-
ing 448 battle casualties, was received at this hospital about 1 a. m.
and unloaded.
On December 14, 1918, Hospital Train Xo. 70 arrived at this hos-
pital after a few moments' notice over the telephone from the rail-
road transportation officer at Gievres, which consisted of patients,
evacuated from Base Hospitals Xos. 53 and 88 at Langres (Haute-
Marne).
A. E. F. BASE HOSPITALS. 2001
On February 10, 1919, this unit was relieved by Camp Hospital No.
43, and to date, March 7, 1919, is still awaiting embarkation orders
for return to the United States.
K2. BASE HOSPITAL XO. 95.
Base Hospital No. 95 was organized at Camp Fremont, Calif.,
August 17, 1918, on the grounds of United States Army base hospital.
At noon November 4, 1918, the detachment left Camp Fremont
for the East in a special train made up of five sleeping cars, one
baggage, and a cook car. Had a very pleasant trip across the con-
tinent, traveling over five railroad systems. Made stops of one-half
hour morning and afternoon of each day, and double-timed the de-
tachment through the streets of the towns in which we had stopped.
Think a record was established in that the unit did not have one sick
man on the trip across the continent. Arrived at Camp Upton, Long
Island, N. Y., on Sunday. November 10, at 3 p. m.
Left Camp LTpton about 5 a. m. November 15, 1918, and boarded
the Steamship La France (one of France's largest passenger boats)
at a little before noon. Pulled out of New York Harbor at 4.45
p. m. Besides Base Hospital No. 95 we had on board Base Hospital
No. 136, and an ambulance company consisting of 180 men. Ship
also carried as passengers about 60 casual medical officers. 36 chap-
lains, and over 297 female nurses. Arrived at Brest, France, at
10.30 a. m. November 22. 1918. Disembarked durinff the afternoon,
and marched 4 miles to the rest camp at Pontanezen Barracks. Base
No. 95 was assigned to Plot No. 87, later being sent to Plot No. 85,
where there were floors for the tents.
Taking three days' travel rations with us we left Brest December
1 in two detachments for our present station. First detachment left
Brest at 6 a. ni. and arrived at Perigueux 6 a. m. December 3. Second
detachment left at 11 a. m. and arrived at Perigueux 11 a. m. Decem-
ber 3. We were met at the station by trucks and taken to our present
station at Camp St. George.
Base Hospital No. 95 was to form part of a base hospital group
together with Base Hospital No. 84, which had at the time of our
arrival been on the ground about five weeks.
At about 9.30 p. m. December 15 we received our first trainload
of patients fi'om Dijon. Base Hospital No. 95 taking only ambu-
latory cases, as we had no trained nurses and our operating room
had not been set up at this time on account of lack of equipment.
AVe received at this time 228 patients, of those 62 were medical and
166 surgical.
L2 BASE HOSPITAL NO. 96.
The nucleus for United States Army Base Hospital No. 96 was
assembled at Camp Kearny, Calif., during the later part of Septem-
ber and the early part of October, 1918. The unit, consisting of
23 officers and 199 enlisted men, left Camp Kearny, Calif., October
15, 1918.
Influenza broke out among the men almost immediately, and two
of them were left in a hospital at La Junta, Colo., October 17, 1918.
The unit arrived at Camp Upton, Long Island, N. Y., October 20,
1918, where it remained until October 27, 1918.
2002 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Influenza was rife in the unit at this time, and when the unit left
Camp Upton on October 27, 1918, its personnel consisted of 23 officers
and 134 enlisted men.
United States Army Base Hospital No. 96 left New York City
on the British ship O^xa October 27, 1918, and reached Liverpool,
England, November 8, 1918. There were several cases of influenza
on the way over, and one fatality.
One enlisted man was left in a hospital at Liverpool, England.
The unit, 22 officers and 133 enlisted men, left Liverpool by train for
Southampton, arriving there November 9, 1918. On November 10
the unit sailed for Havre, France, and disembarked on the morning
of November 11, 1918, and went to English Rest Camp No. 2, where
it remained until November 28, 1918.
On November 28, 1918, the unit left Havre, France, and arrived at
Beaune, Cote d'Or, France (A. P. O. 909), November 30, 1918.
Base Hospital No. 96 never operated as a base hospital, but it did
receive and care for class A casuals sent to it from the other hos-
pitals in this hospital center. The first of these class A casuals —
532 in number — were received December 5, 1918, and on December
6, 1918, 512 more w^ere received. A few more were sent to this hos-
pital at later dates, bringing the total of class A casuals received up
to 1,091.
At the date of writing, February 26, 1919, the unit has wound up
its affairs at Army Post Office 909 and is awaiting sailing orders
for the United States.
M2. BASE HOSPITAL NO. 98.
Base Hospital No. 98, United States Army at large, relieved Base
Hospital No. 28, Limoges (Haute Vienne), Army Post Office No. 753,
February 1, 1919, per paragraph 43, Special Orders, No. 17, Head-
quarters, Base Section No. 2, Service of Supplies, American Expedi-
tionary Forces, dated January 17, 1919. On February 1 there were
remaining in hospital 273 patients.
Base Hospital No. 98 was organized at Camp Greenleaf, Ga., and
left there August 6, 1918, with a complement of 200 men and 2 medi-
cal officers for Camp Hancock, Ga.
At 5.30 p. m. October 3, 1918, Base Hospital No. 98 left Camp Han-
cock, Ga., for Camp Merritt, N. J., for embarkation for overseas duty.
Tlie trip was uneventful. Upon arriving at Camp Merritt the or-
ganization was immediately put on temporary duty at the base hos-
pital at that camp to assist in caring for the soldiers at the base hos-
pital during the influenza epidemic. The organization continued on
that duty during the month of October.
On November 8, 1918, Base Hospital No. 98 had the final overseas
inspection. On November 10 it left Camp Merritt for New York on
foot via Alpine Landing and from there via ferryboat to Pier 61,
New York, where the organization boarded the steamship Empress
of Russia. The vessel sailed at 4 p. m. November 12, 1918, for France,
and arrived at Brest, France, at 11.30 a. m. November 22, 1918. From
the boat the organization marched to Camp Pontanzen to await the
receipt of orders for assignment to duty in France. November 29,
1918, the organization left Camp Pontanzen, Brest, for Paris, and
arrived in Paris at 12 noon November 30, 1918. . The organization
A. E. F. BASE HOSPITALS. 2003
was immediately put on duty at the convalescent camp, Tremblay,
Nogent-sur-Marne.
On December 20, 1918, it left Nogent-sur-Marne for Lourdes
(Haute Pyrenees), arriving there at 11 a. m. December 22, 1918.
About January 1, 1919, orders were received that hospitalization
at Lourdes would be abandoned.
Base Hospital No. 98 left Lourdes (Haute Pyrenees) for Limoges
(Haute Vienne) January 22, 1919, arriving at Limoges January 23,
1919, for the purpose of relieving Base Hospital No. 28.
From January 23 to January 31, 1919, Base Hospital No. 98 was
merely attached to Base Hospital No. 28.
N2. BASE HOSPITAL XO. 100.
Base Hospital No. 100 entrained at Camp Custer at 2 p. m., Octo-
ber 30, 1918, for Camp Upton, N. Y., arriving there at 3 a. m., No-
vember 1, 1918. At Camp Upton the unit was fully prepared and
equipped for overseas service.
The command entrained at Camp Upton for port of embarkation
at 2 a. m., November 10, 1918, with commissioned personnel of 32
officers and 200 enlisted men. Command embarked at noon. Novem-
ber 10, 1918. on steamship Mauretania. sailing at 2 p. m. same day.
Arrived at Liverpool the morning of November 17, 1918, after a very
pleasant and uneventful voyage. Debarked at noon and entrained
for Wmchester, England, at 5 p. m. same day, arriving at Camp
Wmnall Down at 2 a. m.. November 18. 1918. Entrained at Win-
chester for Southampton at 10.30 a. m.. November 19. 1918. and imme-
diately embarking upon arriving at latter place for Havre. France.
Debarked at 9 a. m.. Novemberl^O. 1918. and unit marched to Rest
Camp No. 1. Left Camp No. 1 at 8 a. m.. November 21. 1918. march-
ing to station at Havre; entrained at 12 noon for Savenay, France.
En route the entire personnel was allowed liberty at Le Mans on No-
vember 22. 1918. from 1 to 7 p. m. Arrived at" Savenav at 9 a. m.,
November 23, 1918, and was immediately assigned to Unit No. 3. hos-
pital center, which had but recently been opened and was being oper-
ated under the jurisdiction of Base Hospital No. 8.
On November 23, 1918, there were 1.105 patients quartered in the
wards; 90 per cent of these were battle casualties. All were ambu-
latory cases. Nine hundred of these cases required dressings, some
daily, but the majority were dressed as required bv the conditions of
the wound. The average daily dressings were 175 from November 23
to December 31, 1918.' The majority of the wounds were large, deep,
debridement wounds, granulating. About 5 per cent of the cases
were amputation of an arm or leg. There were 18 cases requiring
strappings by the orthopedist, 191 cases requiring casts, massage was
given to 315 patients, with a total of 905 treatments. The total num-
ber of patients treated was 583. The medical cases treated from
November 23, 1918, to December 31, 1918, were 174.
The records of this unit were taken over from Base Hospital No. 8
on December 10, 1918. At that t.ime there were 968 patients in the
hospital. From that time until the end of the year there were 402
patients admitted and 880 evacuated.
142367— 19— VOL 2 65
2004 REPORT OF THE SURGEON GENERAL OF THE ARMY.
02. BASE HOSPITAL NO. 101.
Early in the year 1917 the 1st Division was assembled in the United
States ready for duty overseas, or wherever the United States needed
Regular Army men. In June, 1917, the}^ embarked for France, land-
ing in St. Nazaire, and from its personnel of men and officers came the
first patients to Base Hospital No. 101. Troops arriving later came
in smaller bodies.
On the 5th of June, 1917, some 37 nurses — members of the Nurse
Reserve Corps — assembled in New York City. They came from
many States in the Union. They were soon attached to Base Hospi-
tal Unit 18, composed in the main of Johns Hopkins men.
Embarking at New York on the Finland they landed in France
on June 28 and went immediately to Savenay. After a few days
at Savenay, they were ordered to St. Nazaire to join forces with the
medical officers and medical department soldiers who had reached
St. Nazaire at about the same time. The latter, numbering about 14
soldiers, were ordered to make up the personnel of the hospital. Not
having any official designation, the officers and men voted to call the
hospital " No. 1," later the name being officially changed to United
States Army Hospital No. 1.
Evacuation department. — In round numbers Base Hospital No. 101
has cared for about 20,000 patients. Statistics compiled from June
27 until the present time show that over 10,000 medical cases have
been cared for and over 8,000 surgical cases. The latter include those
orthopedic cases, battle casualties, and minor cases evacuated from
the advance hospital, and include .the operative cases receiving atten-
tion in our surgery.
Surgical. — On June 30, 1917, a case of cerebrospinal meningitis
was discovered among the enlisted personnel of the Twenty-sixth
Inf antiy. Camp No. 1. This case Avas immediately transferred to this
hospital, then in the hands of the French, and was succeeded by 14
other cases. These cases were in the hospital upon the occupancy of
the Americans, which marks the first epidemic of cerebrospinal menin-
gitis in France.
The arrival of the Bladewasha inaugurated the second outbreak of
cerebrospinal meningitis. Many cases, along with diphtheria and
pneumonia, were abroad.
Lobar pneumonia became noticeable in the late fall, and complicat-
ing empyema increased in frequency, gradually decreasing as April
came. Serum treatment for pneumonia was encouraging. A rib
resection was done as a rule on all cases, excepting a few cases for-
bidding operation. Several of these were tided over by repeated
aspirations and later operated upon. The mortality was — per cent
and those cases operated upon later — per cent.
In September pneumonia appeared — lobar, broncho, and strepto-
coccis. The appearance of pneumonia — increase, rather — so early
was alarming.
In October there was bad weather, and necessary crowding caused
decided increase in both pneumonia and influenza. As a result, the
hospital contained 1,109 j^atients, of whom the majority were medical
cases. Pneumonia cases were 110, about equally divided between
broncho and lobar types. Deaths averaged about 25 per cen*-
/
/
A. E. F. BASE HOSPITALS. 2005
On October 4, pursuant to instructions from base surgeon, Base
Section Xo. 1, we evacuated about 900 cases (to duty and to Save-
nay) to make room for a convoy of troops which had an epidemic of
pneumonia.
The transports Princess JIatoilta, the Mongolia, and the President
Grant, and two other smaller craft, reached St. Xazaire laden with a
great number of men ill with influenza, complicated with pneumonia.
The boats reached port on October 6, 1918. Many of them had died
at sea, and the personnel, officers, enlisted men, and nurses Avere
exhausted from overwork and nightly vigil.
Convoys. — The convoy arrived October 6, and the same evening we
received 108 j^atients, mostly influenza and pneumonia. The follow-
ing day, October 7. we received 850 more of the same type of cases,
including many cases of severe pneumonia. The number of deaths
was quite appalling, and occurred directly after admission to the
hospital.
In the week ending October 22, 1918, 15 nurses arrived from Base
Hospital Xo. G9 for temporary duty and were very Avelcome.
The 1st of Xovember found the epidemic of influenza and pneu-
monia api:)arently passed its zenith and fewer cases coming in. The
usual number of empyemas were resulting.
Medical. — The fir-t train of wounded battle casualties arrived on
June 11 from the Chateau-Thierry setor, and consisted of about 60
mildly gassed cases, 77 wounded stretcher cases, and the remainder
of the 250 walking cases. Some very slight wounds, some practically
healed, and a few cases of mild disease were included, probably evac-
uated intentionally in order to make room in the advanced hospitals
for the more seriously wounded.
On July 7 a train of mixed wounded, gassed, and medical cases was
received from the Paris district.
On July 22 a train of 290, nearly all wounded, Avas received from
the Paris district. The capacity of the hospital Ava-^ taxed, and it
became necessary to increase capacity from 1,000 to 1,500 — done by
crowding and using all available sj^ace.
On August 21 a train of 412, wounded, from Chateau-Thierry, was
received, most of whom were not A-ery serious. It included about 10
mild gas cases and an appreciable number of minor cases. By using
seven Quartermaster Corps ambulances, three Ford ambulances, and
a number of 3-ton trucks (patients in double tier), all were trans-
ported a distance of a mile and in the hospital within two and one-
half hours.
P2. BASE HOSPITAL NO. 104.
United States Army Base Hospital No. 104 was organized July 12,
1918, at Camp Greenleaf, Ga.; transferred from Motor Company
Xo. 4, section B, Camp Greenleaf.
On August 12, 1918, the unit Avas transferred to Camp Dodge,
loAva, Avhere it remained mobilizing until October 31, on which date
the organization left for Camp Upton, N. Y. From Xovember 2
to 10 the command Avas stationed at Camp Upton making final
preparations for OA^erseas service. Leaving Camp Upton on the
morning of Xovember 10. the organization proceeded directly to its
2006 REPORT OF THE SURGEON GENERAL OF THE ARMY.
transport, the Mauretnnia. which sailed from Xew York Harbor that
afternoon.
This unit arrived at Beau Desert hospital center, Base Section
Xo. 2. Ami}' Post Office 705, on Xoveniber 24, 1918, and was tem-
porarily billeted with Base Hospital Xo. 106. Between December
4 and iS the personnel was on temporary duty with Base Hospital
Xo. 22. December 18 the organization began to function a=: a sepa-
rate hospital and took charge of l^nit Xo. 5. stai'ting witli 77 officers
and 1 enlisted man as patients.
During the period of its operation Base Hospital Xo. 104 has re-
ceived practically all officer patients admitted to the center, and has
iunctioned as a receiving hospital. The class of patients handled
have been convalescents, noncontagious, and nonvenoreal; also a
number of orthopedics. During the period between December 18
and 31 there were 2,137 patients admitted and 930 evacuated, with no
deaths occurring.
Operations. — During the month of ^March 1.301 patients vrere ad-
mitted to the hospital and 1.429 discharged. 43 patients going to
duty. Two deaths occurred during the month. On March 31 there
T\-ere 709 patients in the hospital.
Q2. BASE HOSPITAL ^"0. 105.
Base Hospital Xo. 105 was organized Jul.y 22, 1918, at Camp Green-
leaf, Chickamauga Park, Ga., consisting of 2 officers and 100 enlisted
men. August 29, 1918. we were ordered to Fort Benjamin Harrison.
Ind., to complete the unit and prepare for overseas service.
After completing the overseas examinations, gas drills, and other
necessary training, the unit departed from Fort Benjamin Harrison,
Ind., by special train at 4 p. m. October 23, 1918, for Camp Merritt,
X. J., under Confidential Special Order Xo. 109, paragraph 1. Head-
quarters Central Department, Chicago, 111., dated October 20, 1918.
On the morning of the 25th of Octoljer, 1918. we arrived at Camp
Merritt, X. J. After resting here for two days and completing our
equipment, we left at 1 a. m. Sunday, October 27, 1918, and marched
<5 miles over the Palisades to the Alpine Landing on the Hudson River.
Here we boarded a ferry and were *r:)nsported to the docks at Ho-
boken, X. J.
At about 9 a. m. October 27, 19J^, we boarded the U. S. S. ^Vll-
helmina. The following morning the unit was divided and trans-
ported to the American Expeditionai v Forces on four transports,
namely, U. S. S. President Grant, U. S. S. Mongolia, U. S. S. Wil-
helmina, and the British transport Kvrsl\ All four groups left the
United States under the same convoj'^ with seven other transports.
The voyage across the Atlantic Ocean was made without any re-
markable incident.
We landed at Brest. France, on the afternoon of Xovember 9, 1918.
A part of the officers went to Fort Bouguen. The remainder of the
officers and enlisted men went to Pontanezan Barracks. Two days
latei- the officers from Fort Bouguen joined the unit at Pontanezan
Barracks. While at lioth places the officers and men slept in tents.
On Xovember 12, 1918, under Special Order Xo. 311, paragraph 24,
Headciuarters Base Section Xo. 5, Service of Supply, dated Xovember
11, 1918, we left Pontanezan Barracks and came to hospital center,
A. E. F. BASE HOSPITALS. 20"07
Kerluion, where Ave immediately took charge of section No. 2 of the
hospital, this section consisting of 1.'240 beds. The work Me did here
was under Base Hospital Xo, 65. The nature of the work in this
liospital since we came here has been the work of an evacuation
hospital.
In accordance with the plan to return Base Hospital Xo. 105 to the
United States as a skeletonized unit, Special Order Xo. 30, paragraph
11, Headquarters hospital center, Kerhuon. Base Section Xo. 5, dated
February 11, 1919, transferred all officers and enlisted men left to
Base Hospital Xo. 65,
R2. BASE HOSPITAL NO. lOG.
This organization was formed at Camp Jackson, Columbia, S. C-
Left Camp Jackson October 15, 1918, with 23 officers and 200 men
present for duty. P>leven additional officers were attached by War
Department orders to join at point of embarkation. Camp Merritt,
Embarked from Hoboken, X. J., on the Leviathan October 27,
1918. Ten of the 11 officers ordered to join at point of embarkation
joined at Camp Merritt, X. J., and on board ship, so that on landing
at Liverpool. Xovember 3, the organization numbered 31 officers
and 188 men.
From Liverpool, via Southampton and Havre, the organization
proceeded by order to Beau Desert hospital center, arriving at that
place on Sunda}-. Xovember 10. 1918, with 31 officers and 188 men.
The hospital area locally designated as Unit Xo. K was assigned
to this organization.
The original base-hospital equipment requisitioned and approved
before leaving the States has never been received, but by degrees,
through camp medical supply officer and obtaining salvaged equip-
mena of various kinds from St. Sulpice, something approximating^
an authorized base-hospital equipment was gotten together.
The first patients were received in 33 days after arrival, on De-
cember 13. These first patients, comprising 91 German prisoners
of war and 11 United States soldiers, were transferred from Base
Hospitals Xo. 114 and Xo. 22. The first operation was perforzned
in the operating pavilion December 13, the instruments and dress-
ings being sterilized on oil stoves. The hospital was designated ort
December 13 to receive all venereal, contagious, and infectious dis-
eases, tuberculosis, and surgical chest cases for the Beau Desert
hospital center.
Sewer connections complete: water connections about 90 per cent
complete, except there were no hot-water appliances of any kind.
Disinfection building and patients" bath Ijuilding had no internal
equipment of any kind ; also, the boiler for use of the sterilizing-
plant in operating pavilion was not installed. Four ranges only
were available (without hot-water appliances) for food preparations
of the entire officer and enlisted personnel.
From the day of taking first patients. December 4, the work
rapidly increased, the morning report of Deccnibi-r 28 showing-
960 patients in hospital.
On December 13, 1918, an order was issued by the commanding-
officer of the center designating Base Hospital Xo. 106 as a receiv-
^008 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
iiiij hospital for all venereal, contagious, and infections diseases,
tuberculosis, and chest cases for this center.
December 2: Memorandum Headquarters Beau Desert hospital
-center transferred all enemy prisoners of war in hospitals to Base
Hospital Xo. 106. These were received December 4, and from
that date this hospital has taken all cases fallino- under this classi-
fication. One hundred and ninety-seven cases have been received
and treated.
December 7: Memorandum Headquarters, Beau Desert hospital
center, designated this hospital for the reception and handling of
surgical chest cases, arranging for transfer of these cases from other
hospitals. Wards were especially equipped for this class of cases,
and the patients were received and cared for from this time on.
Total number of chest cases (surgical), 242; deaths, 2,
December 2, 1918 : Memorandum Headquarters. Beau Desert hos-
pital center, designated Base Hospital 106 to hold sick call for all
organizations at Beau Desert, except base hospitals, including troops
under command of constructing engineers. This work has been done
by us from December 3 to the present time, serving an average of 18
organizations, mean strength 2.300 men. This work practically
amounted to holding an out-patient treatment clinic in which an
average of 65 cases per day were treated, exclusive of the sick call
and daily irrigation of 125 trachoma cases among the coolie laborers.
One officer and three enlisted men were assigned to this work. The
total number of all cases handled bv this hospital from December 4
to May 20, 1919. was 4,297.
From the outset mumps has played a prominent part among the
contagious diseases, and the total number of patients from this
disease was gi-eater for the period covered by this report than from
any other on the infectious service. The complications were few,
entirely orchitis, with the exception of one man who developed
meningitis, and was entirely relieved by one lumbar puncture.
Di])htheria also was continuous during these six months, though it
was lessening greatly at the end of the period. A great many carriers
were found among the contacts, but many of them were not of the
chronic type and cleared up prompth\ A number of clinical cases
tended to become clironic carriers, but in no instance were we obliged
to admit defeat in our attempt to clear up their throats, though a
few had to remain in isolation for a month to six weeks. No deaths
resulted and no patient had laryngeal diphtheria.
As a sequel to the influenza epidemic of last fall, we had a goodly
number of acute infections resembling influenza which were so diag-
nosed, lacking any other term. Only a few were typical severe in-
fluenza, the majority being much milder, and the number of broncho-
pneumonias developed was comparatively small. However, when
the latter complication did occur it was often a virulent type and
the mortality rate was high. Of the 376 cases of influenza, 16, or
about 4.5 per cent, developed broncho-pneumonia, and of these 6
died, a mortality of 37.5 per cent. The i)ost-mortem findings were
those seem so comm.only in the fall of 1918 in the influenza epidemic.
As the isolation hospital of the center, we have had the carriers
of the enteric infections to care for until they could be sent in isola-
tion to the States. Routine stools cultures among the food handlers
of the center yielded three possible carriers, but the results could
A. E. F. BASE HOSPITALS. 2009
never be confirmed, and after a number of negative examinations
they were released to duty other than that connected with food.
A malignant pustule in our one case of anthrax was on the cheek,
but we were not able to show that it came from his shaving equip-
ment, for all cultures from it were sterile. He recovered quic-Ivly.
During the 6 months 865 patients went through this department,
of whom 234 were classified as having active pulmonary tuberculosis,
and 41 had pleurisy with effusion. The remaining 631 were con-
sidered not active at present. In four cases a pneumothorax was
demonstrated. Many of these patients showed far advanced tuber-
culosis on admission, and as a result there were a number of deaths,
35 in all.
Measures employed to cornbat impending influenza epidemic. — At
one time during February with an influenza epidemic threatening —
increasing number of influenza cases being daily received for treat-
ment from surrounding organizations — the following procedure was
carried out : All members of medical detachment were temperatured
every night : any found with the temperature of 99.5 or over were at
once sent into the observation ward even though they were not com-
plaining of illness. Many were returned to duty in 24 or 48 hours ;
a few developed influenza which ran a mild course; no complicating
pneumonias, no deaths.
At this same time three ward tents were put up to be used as bar-
racks, thus reducing the number of the old barracks — shelter halves
used as cubicles; all mess kits boiled. The use of the tents enabled
the abolition of a double tier of bunks in all barracks and allowed
approximately 600 cubic feet of space per man. We have continued
the use of these tents in addition to barrack buildings up to the pres-
ent time.
At the beginning of this epidemic the throats of the entire hos-
pital personnel, officers, nurses, and corps men, were cultured for
streptococcus hemolyticus. All found harboring the streptococcus
(10 in number from all 3 classes of personnel), were at once isolated,
none of these complaining of illness, and remained isolated until
throats showed negative cultures. (Xone had to be isolated for this
cause longer than nine daj's. None required a second isolation.)
Whether or not because of these measures, it is a matter of record
that the incidence of influenza in this hospital was very light, the
cases mild, and the hospitalization period for those sick with it
comparatively short. This in the face of the fact that we were re-
ceiving and caring for many cases of influenza from surrounding
organizations.
S2. BASE HOSPITAL NO. 10 7.
On October 16 overseas clothing was issued, and on October 24,
at 2 p. m., orders to move the unit to Camp Upton were received.
Thirty-five men were left ill or otherwise unfit for overseas service.
General Hospital Xo. 29 supplied 37 men to complete the enlisted
quota, and the unit was ready to depart from Fort Snclling. Twenty-
eight hours later the unit was on board the train for Camp Upton.
The trip to Jcrsev Citv was broken by a six-hour stop at Buffalo,
N. y., Sunday, October 27.
2010 REPORT OF THE SURGEON GENERAL OF THE ARMY,
The train arrived at 7 a. m. at Jersey City, October 28. The trip
continued by ferry to Lono^ Island City, and by Long Island Rail-
road to Camp Upton, arriving there at 2 p. m. the same day.
The unit was moved to Hoboken, leaving Camp Upton at 4 a. m.^
October 30.
The unit was assigned to the U. S. S. Great Northern^ and after
a 24-hour rest on board the latter, accompanied by the U. S. S.
George Washington^ left the port of Hoboken, October 31, 1918.
On the mornmg of the 10th of November, 1918, the vmit was put
ashore at Brest, and later in the day marched out to Pontenazen
rest camp, where the officers and men were assigned to section No. 87,
and were given shelter and blankets.
November 14, 1918, the unit left Brest under the command of
J. M. W. Scott, major. Medical Corps, and entrained for Mars-sur-
Allier hospital center. The journey of 440 miles was made by way of
Le Mans, Tours, San Caise. to Mars-sur-Allier. It was a rather
tedious journey, traveling in a windowless, heatless. and lightless
troop train for three" days, and the men were very much relieved when
they found that they had at last reached their destination. The train
made many long stopovers on the way, the longest being at Vierzon,
which was seven hours.
On arrival at the hospital center the unit was given breakfast and
opportunity to bathe and rest. The next day, November 18. the
annex of Base Hospital No. 35 was taken over by Base Hospital No.
107, with its 1,139 patients and convalescents. Officers and men were
assigned to their respective places, and within 24 hours the hospital
was functioning as such. The unit came to the hospital center at a
very inopportune time. The signing of the armistice put a stop to
all building construction.
April 15 : The same day orders were received from Headquarters
Mars hospital center, that the unit would cease functioning as a
unit the 20th of April, 1919. and due preparations were made for the
same.
T2. IJASE HOSPITAL XO. 10 8.
August 15, 1918: Base Hospital No. 108 was formed at Camp
Greenleaf. Ga.. from casual source.
September 12: Base Hospital No. 108 left Camp Greenleaf under
orders to proceed to Fort Snelling, Minn., for mobilization.
September 14: Arrived at Fort Snelling, Minn., and found await-
ing their arrival for mobilization seven officers.
October 6 : One hundred enlisted men assigned to us from Camp
Dodge. Iowa, arrived and were quartered in B. 6 south, apart from
those alread}' there because of exposure to the " flu " at Camp Dodge.
On October 24 orders were received to proceed to Camp Upton,
N. Y., to complete outfit and embark for overseas dut}'. In com-
pliance with this order, we entrained in five coaches — one parlor car
and one cook car — and left Fort Snelling at 6.15 p. m., October 25.
October 28 : Arrived at Camp Upton about 3 p. m. and spent the
remainder of this and the following day in outfitting for overseas
service.
October 30: We entrained for Hoboken, N. J., at 4.45 a. m., and
by noon were embarked upon the U. S. transport George Washing-
ton, which left the pier at about 3 p. m., October 31.
A. E. F. BASE HOSPITALS. 2011
November 9 : Arrived safely at Brest at about 10 a. m. Debarked
about one-half the enlisted men at 3 p. m., and arrived at our allotted
plat, Xo. 283, in the rest camp at 9 p. m.
November 17 : We left Brest under orders to proceed to our per-
manent location, Mesves-sur-Loire, or Mesves-Bulcy, where was lo-
cated the Mesves Hospital Center.
Leaving our camp at Brest in formation, we entrained at the sta-
tion, which Ave left at 10.15 a. m.
Traveling by way of St. Brieux, Rennes, and Le Mans, we arrived
at Mesves-Bulcy on November 21, at about 9 a. m., and at once
marched to Unit No. 16, our prospective station.
On November 29 we received our first quota of 500 patients by
transfer from other units operating in the center and commenced
active work.
The rapidity with which our patients were evacuated soon dimin-
ished the call upon our resources, and with the exception of a brief
interval of operation from April 22 to May 1, when we were trans-
ferred to Evacuation Hospital No. 24, our activities ceased on March
14, 1919.
With the temporary organization immediately eflPected at Fort
Snelling, the process of bringing the command into effective shape
progressed rapidly. Unfortunately, this work was no more than
fairly started than it was interfered with to a serious degree by the
establishment of a camp quarantine on account of the appearance at
the post and in neighboring camps of the epidemic influenza. Be-
cause of this, arrangements which had been made to give our enlisted
personnel training in city hospitals of St. Paul and Minneapolis were
nullified, and the only actual experience in the care of the sick gained
by the men was that afforded in United States General Hospital No.
29, Fort Snelling, and even this was interfered with by the occa-
sional occurrence of mumps, measles, and influenza among the men.
Several casual officers arrived between September 14 and October
4, and these men. having been exposed to the contagion of the epidemic
before leaving Camp Dodge, were segregated in Barracks B 6. south.
The wisdom of this course was manifested almost immediately,
practically two-thirds the entire number being sent to United States
General Hospital No. 29 suffering from influenza within the next
three days, and at the end of two weeks 72 of the 100 had been in the
hospital. The crest of the westward spreading epidemic reached the
post at this time.
All possible precautions were used to check the onslaught and pre-
vent the spread of the influenza in our unit ; segregation, ventilation,
masks, cubicles, and vaccine being employed, a supply of Dr. Rose-
nau's latest vaccine being generously sent us from Rochester, Minn.
Despite these precautions, on October 23. the influenza developed in
that portion of the detachment quartered in F 22, which had up to this
time escaped infection. 17 enlisted men being sent to General Hospital
No. 29 on that day and 10 more on October 24. But of all the person-
nel attacked during this epidemic none succumbed.
Hospital officially closed May 16, 1919. by telephone orders from
chief surgeon, American Expeditionary Forces.
Orders received to move May 23, 1919, per telegraphic instructions,
general headquarters.
2012 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
U2. BASE HOSPITAL NO. 110.
This unit was organized at Fort Oglethorpe, later being sent to
Camp Sevier.
On November 1, 1918, at 3.30 p. m., the entire eommancl, consisting
of 18 officers and 200 enlisted men, entrained for Camp "Upton,
Long Island. Our trip was very interesting but uneventful. We
arrived at our destination all hale and hearty on November 3, 1918.
about 11.30 a. m. On November 10, 1918, before dawn, the second
lap of our journey to foreign shores was begun. Afternoon of the
same day saw us on the Empress of Asia. On the 22d day of Novem-
ber, 1918, we entered the beautiful harbor of Brest.
December 2, 1918. proved another fortuitous day. for we broke
camp at 4 a. m., marched to Brest, and entrained at 10 a. m.
We arrived at Mars-sur-Allier on AVednesday, December 4, 1918,
at 4.30 p. m. The end of December, 1918, saw this unit firmly estab-
lished at ^lars. All departments were in working order and run-
ning smoothly. The dental service was going full blast. The labo-
ratory was running a close second. The medical and surgical serv-
ices at this time were not very busy. No. 110 was unfortunate enough
to arrive after the " big show."
In January, 1919, Base Hospital No. 110 was officially designated
as the center for neuropsychiatric cases for this section of France.
In conjunction with this, ward 4 was given over to reconstruction
work and industrial therapy.
V2. BASE HOSPITAL NO. 111.
Base Hospital No. Ill disembarked at Brest, France, November
22, 1918, with 28 officers and 183 enlisted men, per part A, Confiden-
tial Order No. 515, headquarters Camp Upton, N. Y., dated Novem-
ber 9, 1918. Hospital quarters at rest camp, Pontanezen Barracks,
until ordered to Beau Desert hospital center. Army Post Office 705,
paragraph 11, Special Order 323. headquarters Base Section No. 5,
Services of Supply, Army Post Office 716, dated November 23. 1918.
En route from Pontanezen Barracks to Beau Desert hospital center
November 25, 1918, and November 26, 1918, paragraph 11, Special
Order 323, headquarters Base Section No. 5, Services of Supph%
Army Post Office 716, dated December 23, 1918. Arrived Beau
Desert hospital center. Army Post Office 705, November 26, 1918.
Hospital quartered in Unit No. 7, Beau Desert hospital center. Base
Section No. 2, Services of Supply, Army Post Office 705, upon ar-
rival. Hospital operating under jurisdiction of Base Hospital No.
114, from December 7, 1918. to December 22, 1918. Hospital operat-
ing under own jurisdiction December 23. 1918.
Red Cross established at Base Hospital No. 111. January 3. 1919.
Hospital on duty entire month of January, 1919, at Beau Desert
hospital center. Base Section No. 2, Services of Supply, Army Post
Office 705, with 39 officers and 240 enlisted men.
W2. BASE HOSPITAL NO. 113.
First orders were received August 20, 1918, for mobilization at
Camp Sherman, Ohio. Ordered to port of embarkation at Camp
Upton, N. Y., November 1, 1918.
A. E. F. BASE HOSPITALS. 2013
Embarked from New York on transport Empress of Russia No-
vember 12, 1918. Ten days' voyage, with frequent lifeboat drills;
passage smooth and uneventful, arriving at Brest November 22, 1918.
Ordered to hospital center, Savenay, arriving November 25, 1918.
Unit assigned to take over group at Savenay; 100-bed hospital,
then under the supervision of Base Hospital No. 69.
X2. BASE HOSPITAL NO. 114.
During the month of February the hospital was changed from a
combined evacuation and base hospital to a base hospital, acting only
for receiving of patients. Evacuations are now made through Evac-
uation Hospital No. 20, this center. A block of 10 wards has been
ti-ansferred to the above-named hospital for this purpose. Evacua-
tions to date are 15,148 and admissions 15,991.
On February 6 ward 23 was totally destroyed by a fire starting
from a defective oil stove. The fire platoon rendered heroic service
and, in spite of a high wind, confined the fire to a single ward. The
patients were all removed in an orderly manner and excellent dis-
cipline was maintained.
The general health has been good with the exception of the de-
velopments of 27 cases of diphtheria. Patients are carefully ex-
amined: and if any show symptoms, they are cubicled or sent to
observation ward. Nineteen carriers were isolated. One case of
cerebrospinal meningitis developed during the month. There were
5 cases of mumps and 1 of influenza.
Y2. BASE HOSPITAL XO. 116.
December 20, 1917 : Mobilization began at S'eventy-first Eegiment
Armory, New York City.
March 25, 1918 : Left New York City on steamship Mauretania.
April 2, 1918: Landed at Liverpool, England.
April 9. 1918: Arrived at Bazoilles-sur-Meuse (Vosges), taking
quarters on west bank of the river.
April 19. 1918: Moved into unfinished quarters on the east bank
of the river.
June 2, 1918 : First patients received.
June 8 to December 3, 1918: Surgical Team No. 34 on detached
service at Paris, Sebastopol, and Froidas.
June 15, 1918: Operating room opened.
September 19, 1918: The nucleus of the personnel of Mobile Hos-
pital No. 9 left for Paris.
June 2 to Septemlier 12, 1918: There had been received 4,528 pa-
tients and 317 operations had been performed.
September 12 to November 12. 1918 : There had been received 5,669
patients and 832 operations were performed.
Noveuiber 12, 1918. to January 31, 1919: There had been 2,243
patients admitted and 110 operations performed.
Tt will be soon that this organization functioned as a hospital in
the Anioricau Expeditionary Forces during a period of eight months.
The total number of admissions were 12,440. It will be seen during
the two months from September 12 to November 12, 1918, over
/
2014 REPORT OF THE SURGEON GENERAL OF THE ARMY.
46 per tent of the total number of cases were admitted and over 66
per cent of the total number of operations were performed.
On January 31, 1919, this organization ceased to function as a
hospital, its plant, patients, and property being taken over by Base
Hospital No. 79.
Svmniary.
Medical admissions 5, 837
Surgical admissions 6, 603
Total number of admissions 12,440
It will be noted that only 6.603 cases were admitted, but the analy-
sis of surgical cases gives a total of 7,226. This apparent discrepancy
is due to the fact that in many instances more than one severe trau-
matic condition existed in one individual. For purposes of classifi-
cation it has been necessary to list such a case under two headings.
Trivial conditions liave not l^een listed unless they were the cause of
admission. Trivial conditions in conjunction with more serious
conditions have not been listed here.
Z2. BASE HOSPITAL NO. 118.
Base Hospital No. 118 mobilized at Camp Zachary Taylor, Ky.,
from September 13 to November 3, 1918. From time to time the com-
missioned personnel was increased from Medical Officers Training
Corps, Camp Greenleaf, Ga.. and, on October 25, 1918, 100 additional
enlisted men were transferred from the base hospital. Camp Taylor,
Ky., completing the authorized quota.
On November 3, 1918. the unit entrained for Camp ^lills, N. Y.,
and sailed on steamship Oedric, November 11, 1918, for Liverpool,
England. November 30. 1918, the unit arrived at Savenay, France,
via Havre, with 198 enlisted men. no nurses.
Base Hospital No. 118 is now functioning as a contagious hospital
of 231 beds, caring for all contagious cases in the hospital center,
Savenay, France, and also operating a tuberculosis hospital of 212
beds.
At the contagious hospital, the receiving office is combined with
that of the registrar, operating with entire satisfaction and easily
coordinating two important features of the record work. Eeports
closing as of April 16, 1919, show the following movement of pa-
tients: Admitted, 1,668; evacuated to United States, 571; died, 34;
returned to duty or otherwise disposed of, 878; remaining in hos-
pital, 182.
January 27, 1919, Base Hospital No. 118 was confronted with the
new duties of evacuation of patients to the United States.
Two convoys were called for and evacuated January 30, 1 of 57
walking tuberculosis patients, via Brest, and another of 29 walking
tuberculosis suspect cases and 10 litter tuberculosis cases, via St.
Nazaire.
February 4, 1919, 10 cases of tuberculosis and 2 cases of trachoma
were evacuated via St. Nazaire.
For the rest of the month only small convoys were called, giving
a total of 105 patients for the month, including 2 trachomas and 8
diphtheria carriers.
A. E. F. BASE HOSPITALS. 2015
In March, 270 walking tuberculosis patients and 123 litter tuber-
culosis patients were transferred to the United States, giving a total
of 290 evacuations from this hospital for the month. The last of the
March convoys from the tuberculosis camp depleted it to a low figure
of 19 jDatients.
A3. BASE HOSPITAL XO. 119.
Base Hospital Xo. 119 organized at Camp Zachary Taylor, Ky.,
about September 1, 1918; this organization was attached to the base
hospital of that camp for instruction and duty. Both officers and
enlisted men received considei'able training from September 1 until
October 30 along hospital lines, as at that time the influenza epidemic
was at its height.
Base Hospital Xo. 119 left Camp Zachary Taylor, Ky., October 26,
1918, arriving at Camp Upton. X. Y.. October 28. 1918; after remain-
ing in that camp for about 18 hours, entrained for Hoboken, N. J.,
and arrived at that station October 30. 1918, with 23 officers and 200
enlisted men. At this point three enlisted men were transferred from
the unit, due to physical condition. The steamship Great Northern
Was boarded the noon of October 30. 1918. and anchor was drawn on
November 1. 1918. The trip to France was uneventful. The steam-
ship Great Northern arrived at Brest. France. Xovember 9. 1918. and
this organization debarked on the morning of the 10th of Xovember.
Upon landing were assigned to Pontanezan Barracks, about 3 miles
from Brest, where we remained until Xovember 13, 1918. awaiting
orders for assignment. The entire unit left Brest. France, en route
to Savenay, France, with 23 officers and 197 enlisted men. and ar-
rived at Savenay. France. Xovember 11. 1918, being assigned to
hospital center at that point: the unit was immediately assigned to
take over Provisional TJnit Xo. 5, in connection with Base Hospital
Xo. 8 of that center, running it as such up until Xovember 30. when
a formal transfer was made, designating Provisional Unit Xo. 5
as Base Hospital Xo. 119, Base Hospital Xo. 119. since December
1. 1918. has })een running as an ambulatory and evacuation hospital,
with a total number of admissions for the month of December of 735
and evacuations amounting to 1,055.
B3. BASE HOSPITAL NO. 12 0.
Base Hospital Xo. 120 was organized at Camp Greenleaf, Chicka-
mauga Park. Ga.. August 28. 1918, with 100 enlisted personnel and
2 medical officers.
After the usual instructions, orders were received on September 10,
1918. to proceed to Camp Beauregard, La., and on September 12,
1918. the unit arrived at this camp. At this camp the officer per-
sonnel Avas increased to 21.
While the unit was stationed at Camp Beauregard an epidemic
of influenza broke out. The unit assisted the hospital proper to take
eare of the patients.
On Xovember 1, 1918, in compliance with orders of a few days be-
fore, the unit left Camp Beauregard and proceeded to Camp Upton,
arriving on Xovember 5. 1918. On Xovember 10, 1918. left Camp
TTpton at 5 a. m. from Pier 61: for two days the ship remained
2016 REPORT OF THE SURGEON GENERAL OF THE ARMY.
anchored, and at 4.12 p. m., November 12, set sail overseas on H. M. S.
ETnpress of Russia^ escorted by a convoy of three ships.
After three davs at sea the ship turned back in order to assist one
of the convoy which became disabled, but after 24 hours' delay re-
sumed travel.
On November 22, 1918, the ship arrived at Brest, France, Base
Hospital No. 5. The organization was sent to the rest camp at Pon-
tanezan and functioned under the camp hospital.
On December 10. 1918, orders to proceed to hospital center, Ker-
huon, were received and complied with. There the officer personnel,
functioning under Base Hospital No. 65, were assigned to duty in
wards in this hospital center and such duties as were necessitated by
the unit's organization. On January 10, 1919, orders were received
to proceed to Tours. The unit left Kerhuon, arriving in Tours on
January 15.
This hospital center, at the time of arrival. Base No. 7, was func-
tioning, but was relieved by Base Hospital No. 120, Base Hospital No.
T, returning to the States.
About 400 German prisoners of war were hospitalized here.
At the present time, April 10, Base Hospital No. 120 is functioning
at Joue-les-Tours.
C3. BASE HOSPITAL NO. 121.
For the month of January, 1919: The first patients were received
January 24, 1919, 207 having been transferred from Base Hospital
No. 106, this center.
Sixteen members of the Army Nurse Corps joined for duty Jan-
uary 30, which amply provided for the nursing of the patients.
Shortage of medical officers still exists.
There are two Red Cross workers on duty at this unit.
For the month of February, 1919 : During the month this hospital
has received 1,112 patients and transferred 944, although the medical
staff consisted of only 15 medical officers, 2 of whom were on details
not involving medical work. This hospital also provided accommo-
dations and messed the personnel of Base Hospital No. 22, Base
Hospital No. 13, and Hospital Unit Q.
For the month of March, 1919: During the month of March this
hospital received 1,644 patients and transferred 1,310. The medical
staff was augmented by the assignment of one additional officer for
duty and the temporary assignment of five, two of whom remain on
duty at this time. A clinical building, housing the laboratory, infirm-
ary, surgical dressing room, eye, ear, nose, and. throat clinic, and den-
tal clinic was established and has proven an important addition.
Payment of patients has been introduced this month, and all
patients are paid before being transferred to Evacuation Hospital
No. 20, this center.
D3, BASE HOSPITAL NO. 123.
Base Hospital No. 123 was organized at Camp Greenleaf, Chicka-
maugua Park, Ga., on September 5, 1918. Only 2 officers and about
100 enlisted men were comprised in the unit's first formation. This
unit was made up from casuals.
A. E. F. BASE HOSPITALS. 2017
September 9, 1918, Base Hospital Xo. 123. was ordered to report
to Camp Greene, N, C. At this camp this strength of the unit was
increased by something like 20 officers and 90 enlisted men, bringing
the total strength up to 22 officers and 190 enlisted men.
Persuant to telegraphic orders under date of October 30, 1918,
this unit reported to Camp Mills, Long Island, N, Y., where the
personnel of officers and men was completed to the strength of 30
officers and 204 enlisted men.
Orders dated Camp Mills, November 10, 1918, Base Hospital No.
123, was placed aboard transport No. 206.. at Pier No. 59, North
River, and on November 13, 1918, this unit left the United States
for duty with the American Expeditionary Forces. During the
voyage the commanding officer held daily meetings instructing the
different officers relative to the duties that would be expected of them
while in P^rance. Similar meetings were held with the enlisted
personnel, and they were instructed along lines which would make
them efficient in the part they were to take in the managing of a
hospital.
It was on November 24, 1918, that this transport landed in Liver-
pool, England. Here the different units were debarked and placed
aboard trains. Base Hospital No. 123 was ordered to a rest camp
in England. A part of the unit was sent to Winchester and the
other part to Southampton, England. The stay at these camps was
of very short duration, comprising only about two hours of waiting.
The troops and officers were again placed aboard trains and sent to
the embarkation port at Southampton, where the transport Manhat-
tan was waiting to carry them to France.
On November 26, 1918, this unit was landed at Havre, France, and
sent to Rest Camp No. 1. Here the unit remained until November
29, 1918. Special Orders, No. 327, came and the unit was placed
aboard a French train, and after three days' journey was landed at
Mars-Sur-AUier, Department Nievre, France, better known as Mars
hospital center, on the 2d day of December, 1918.
December 5, 1918, marks the date of the beginning of actiA'e service
of Base Hospital No. 123. On that date it took over Base Hospital
No. 68 annex and began functionating. This unit operated this
hospital until February 4, 1919, when it received orders to close up
this unit and assume the operation of Evacuation Hospital No. 30,
which unit it is operating toclav, but doing so under the name of
Base Hospital No. 123.
E3. BASE HOSPITAL NO. 131.
Base Hospital Unit No. 131 claims the distinction of being the
representative of Jefferson Barracks, St. Louis, Mo., in the war.
Although thousands of volunteers and drafted men were recruited
at Jefferson Barracks, Base Hospital No, 131 was the only complete
organization to leave that post for overseas service.
On Monday, August 19, the personnel was submitted to a neuro-
psychiatric examinatioji as a preliminary to the overseas examina-
tion later.
On Wednesday, September 25, the unit entrained at Jefferson Bar-
racks for Camp Upton, Long Island, N. Y. The route was over the
2018 REPORT OF THE SURGEON" GENERAL. OF THE ARMY.
Clover Leaf to Toledo. Ohio, and thence over the New York Central.
The ferry circled the Battery and left her load of soldiers at Long
Island City, where 131 entrained for Camp Upton. The ride to
the camp was brief and the unit was safely housed at the corner of
Fourth Street and Fifth Avenue, Upton, by 9.30.
On September 28 the unit awoke to complete the details remaining
before embarkation and found Camp Upton infested with the epi-
demic of influenza. In 2 days 40 members of the detachment were
in the temporary infirmary of the unit. This delayed the departure
from America.
On Columbus Da}^, October 12, Unit No. 131 left Camp Upton
and after again rounding Manhattan by ferry embarked on the
Cunard steamer Ortega. Early in the afternoon the Ortega left the
pier and steamed down the river into New York Harbor. The con-
voy was completed and left the harbor at 3 o'clock the next after-
noon— October 13. Thirteen transports and two battleships made up
the party.
Seemingly submarines were oblivious of the presence of the group
of ships and stayed clear until Wednesday, October 23, after land
had been sighted early in the day, and the troops were privileged to
witness the "brush" between three destroyers and two submarines,
in which the subs were losers.
The Ortega docked at Liverpool on the 24th and Base No. 131 at
10 p. m. entrained for the south.
Early on October 25 the unit arrived at Winchester and marched
with full pack through that historic city to the combined British
and American rest camp on the heights of Morn Hill.
The next day, October 26, the journey A^as continued to Southamp-
ton and on across the channel to Cherbourg. France. The first im-
pressions gained by the hospital personnel of France were that of a
long, hilly road to a British rest camp at Tourlaville.
Late in the afternoon of October 31 Base No. 131 entrained again,
this time in an improvised collection of first-class coaches and box
cars, for the trip across France to its destination. November 3,
three days from Cherbourg, the unit reached its future home, hos-
pital center. Army Post Office 780, Mars-sur-Allier, Nievre, France.
At the time that Base 131 arrived this center was one of the largest
hospitals in the world and was handling thousands of cases which
arrived on numerous Red Cross trains daily. The buildings and
quarters for the unit were far from completion and the first work of
131 was to build itself in. This was accomplished by the undi^dded
attention of officers and men by November 18, when the first patients
were received by the hospital. During the 24 hours, starting at 4
p. m. on the 18th, 986 patients were admitted to the hospital and the
work of No. 131 was in full swing.
One of the first results of the new year was the addition of 63
German prisoner patients to the hospital. These Germans were part
of a German hospital which failed to get out of the way of the ad-
vancing army quickly enough and were found occupying territory
given up under the conditions of the armistice.
On January 15 Base Hospital No. 131 took over the patients,
property, and buildings of Base Hospital No. 14 of the same center,
moving the offices and patients in the new location. This move gave
A. E. F. BASE HOSPITALS. 2019
No. 131 more commodious quarters in better buildings and increased
the efficiency of the Avork of the hospital. On the 20th, five days
later. Base Hospital No. 68 was taken over, patients and property.
The addition of these two hospitals gave Base 131 the highest total
of patients that were accommodated at any one time, 1.031.
On March 28 orders were received to prepare to cease functioning
as a hospital by April 10.
3. BASE HOSPITAL NO. 136.
Base Hospital No. 136 had its origin on September 10, 1918, at Camp
Oreenleaf, Ga., and 100 enlisted men were ordered to proceed to Camp
Wheeler, Ga.. for the purpose of organizing and equipping for over-
seas duty. Camp Wheeler was reached on September 12.
On October 14, 100 class B men were assigned to the unit and on
October 16 orders were received to proceed to Camp Merritt, N. J.
On that day the epidemic of influenza appeared m the unit and
within two daj^s about 42 men had been sent as patients to the camp
hospital.
Between midnight of October 17 and 7 o'clock of the following
morning 42 men were transferred out of the organization and 42
others were transferred to take their places. On October 18 the unit
left Camp Wheeler for Camp Merritt, arriving there on October 20.
During the journey influenza again appeared and by the time Camp
Merritt was reached 30 cases had developed and were sent at once
to the camp hospital. As the greater part of the officer personnel had
failed to report at the end of five days, the unit was ordered to Camp
Upton, where it arrived on October 25.
The unit left Camp Upton with 196 enlisted men on the morning
of November 15 and embarked from New York City on the afternoon
of November 15 on the French liner La France^ known as transport
No. Jf68.
There was a remarkable absence of illness, only seven cases being
admitted to the sick bay, four minor ailments.
We arrived at Brest on November 22, 1918, and marched without
delay to the rest camp near Pontanezen Barracks.
We remained at Brest for one week and were then ordered to
Vannes. in the Department of Morbihan, where we arrived on
December 1, 1918.
On Januar}' 18, 1919, Base Hospital No. 236, stationed at Carnac
and Quiberon, forming a part of the hospital center at Vannes, ceased
to exist and became part of Base Hospital No. 136.
From January 18 to February 15, 1919, the hospital at Carnac was
operated as an annex to Base Hospital No. 136 at Vannes and was
utilized especially for convalescent patients.
The number of contagious diseases was fortunately small. No
cases of smallpox or chicken pox were seen. There were 10 cases of
diphtheria successfully treated with antitoxin, 12 cases of scarlet
fever (one of which developed otitis-media), and 4 cases of measles.
There were 43 cases of mumps and 1 case of meningitis. The latter
was treated with antimeningococcic serum and recovered, the first
injection being 36 hours after admission. There were no cases of
dysenter3\
142367— 19— VOL 2 66
2020 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
The possibility of an outbreak of typhoid fever was feared when
a case of this disease was recognized in the person of one of the
nurses. AUhough she presented the clinical picture of typhoid, it
did not seem possible at the time that she could be suffering from this
disease, as she had received triple vaccine seven months previous.
There was a delay in making a blood culture, which proved to be
negative, though an examination of the stool showed the presence of
typhoid bacilli.
Every effort was then made to prevent the possible spread of the
disease. Examination of feces and urine of all cooks and kitchen
police were made, with negative results. Bacteriological and chem-
ical examination of the water supply was negative.
Venereal disease. — While the venereal rate became quite high in a
large camp a few miles from the city of Vannes, the number of cases
occurring in the personnel and among the ambulatory patients was
very small. A prophylactic station was operated at the entrance to
the hospital and inspections were held regularly every week. Other
prophylactic stations were available in the town of Vannes. During
one month only one new case of infection was reported and in another
month no new cases, the mean strength at the time being over 400.
G3. BASE HOSPITAL NO. 2 04.
Hursley Camp Hospital was formally occupied by American
troops hospital unit I April 20, 1918.
The hospital as then occupied consisted of a group of 8 wards, each
capable of accommodating 33 patients. These wards, together with
a few smaller outlying isolation wards and other buildings, were
later known as the A group.
At the time of American occupation 30 beds were reserved by the
British for British patients, and a variable number of these have
constantly received attention in this hospital.
September 30, 1918, definite plans far the enlargement of the in-
stitution having been adopted the hospital was officially known as
United States Army Base Hospital No. 204, and it remained such
until its final disorganization.
September 3, 1918, ward 1, in the D group of buildings, was first
opened, being occupied by 22 mumps contact cases. September 23
wards D 2, 3, and 4 were opened to provide for the influenza epi-
demic. September 30 the hospital was officially designated as Base
Hospital No. 204. On October 3 the largest number of isolation
cases in the hospital any single date were treated. The number was
350. On October 8, 20 patients were housed in bell tents, principally
in the A group. October 16 the hospital began receiving wounded
recently from the front. These cases included many patients gassed
with chlorine, phosgene, and mustard gas. The admission of wounded
continued intermittently up to the closing of hostilities, a small num-
ber of cases arriving thereafter, transferred from other hospitals.
October 24 ward B was opened with 58 patients, and October 28
ward B 3 opened with 88 patients, and November 3 ward B 1 opened
with 21 patients.
November 25 all hospital construction work ceased by order. De-
cember 1, all staff and personnel began preparations for the first of
A. E. F. BASE HOSPITALS. 2021
the series of evacuations of patients by which the hospital was
finally emptied.
Convo}' Xo. 1. lea vino- December 3, took 248 patients; convoy No.
2, consisting of 104 walking- cases, occurred December 8. December
13, 248 patients of all classes, sitting, stretcher, and ambulatory, com-
posed convoy No. 3, and permanently emptied wards B 2, 3, and 4.
Convoy No. 4, consisting of 193 patients of all classes, was the final
convoy to the United States, and together with the evacuation of
58 patients to the American Red Cross hospital at Sarisbury Court
on the same date, December 21, 1918, cleared the hospital of patients,^
a few being discharged to duty. December 24 the last morning re-
port was completed and the hospital officially closed.
The typhoid epidemic affected a total of 40 cases, wdth a mortality
rate of 13 -j- pei" cent. The first cases were received in hospital July
16, 1918.
The influenza epidemic began September 21, 1918, with the receipt
of a large convoy of cases from the steamship Olympic. New wards
in the D group of buildings, former!}^ used by the British as mess^
recreation, and instruction halls, were quickly cleaned and opened
for use, and specially screened to prevent the spread of infection.
The use of gauze masks by all ward attendants was required in
all cases. Total number of cases was 275, resulting in 50 deaths.
As has been the history of the epidemic elsewhere, pneumonia was
the most frequent and fatal complication.
H3. BASE HOSPITAL 2 08.
Camp Hospital No. 47, at Autun, Saone-et-Loire. doubtless was
primarily organized for the purpose of affording hospital care to a
comparatively small floating garrison.
Camp Hospital No. 47 was first organized from casual personnel
for service in Autun about the middle of June, 1918. This personnel
began preparation for the care of patients, but departed about a
month later without having functioned, leaving a guard for the
equipment, the detail going to a Red Cross military hospital.
September 24 : A medical officer and 50 enlisted men arrived, and
this day marks the beginning of the reorganized Camp Hospital
No. 47. A few daj's later began an increase of personnel, organiza-
tion, and function as a hospital.
First influenza case admitted from local 3.1. P. T. D. All pre-
cautions taken to safeguard other patients, the newspapers and official
bulletins ha\ing brought news to us of an epidemic of a serious type
almost everywhere. The civilian population in town showed a large
morbidity and mortality rate.
October 14: Ten influenza cases admitted. Eight are from the
local garrison and two from a passing supply train. Some gravely ill.
October 15 : Four additional influenza cases admitted, all seriously
ill.
October 17 : Influenza ward increased by four. A dental surgeon
reports for temporary duty.
October 19 : For the first time five nurses, who arrived the pre-
vious evening, appear in the wards. Later in the day flat hunting for
their quarters begins, none being available at the hospital.
2022 REPORT OF THE SURGEOI^^ GENERAL OF THE ARMY.
October 20: A schedule of officers of the day is arranged for the
first time. Two cases of influenza admitted, but four are discharged
cured.
October 21: Seven cases of influenza admitted. Two such cases
discharged cured, as is one mumps case. First death in hospital is a
military police soldier, broncho-pneumonia.
October 23 : Three more cases of influenza admitted, also three cases
of mumps. Nine cases of influenza discharged cured. Two deaths
from influenza-pneumonia.
October 24: Admissions, three influenza cases. Seven influenza
patients discharged cured. One death, pneumonia (the deceased
is a member of the detachment) . All entertainments of officers and
men called off.
November 1 : Camp Hospital No. 47 was changed in name to Base
Hospital No. 208.
Evacuation of all patients was ordered and accomplished about
the middle of December and all equipment returned to a supply
depot.
On the last day of the year the entire personnel left Autun for
Bordeaux to take over Base Hospital No. 6.
13. BASE HOSPITAL NO. 210.
Base Hospital No. 210 (organized as Provisional Base Hospital
No. 1), Avas organized in the Justice Hospital group, November 1,
1918, and composed of offic^ers and men already in the group.
This hospital is located in '' Mareshal Ney Caserne." near Toul,
Menrthe-et-Moselle. This " caserne '• consists of an 8-acre parade
ground in a rectangle around which the larger buildings are grouped,
three large 4-story buildings, two 2-story buildings, and three 1-story
mess halls.
On our arrival here we found everything filthy beyond the power
of words to describe. Human feces were found on each square yard
of terrain in the parade ground, in many of the rooms of the build-
ings, and plentifully^ on the floors of three of the kitchens. The gen-
eral dirt and disorder could not have been worse. The decomposing
body of a dead French soldier was found in a room in C building.
The cleaning of the buildings and grounds was commenced on
October 29, 1918, and the first patients were admitted on November
4, 1918, 50 of them.
Everything was about ready for opening the operating room
when the armistice was signed. Shortly after this we received orders
from headquarters Justice Hospital group to stop all preparations
to care for acute surgical cases, and to prepare for handling con-
valescent cases only.
J3. BASE HOSPITAL >CO. 2 IS.
The hospitalization for the American Expeditionary Forces at
Poitiers (Vienne), France, was designated Camp Hospital No. 61,
bv letter from the chief surgeon's office, American Expeditionary
Forces. August 9, 1918.
On August 28, 1918, the building known as the Ancienne Seminaire,
Rue de Carmeletes previously occupied by the ser^ace de stinte as
I'Hopital Temporaire No. 16, was taken over with its equipment
A. E. F. BASE HOSPITALS. 2023
and linen. This was designated as division 1. and had a maximum
capacity of 400 patients; this division was ahnost exclusively sur-
gical.
On September 18, 1918, a portion of the building in the Rue de la
Trinite, owned b}^ ecole de theologie, and occupied by the French as
I'Hopital Temporaire No. 21, was also taken. This was designated
as division 2, had a maximum capacity of 325 beds, and was used very
largely for medical cases, although many slightly wounded were
treated here.
Although the repairs and installation of electric lights were not
comjDleted until N^ovember 12, 1918, 100 beds were reported avail-
able on November 4, 1918, and on November 5, 1918, Camp Hospital
No. 61, was designated Base Hospital No. 218.
On November 5. 1918. the first liospital train. No. o5, arrived with.
471 battle casualties, direct from the front.
After a busy three months, during which the hospital .vas crowded,
a great part of the time to capacity, on February 13, 1919, by au-
thority of telegram 1394, chief surgeon's office, American Expedi-
tionar}' Forces, Base Hospital No. 218 became Camp Hospital No.
61 again, for the purpose of the medical and surgical care of the
Engineer troops in the Department of Vienne.
K3. BASE HOSPITAL XO. 2 3 0.
The following is a history of the organization successively known
as Convalescent Hospital No. 3, Camp Hospital 92, and finally Base
Hospital 236.
The original eight officers of Convalescent Hospital No. 3 left
Camp Greenleaf, Fort Oglethorpe, Ga., on ]\Iay 30, 1918, as part of
replacement draft No. 2. They arrived at Blois on June 19, 1918,
having traveled to France by way of Liverpool and Southampton.
On June 23, 1918, the 8 officers with a detachment of 60 enlisted men
entrained for Quiberon, Morbihan, arriving there on the following
day. They prompth' took possession of 11 summer hotels previously
leased for use as a hospital, with a capacit}^ of 990 beds.
On September 1 the first convoy of patients (29 in number) was
received. At the end of the month there were 228 patients, none
having been evacuated. They consisted chiefly of gunshot wounds,,
gassed patients, and convalescent medical cases.
Influenza appeared on October 12, necessitating the addition to
the hospital personnel of five female nurses. The Villa Ker Mignon
was utilized as an isolation hospital for respiratory diseases. This
was kept full to its capacity of 724 beds during the epidemic, when
four deaths occurred, three of which were due to pneumonia.
On November 18 Camp Hospital 92 because Base Hospital 236
and part of the hospital center at Vannes.
During the month of December 19 patients were received and 147
evacuated.
On January 18, 1919, Base Hospital 236 ceased to exist, its per-
sonnel being taken over by Base Hospital 136 at Vannes,
L3. BASE HOSPITAL NO. 238.
Hospital was organized November 20, 1918, as per authority con-
tained in section 2, Circular .')7, chief surgeon, American Expedi-
"2024 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
tioiiarv Forces, dated Xoveniber 20, 1918, at Rimaucourt (Haiite-
Marne), France. Army Post Office No. 919. The professional per-
sonnel and the enlisted personnel and the nursing corps of this hos-
pital were drawn from Hospitals Xos. 52, 58, 59, and 64, already in
this center.
Disbanded and ceased to exist on February 15, 1919, by order
chief surgeon American Expenditionary Forces, per indorsement
dated February 10, 1919, General Order No. 57, paragraph 1, Head-
vquarters hospital center, Eimaucourt, Army Pc^rt Office Xo. 919.
This hospital specialized in cases of the following nature: Eye,
ear, nose and threat, skin and genitourinary diseases, and also con-
tained the central laboratory and had supervision over the centn;.!
morgue. It also maintained an outdoor clinic in all of its depail-
ments, and many patients from the surrounding area as well as fro:n
the other hospitals in this center were treated as ambulatory cases.
No communicable diseases were kept in this hospital but were ii:i-
mediately transferred to designated units. If in any of these units
cases required special treatments, consultation from services in Base
Hospital Xo. 238 was furnished.
There are no incidents of special interest having occurred, as this
hospital was rather short lived, being organized Xovember 20, 1918,
and ceasing to function on Februar}' 15, 1919.
6. American Eed Cross Military Hospitals.
a. hospital no. 1.
Introduction. — This organization had been in existence as the
*' American Ambulance " since August, 1914 — a benevolent institution
supported by private funds contributed from all sections of the
United States. The object of its organization was to represent
American sympathy for the allied cause, and to treat such wounded
as were sent to its doors. At various times British, Franch, and
colonial wounded were admitted. The hospital was under the direc-
tion of a committee of American citizens, and under the military con-
trol of the French Service de Sante, and was unofficially known as
the "American Ambulance," and in the official French records as
■" Hospital Benevole Xo. 2 bis." It commenced as a hospital of ap-
proximately 250 beds, and increased gradually to 575. The parent
institution of the "American Ambulance " was the American Hospi-
tal of Paris, 44 Rue Chauveau, Xeuilly Sur-Seine. At first certain
French and American doctors resident in Paris, treated the wounded.
Later they were assisted by units from the Western Reserve Uni-
versity, Harvard, the University of Pennsylvania, and the Pennsjd-
vania unit. These units served three months each with the exception
of the unit from the Pennsylvania hospital, which began its service in
October, 1915. On July 22. 1917, it was turned over to the American
Ked Cross and the American Expeditionary Forces, and has be?n
called since that date the American Red Cross ]Militarv Hospital
No. 1. '
The original idea of the American Expeditionary Forces was that
this hospital should remain in its original capacity for the French,
l>ut in Xovember, 1917, this plan was changed, and it was to be used
A. E. F. RED CROSS HOSPITALS. 2025
equally for the French and the Americans. Later on the proportion
of American to French was two to one. The first American wounded
entered the hospital in March. 1918. after the battle of Cantigny.
At this period the hospital had increased from a 500 to a 1,000 bed
organization. Throughout the offensive of June and after the battle
of Chateau-Thierry the hospital was taxed to its utmost capacity,
and had to be enlarged to care for 2,100 patients. This necessitated
a large increase in the material equipment, such as tents and build-
ings in the neighborhood, a large part of which were provided by
the Red Cross. The American Hospital of Paris also came to the
assistance of the American Red Cross Military Hospital No. 1 by
placing in its gardens sufficient tents to take care of 270 solcliers and
60 officers. This material was again supplied by the American Red
Cross.
Technical. — During the existence of the hospital all types of sur-
gical cases were received, but the hospital had achieved some renown
for its treatment of fractures of the long bones, nerves, and other
woundsof the face and jaws. There were 13.432 American and about
12,000 French admitted for treatment, the time of hospitalization
varying from a few days to many months. The hospital was never
considered as anything but a surgical center. During the period be-
fore the United States entered the war it was one of the maxillo-
facial centers, and it continued to act as such after having been taken
over by the American Expeditionary Forces. It also had an active
eye, ear, nose, and throat department in conjunction with its general
surgical service. The X-ray department was thoroughly equipped
with every modern improvement. 25,000 examinations, at least, hav-
ing been made.
The hospital was housed in a modern building that had never been
occupied, and had been designed as a high school, so that the gen-
eral sanitation was excellent.
The greatest capacity of the hospital was reached in June, July,
and August, 1918, when it became an evacuation hospital, receiving
its patients directly from the battle field. It had at that time a staff
of 90 surgeons, made up of its regidar staff and mobile operating
teams, and four operating rooms and 18 tables were kept busy night
and day.
B. HOSPITAL XO. 2.
The American Red Cross Military Hospital Xo. 2 was begun in
Paris by Americans as an institution for French wounded some
months before America declared war. It represents the ideals of a
group of men who had been working with the French service since
1914, men whose work and character were then almost as widely
known among the French as tliev had formerly been known to the
Americans. In the spring of 1917, when the American Expedition-
ary Forces and the Red Cross were establisliing their headquarters in
Paris, the hospital was frequented by numerous officials in search of
assistance and ideas, and many medical officers came to observe the
cases and methods of treatment employed. Later, when the city was
flooded with Americans and hospital facilities for the sick becauie a
sore need, this hospital received the sick. By Xovember 1, 1917, it
■was militarized and acted as a post hospital throughout the winter
2026 REPORT OF THE SURGEON GENERAL OF THE ARMY.
and spring of 1918. In the emergency of the Chateau-Thierry push
in June, 1918, the post cases were rapidly evacuated, the capacity
increased, and it functioned as an evacuation hospital during the
summer months, but as the front receded from Paris it gradually
assumed the work of a base hospital and continued thus until the end.
A glance at the record of admissions shows what a varied life the
institution has led in the course of its short existence :
Total number of admissions 8, 965
Medical cases 2, 020
Surgical cases (post surgery) 1,075
Genito-urinary cases 441
Eye. ear, nose, and throat cases 634
Battle casualties (American and French) 3,906
Unclassified cases 24
Selection of huildmg. — In searching for a building it was found
that the Doyen Clinique, located at 6 Eue Piccini, was available. It
had served as a surgical hospital for private and semiprivate patients
for about 20 years, and although in a fair state of repair only a small
portion could be used in operating the institution as a war hospital.
Nevertheless, it was splendidly located, could be rapidly equipped,
and possessed splendid operating rooms and very unusual laboratory
equii:)ment. Hence, in view of the type of work, namely, the treat-
ment of fractures and research on wound infections, the patients to
be admitted in small numbers and to remain until treatment was com-
plete, this building was decided upon by the committee. The labora-
tory expanded rapidly, developed its own policies, and became an
institution in itself.
First peHod^ under French ad/ministration. — The work of cleaning
the building, receiving supplies, and settling the various departments
was undertaken on the 5th of April, 1917.
By the 1st day of May, 1917, the administrative department, op-
erating room. X-ray department, and two Avards with a capacity of
100 beds were ready for the reception of patients. On the afternoon
of this date the hospital Avas inspected by the officials of the service
de sante and that evening it received its first patients, 45 fractures
from the latter part of the Champagne Battle.
By the last Thursday in May four floors on the other side of the
building were ready for patients. On this date occurred the formal
opening of the hospital. It was attended by the President of the
Republic, all the leading members of the French medical profession,
and a large number of American medical officers. Immediately fol-
lowing the formal opening 125 beds, which had been gotten ready in
the other building, were rapidly filled with French wounded.
Second period^ transitioned. — Red Cross and Army headquarters
were just organizing in Paris. Hundreds of Americans were report-
ing to their various headquarters daily, and many of them were in
need of medical care. A number of independent volunteer units,
which had been operating with the French, were being combined and
absorbed by the Army or the Red Cross, the largest unit of this type
being the American Field Service, with a personnel of over 5,000.
Hence tliere were hundreds of Americans in Paris at this time, and if
the}' became ill there was no hospital to which the}^ could apply for
treatment. The American Hospital at 44 Rue Chauveau — a private
hospital founded for Americans before the war — had but a verv few
A. E. F, RED CROSS HOSPITALS. 2027
beds, and there \Nere no free beds. The hospital of the American
Ambidance in Xeuilly was closed to Americans — it received only
French wounded. The question of their admission here under the
existing contract with the French simply meant that the hospital
would not be reimbursed by the Government for the days lost in hos-
pital by them. In the latter part of August, 1917, Americans began
to be admitted on this basis. Another hundred beds, which as yet
had not been used for French wounded, were made available for them,
regardless of their status.
While this work was progressing the status of the hospital itself
and its future policy became a serious question. Would the Red Cross
operate it with Red Cross officers and nurses for the sick among their
own personnel or offer its beds for the Army's sick and wounded as
well? Or would the Army take the hospital, supply its personnel,
and use it as a post hospital? In the discussion of this proposition
was worked out the status of the combined administration of the
American Red Cross military hospitals.
The administrative officers, medical officers, nurses, and enlisted
men for office, ward, and police duty were to be supplied and paid by
the Army. The lease on the building, with its equipment and the
financial obligations of the institution, were to be assumed by the
American Red Cross, and a disbursing officer responsible to the Red
Cross for the administration of the finances of the hospital was as-
signed. Requisition for supplies, food, and equipment were sent to
the Red Cross, with the exception of such office equipment, forms, and
returns as Avere concerned with the paper work of the Army. The
Red Cross Avas to be reimbursed for the number of days lost in hos-
pital by Army sick at the rate of 60 cents per da}'. By mutual agree-
ment between the Army, the Red Cross, and the service de sante. 100
beds were kept for the French, with the proviso that in case there
should be an influx of American wounded such of these 100 beds as
might be vacant at the time could be used for them.
The plan, in brief, was —
1. To appoint a committee to be called the research committee of
the Red Cross to act as the administrative body for what might be
called an informal medical society, the idea being that it should ar-
range for monthly meetings with programs embodying lectures and
papers by authorities from the British and French Armies, and
should perfect an agreement with the chief surgeon's office whereby
orders could be obtained to send medical officers from all our units to
these meetings.
2. To arrange to publish and circulate to members of the allied
armies extracts from these lectures and papers and from current
medical publications.
3. To establish at some central point an adequate medical library
to be made available to all members of the medical corps.
4. To set about collecting pathological specimens and autopsy
material for the museum of the Surgeon General's Department, or
for use of the Army schools of instruction.
Third peHod., under Ameyncan administration. — This period ex-
tended from November 1, 1917, until the hospital was evacuated of
all patients on January 31, 1919. During this time 8,466 patients
were treated, making an average of admissions and discharges of
about 19 per day.
2028 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Until June 6, 1918, practically no wounded had been treated among
the Americans, but the hospital had been filled to capacity practi-
cally all the time with medical, genitourinary, and post-surgical
cases. No contagious diseases were admitted.
During May. as the Germans advanced toward Paris, it became
apparent that the hospital would probably have to function as an
evacuation hospital. Accordingly the genitourinary service was
transferred to another hospital which had just opened and the medi-
cal and post-surgical cases were evacuated as rapidly as they were
admitted. In short, the hospital was prepared for a rush of freshly
wounded, and was holding beds for them, but it was not prepared
for such a deluge as was precipitated on June 6 and 7.
Practically all the wounded from the Chateau-Thierry engagement
were evacuated into Paris, most of them the entire distance by ambu-
lance, and they were in bad condition. On the night of the 7th more
than 700 cases, of whom some 500 were unoperated cases, were re-
ceived at this hospital. The hospital's capacity normally was 340,
and because of its situation and nature much expansion was im-
possible. In consequence, when the beds had been crowded together,
numbers of cots were placed in the wards and corridors, and all space
taken, wounded were still arriving. No other hospitals were avail-
able, and these cases had to be cared for. Furniture was thrown aside
in the laboratories, and stretchers placed in the offices and the cor-
ridor on that floor. The administrative offices were filled with
wounded. The out-patient department, the garage, the chapel, the
enlisted men's quarters were all filled, and still they arrived. By
that time, however, the more lightly wounded had been dressed and
fed, and as ambulances unloaded the lightly wounded were sent by
the same ambulances to American Red Cross Military Hospital No.
5 — then only a group of tents containing beds, but no other equip-
ment— there to await evacuation by train.
This tremendous strain fortunately lasted only three or four days
before letting up, and a fairly quiet time during the latter part of
June and the first two weeks of July gave us an opportunity to
originate a triage system, which was completed only the day before
the big rush of patients began on July 16, the time of the great
counterattack in the Soissons- Chateau Thierry-Reims sector.
The heavy work continued well into October, as an average roster
of over 400 patients a clay for the month of September will testify —
this for a hospital of 338 beds and less than 100 cots in the halls and
between the beds. But by the end of September we had accumulated
many fracture and other cases which could not be moved on, so
there was less going and coming and the tension had relaxed. Hence
the work was reduced to the simple care of the patients and sec-
ondary operations and the treatment of medical complications.
It is of interest to note that in 16 days, the end of July, we ad-
mitted just under 2,000 patients, or about four and a half times our
emergency capacity. At one time there were 120 patients in this
hospital awaiting operation. At another time, for a period of six
daj^s, the operating room ran continuously with the exception of
two hours, and by a wonderful piece of fortune the only air raid
of the six days occurred during those two hours, beginning about a
half hour after the operating room had closed and ending about a
half hour before the arrival of a new convoy of wounded.
A. E. F. RED CROSS HOSPITALS. 2029
The air raids were a considerable problem for us. as for all the
hospitals in the bombing areas. The fact that so many of our
patients were fracture cases and strung up in fracture frame, made
it impossible to move them down to the lower floors during the raids,
and so everybody had to sit still and be cheerful during the terrific
barrage connonading. while all the lights were out except an occa-
sional well-sheltered candle. Even the days were not without that
constant subconscious tension which one can not avoid when there is
no telling where and when the next long-range shell is to arrive.
One hundred and thirty-three shells altogether landed inside the city
walls on 44 different days, but fortunately none came nearer to the
hospital than a half mile. During the same period 138 aeroplane
bombs were dropped on Paris during 10 successful raids, but there
were 30 or 40 other attempts made to penetrate the aerial defenses
of the city during that period of spring and summer, 1918. that
were not successful owing to the terrific barrage fire that was put up.
Many of the patients thought it much harder to endure the sounds
and darkness of an air raid on Paris than the violence of a bombard-
ment at the front.
C. HOSPITAL NO. 4.
American Red Cross Military Hospital No. 4, Mossley Hill, Liver-
pool, was officially opened for patients January 10, 1918. Mossley
House was the first building to be occupied for the treatment of
patients. It is a three-story building and basement, and contained
an operating room, offices, nurses' quarters, kitchen, and wards,
accommodating 60 patients.
The greater percentage of cases treated at this hospital have been
pneumonia — both bronchial and lobar; 104 cases of infections
diseases, consisting principally of measles and mumps, wdth a few
cases of scarlet fever and diphtheria. Acute rheumatic fever has
likewise been more or less prevalent.
The surgical work has been extensive, consisting of major opera-
tions of all kinds, including several amputations, mastoidectomy,
tonsillectomy, rib resections, in cases of empyema.
D. HOSPrPAL NO. 5.
On May 6, 1918, after a preliminary survey of the Auteuil race
track in the Bois de Boulogne, Paris, the American Red Cross set
up 15 tents of the Bessonneau type, having a total capacity of 360
beds. A bathhouse, kitchen, and operating pavilion, to be installed
in 6 by 18 meter section barracks (wooden), were also contemplated.
The original intention of the American Red Cross was to use this place
as a rest camp for the Paris troops. The fluctuations of the battle
made it imperative that an evacuation hospital be established as
rapidly as possible.
On May 31, 1918, while the barracks were still in process of con-
struction, the hospital received its first convoy of sick and wounded,
at first largely the overflow from the older United States hospitals
in the Paris district ; 196 cases were thus hurriedly received. The
few surgical cases requiring operation were operated upon in an
extemporized room fitted up in one of the tents.
2030 REPORT OF THE SURGEON GENERAL OF THE ARMY.
From May 1 to June 8, 552 cases were admitted and treated by
the original staff of five officers, Medical Corps, aided by the nurses
and civilian help. On June 8, 50 casuals (enlisted personnel. Hos-
pital Corps) reported for duty. The total number of cases admitted
from May 30 to June 30, 1918, was 1,839. The increase in the num-
ber of beds was correspondingly rapid — 433 on June 2, 506 on June 9,
900 on June 12, and 1,000 on June 13.
By July 1 the operating room was fully equipped with five operat-
ing tables and the surgical work divided among five surgical teams.
During the month of July the total number of beds was increased
from 1,000 to 2,000.
On July 31 the hospital had 28 officers, 57 Army nurses, 39 Ameri-
can Red Cross nurses, totaling 96, and 203 Hospital Corps men.
Total number of admissions.
June, 1918 1, 839
July, 1918 3, 425
August, 1918 1, 205
September, 1918 2, 549
October, 1918 1, 995
November, 1918 , 390
Total 11,403
The total number of beds carried continued to be 2,000, with an
emergency expansion of 250, making a total of 2,250, housed in
77 Bessonneau tents, and a long tunnel under the Auteuil race track,
with an accommodation of 100 beds. Only on three occasions was
the total bed capacity reached. By shifting personnel and the use of
the tunnel available beds were always found.
Mortality. — Total mortality from May 31 until the hospital was
closed, on or about December 10, 1918, was 135 cases, or 1.1 per cent
almost equally divided between medical and surgical cases — 65 medi-
cal deaths and 70 surgical deaths.
Returned to duty. — Throughout the months of June and July,
when evacuations had to be as rapid as possible, no cases were re-
turned to duty, all patients transportable being sent to base hospitals.
As the battle quieted down and the battle line receded, patients were
hospitalized for longer periods of time, and in August, 141 ; Septem-
ber, 349; October, 343; and November, 650 cases were returned to
duty.
Number of patients evacuated. — The records of June and July
were not available. In August, 1,451; September, 738; October,
1,482; and November, 824 cases were evacuated to different base hos-
pitals.
Final evacuation. — Final evacuation occurred between the period
of December 1 and December 10, 1918, 1.738 cases being sent either
to base hospitals or distributed among the United States hospitals
in the district of Paris. The different units and surgical teams were
ordered back to their base hospitals, and on January 8, 1919, the
commanding officer and the adjutant were the sole remaining mem-
bers of the old staff.
It is of interest to note that among the severely gasses cases with
their damaged respiratory tracts, there was a much higher incidence
of positive diphtheria culture without clinical evidence than among"
A. E. F. RED CROSS HOSPITALS. 2031
the other types of patients. The four wards in which most positive
cultures were found were largely filled with severely gassed patients.
E. HOSPITAL NO. 6.
The building occupied by the American Red Cross Military Hos-
pital Xo. 6, formerly a private home, was taken over by the Ameri-
cancan Eed Cross June 18, 1918.
On July 19 the building was considered in condition for the re-
ception of patients, and August 1 the first patients were received
from the front. Convoys arrived as follows :
Convoy — Patients.
August 1 96
August 2 123
August 4 4
August 6 85
August 7 76
August 8 6
The first evacuation took place on August 9, of 130 patients.
During the period August 27 to September 10 patients were ar-
riving from the front almost every day; during this period 1.329
admissions were recorded. This necessitated many evacuations, and
during the same period 730 patients were evacuated to the different
base hospitals of the Services of Supplies.
During the entire operation of the hospital the monthly admissions
were as follows:
August J, 748
September 1,378
October 721
November 149
December 1 to 12 4
After September 15 all evacuations were to the base hospitals
within the district, to convalescent camps, and return to a duty
status.
The hospital was entirely evacuated and closed to the reception of
patients on December 14. 1918; 300 patients being evacuated to Base
Hospital No. 57 ; 75 returned to duty ; and 109 evacuated to a hospital
train for transportation to a base port.
F. HOSPITAL NO. 9.
This hospital was organized primarily to take care of the skin
cases of the district of Paris and, secondarily, to take care of the
venereal cases of the same district. It was opened in accordance
with verbal instructions of the commanding general, district of
Paris, July 17. 1918. The building occupied was a Turkish-bath
establishment at 32 Boulevard des Batignolles.
Four days after getting possession of the building 40 patients
were received, and in a short time the hospital Avas full. The build-
ing was well adapted for its original purpose as a skin clinic, but
poorly adapted and entirely inadequate to meet the demand of a
venereal hospital.
The basement of the building was used for the genitourinary clinic,
which eventually averaged 200 cases a day. The first floor was used
for the skin clinic, which averaged 100 cases a day.
2032 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The bed capacity was 108 ; during the winter 80 ; and during a crisis
expansion 150 cases were present in the hospital.
The skin service instituted an ambulatory treatment of scabies and
lice cases, which saved a great deal of hospitalization. All cases in
the district as soon as recognized were sent to the clinic, with their
complete equipment. The men's clothing and bedding were ster-
ilized in a large, portable sterilizer, Avhile the men were given hot
batlis and sulphur rubs. This process was repeated twice, each time
the man's entire equipment being sterilized; this was eifective in
almost all cases. Onl}' well-marked pyodermias were admitted to
the hospital.
January 28, 1919, the hospital was abandoned.
G. HOSPITAL, NO. 21.
The American Women's War Hospital was opened in September,
1914, at Paignton, Devon, England, as an expression of sympathy
of America for Great Britain, by a committee of American women
living in England. The American Red Cross furnished a unit of
seven doctors as a surgical staff and the hospital was conducted as
opened until January 1, 1918, when it was taken over by the Ameri-
can Red Cross under the name of the American Red Cross Hospital
No. 21. Word was received on July 4 that the United States Army had
taken over the hospital under the name of the American Red Cross
Military Hospital No. 21, formal transfer being effective on August
17, 1918.
Originally the hospital had a capacity of 255 beds, which was in-
creased to 375 when the hospital was taken over by the United States
Army. On September 26, 1918. the capacity was increased to 575
b}^ the taking over of the Redcliffe Hotel, which is situated on the
beach about one-half mile distant from the main building. The
normal capacity was increased to 700 in October, 1918, when the
Esplanade Hotel was taken over. The maximum number of patients
at any one time was 813.
H. AMERICAN RED CROSS HOSPITAL, PADOVA. ITALY.
This institution was established October 28, 1918, as a hospital for
members of the Aviation Corps. The building occupied was the
chemical laboratoiT of the medical university.
The bed capacity was small, also the personnel, consisting of 1
medical oiRcer. 10 nurses, and 3 Medical Department enlisted men.
The hospital was established primarily for the Air Service per-
sonnel. However, the doors were open to any American who re-
quired hospital attention. The Three hundred and thirty-second
Regiment of Infantry, during a severe epidemic of Spanish influenza,
saw fit to use it. and at one time during the height of the epidemic
there were 65 officers and men from this regiment alone in the hos-
pital.
The hospital was closed on March 30, 1919. due to the fact that all
American Red Cross personnel were leaving Italy.
A. E, F. BASE SECTIONS. 2033
7. Base Sections,
a. base section no. 1,
Tlie office of the surgecn, Base Section Xo. 1, American Expedi-
tionaiy Forces, France, was established at Xo. 2 Rue de I'Hotel de
Ville, St. Xazaire, on July 2, 1917, immediately after the arrival of
the first convoy of American troops in St. Xazaire.
Th6 space occupied by the office was one- fourth of a room used by
the base commander as a filing department. Xo office equipment
was then obtainable, except one small table and two chairs. The
first duties of the office consisted of (a) the establishment of infirm-
aries in and about the city of St. Xazaire, (b) the establishment of a
base hospital in the city (French Hospital Xo. 59, now Base Hos-
pital Xo. 101), (c) the assignment of Medical Department personnel
to camps and infirmaries, (d) the boarding of incoming transports,
inspections of personnel, etc., (e) the establishment of Medical De-
partment Avarehouses for incoming supplies and the forwarding of
these supplies to the medical supply depot being organized at Cosne,
or in the case of base hospital units, to the place where each unit was
to be located.
Practically no change in the duties of the office occurred until
August 4, 1917. when several organizations arrived from the United
States, including Base Hospitals Xos. 8 and 9. Base Hospital Xo. 8
was permanently assigned to Savenay, Loire Inferieure. This gave
two base hospitals and several small infirmaries to the supervision of
the office. During the latter part of August, 1917, Base Hospital
Xo. 27 was established at Angers.
Very early it was realized that the problem of protecting our men
against the ravages of venereal disease was to be one of our greatest
problems. This problem was made more difficult by the lack of co-
ordination between commanding officers of American organization
and the French officials. Besides the many cases of venereal dis-
eases developing from a French source, many were also arriving
from the United States, which facts called for extra vigilance on
the part of this office. Xumerous prophylaxis stations were estab-
lished in the city, instructions were sent to all troops in the section,
stating the conditions and giving advice as to methods for reducing
the chane of infection. A base urologist was assigned to the office to
have general charge of the venereal situation. With the steady ar-
rival from the United States of troops bringing many cases of dis-
ease, this office made still further efforts to improve the conditions in
St. Xazaire by the isolation and treatment of the cases arriving on
transports. Instructions were later issued for all the base ports, in
General Order Xo. 77, series of 1917, general headquarters, Ameri-
can Expeditionary Forces.
The base commander was on August 12, 1917. given blanket au-
thority to send patients to the United States Avho were recommended
by the disa])ility boards at tlie various hospitals in the section and
upon the approval of the base surgeon. From the middle of Sep-
tember to the 22d of ]May, 1918, tliis office sent to the United States
1,003 patients passed by the disability boards in the section.
The 1st of October found the office divided into three departments,
as follows :
2034 EEPORT OF THE SURGEOX GENERAL OF THE ARMY.
(a) Office proiDer, ■which consisted of general correspondence
branch, which handled reports, records, the establishment of hos-
pitals and infirmaries, the issning of instructions and information
to all surgeons in the section, and the inspection of transports ar-
riving at this port.
(b) Motor transportation branch, Avhich had charge of the receipt,
assembly, and delivery of this transportation to destinations over-
land.
(c) Medical property branch, which had charge of the receipt,
storing, and shipping to various points medical supplies arriving
on transports,
August, 1918: There were now established in the section 10 base
hospitals, 6 camp hospitals, 3 venereal segregation camps at large
troop centers, a large number of permanent infirmaries acting as
hospitals, and approximately 120 organizations with Medical Depart-
ment personnel attached, besides the casual troops in the section en
route to other sections.
For the purpose of aiding in the evacuation of patients from hos-
pitals and hospital trains, an evacuation motor ambulance battalion
was formed and stationed at Camp Xo. 1, under direct supervision
of this office.
At the present time the section comprises the French Departments
of Morbihan. Loire Inferieure. Maine et Loire, Deux Sevres, and
Vendee, over which is scattered the various hospitals and medical
detachments, with a total strength of 126,838 troops. The present
activities of the office are the evacuation of patients from hospitals
in the section to the United States, the maintenance of the hospitals
and infirmaries in operation, supervision of the sanitary conditions
of the section, the direction of the campaign against venereal dis-
eases, the control of Medical Department transportation, medical
supply depot, St. Xazaire, warehouses at ^Montoir and Xantes, and
the inspection of troops before departure for the L^nited States.
Liaison hranch. — A naval medical officer on the staff of the naval
port officer, acts as liaison officer between the Army and the Xavy
transports, so far as the evacuation of sick and wounded is concerned.
The duties of this officer are {a) to determine the suitability and
capacity of each ship and the number and classes of patients that it
can transport; (&) to transmit to the personnel branch any infor-
mation as to the arrival, departure, destination, change of plans,
etc., in the case of any ship; (c) to transmit to the personnel branch
information as to additional medical officers, enlisted personnel,
nurses, supplies, etc., that will be required by any ship.
Influenza and pneumonia.. — The history of the widespread epi-
demic of influenza of 1918-19 has been essentially the same in Base
Section Xo. 1 as throughout the rest of the American Expeditionary
Forces: that is. its appearance in a mild form during the summer
of 1918 to be followed by a subsidence and then an increase of its
incidence in the fall of 1918, with a marked tendency to develop
broncho-pneumonia as a complication and a high percentage of
mortality. There was a third wave in February, 1919.
The French population has been heavily affected at the same time.
Brittany and Vendee were considered by the French authorities as
being among the regions showing a particularly high incidence in
France.
A. E. F. BASE SECTIONS. 2035
Influenza and pneumonia were prevalent on some of the trans-
ports arriving at this port during Septeml)er. October, and Xovem-
ber. The prevalence on a convoy arriving Octol)er G and 7 was so
extensive that the figures in regard to it are given. .
This convoy consisted of eight ships, the Princess. Mato'ika^ the
Mongolia, the ^Vilhelinlna, the Pastores. the AiUlgone. the President
Grant, the Rl'jndam, and the Ascania. The arrival at this port
(Saint-Xazaire) was on the 6th and Tth of October. 1918. The total
troop strength aboard this convoy was i^-t.^flS'. The following table
shows the incidence and death rate :
Number.
Percent-
age of
total
convoy.
Cases of influenza and pneumonia during passage
Deaths from influenza and pneumonia during passage
2,610
265
10.663
1.083
New cases of influenza and pneumonia 5 days after debarkation
Deaths from influenza and pneumonia 5 days after debarkation
Total cases of influenza and pneumonia during passage and 5 davs after debarkation.
Total deaths from influenza and pneumonia during passage and o days after debarka-
tion ■
263
254
2,873
519
1.075
1.038
11. 738
2.121
Mortality percentage among the total 2,873 cases up to 5 davs after debarkation
18. 072
The above instance was without parallel, and it is believed that a
consideration of the figures alone will give an idea of the gravity of
the situation and the severity of the influenza epidemic at this time.
B. BASE SECTION NO, 2. SERVICES OF SUPPLY.
The facts of major significance in the develoi)ment of medical work-
in this base are arranged hereafter in the order of their occurrence:
July 28. 1917 : Arrival of Base Ho.spital Xo. (i at the Hospital Com-
plementaire Xo. 2.5 (French) at Talence. This hospital was not offi-
cially turned over to th.& Americans until Se[)tcmber 1. 1917.
August 2. 1917: United States Army Base Hospital Xo. 6 desig-
nated United States Army Base Hospital Xo. 4.
September 12. 1917: Medical Department activities in Bassens
dock area began with assignment of a medical officei' from the IStli
Engineers to duty with the Phoenix Construction Co., jurisdiction
confined to that camp. The sanitation of this area presented a prob-
lem of supreme difficulty (discussed under "Sanitation.").
September 21, 1917: T'nited States Army Base Hospital Xo. 4
redesignated United States Army Base Hospital Xo. C (Talence).
December 21, 1917: Meeting of French and American officials at
Bassens, giving Americans sanitary control over considerable area
beyond their actual working territory. The mayor of Bassens gave
the Americans hearty support.
]\rarch 3, 1918: Base Hospital Xo. ?> arri\ed at Montixiut, Dor-
dongne, organized formerly by Base Hospital Xo. 39 ( Haviland China
Factory).
June 10, 1918 : Arrival of Base Hospital No. 13 at Limoges. This
unit was formed in Chicago. Its location was in the Champs Juillet
section of Limoges.
142367— 19— VOL 2 67
2036 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
June '2'2, 1918 : Ai rival of Base Hospital Xo. 114 and Base Hospital
Xo. 22 at Beau Desert.
June 28. 1918: According to (leneral Order 2G, section 11. head-
quarters. Services of Supply, of this date, Charente Inferieure. for-
merly a part of Base Section Xo. 2, constituted Base Section Xo. 7.
On the other hand. Base Section Xo. 2 Avas made to include the De-
partments of Gironde, Charente. Haute- Vienne, Creuze, Correze,
Lot, Tarnet-Garonne, Haute Garonne, Ariege, Hautes Pyrenees,
Basses Pyrenees, Landes, Dordogne, Lot-et-Garonne, and Gers,
Thus while this office lost jurisdiction over the medical work of Roche-
fort and La Rochelle (including La Pallice), it took over the impor-
tant center at Limoges, the camp hospital at La Courtine, future
formations at Angouleme, and Perigueux. The extent of the base
was approximately doubled, with medical responsibilities likewise
increased.
August 19, 1918: The hospital at Camp St. Sulpice designated as
Camp Hospital Xo. 66.
September 1, 1918: Hotel du Globe at Limoges occupied by head-
quarters. Limoges hospital center.
September 12, 1918: Camp hospital construction at Dax reported
complete. 72 beds being ready for use.
September 15, 1918: Camp Hospital Xo. 54 established, especially
for the sick and injured of the 84th Division, headquarters at Xeuvic.
Location of hospital was in the Chateau La Roche Beaulieu. near
Razac, Dordogne.
September 18, 1918 : Arrival of Base Hospital Xo. 84 at Perigueux.
Xovember 8, 1918: The "Caserne Carayon-Latour " at Bordeaux
was announced by the chief surgeon American Expeditionary Forces
as Base Hospital Xo. 220. This hospital never became more than a
name, however, because of the armistice of Xovember 11.
Xovember 10. 1918: Arrival of Base Hospital Xo. 106 at Beau
Desert.
Xovember 11, 1918: The armistice. Hospital construction was
generally stopped. At this time the hospitals were taxed to their
limit, e. g.. Base Hospital Xo. 6 with 4,500 patients and a normal
capacity of only half that number. After about two Aveeks the hos-
pitals resumed more nornuil functioning.
Xovember 19, 1918: Base Hospital Xo. 71, at Pau, assigned by
chief surgeon American Expeditionary Forces.
Xovember 23, 1918 : Base Hosjjital Xo. 95 assigned by chief sur-
geon American Expeditionary Forces to hospital center at Peri-
gueux.
Xovember 24, 1918: Arrival of Base Hospital X^o. 104 at Beau
Desert.
Xovember 24, 1918 : Rest Camps Xos. 2 and 1 were officially consoli-
dated as the Bordeaux embarkation camp.
Beau Desert hospital center was made the collecting point for con-
valescents, etc., returning to the States. Extensive arrangements
were made by the base surgeon for the care of patients during trans-
fer from train and hospital to the ships. Likewise, examination of
all troops embarking from this port, with appropriate measures of
disinfection and disinfestation, were provided for.
X'ovember 27, 1918: Base Hospital Xo. Ill arrived at Beau Desert.
A. E. F. BASE SECTIONS. 2037
Xoveiuber 27, 1918 : The Sierra left this port with the lir.st install-
ment of convalescents, etc., for the States. There were 1,435 officers
and men evacuated.
Xoveniljer ;^8, 1918 : The Tenmlorvx. left this port with the second
oroup of convalescents, etc.. evacuated to the States (853 men and
officers).
November 29, 1918 : Base Hospital Xo. 121 arrived at Beau Desert.
December IG, 1918 : Camp Hospital Xo. 78 at Razac closed.
December 10, 1918: Camp Hospital Xo. 102 at Yirelade opened.
Sanitation. — The first serious problem for sanitation for the medi-
cal departments of this base to solve was that of the Bassens dock
area.
Amono- the nationalities working- there might be mentioned 5,000
Anamites, 200 Spanish, 300 Chinese, German prisoners, Xeg-roes,
and French peasants, all with primitive ideas of sanitation. The
land was marshy, covered with reeds, underbrush, and filth of long
standing. Labor was commandeered from along the Anamites for
the correction of these conditions, while a small medical detachment
instituted a strenuous educational campaign among these foreign
inhabitants. In December, 1917, an enlarged medical department
was established for the dock area, and shortly aftei'wards a pier
was built, cut into the Garonne River, to dispose of garbage and
refuse from the whole area (as well as from the rest camps and
several other American institutions). The opening and cleaning of
drainage ditches, the removal of refuse of years' standing from the
rears of old chateaux, and the draining of the swamps and marshes
were the features of the ensuing labors. The sanitary inspector for
the base was instrumental in remedying various conditions endan-
gering the health of our troops both in the Bassens area, the rest
camps near by, the camps to the south of Bordeaux, etc. Concerning
the disposal of feces, urine, and garbage in the dock and rest-camp
area he says :
This had been done most unsatisfactorily hy French contractors, using
French trucks, (Jerinan labor, and American f-asoline. The advent of any
large nunilier of troops in the camps caused th.^ entii-e system to fall (\o\\\\
and the work to be eventually done l>y our own men. Due to the condition
of the ground and the number of troops in this area pit latrines were im-
practicable, so tlie Tinnette type of latrine was standardized throughout.
A regular truck .service, with American trucks and drivers, was maintained.
This system has stood the test of six months' trial and has served as high
as 20,000 troops.
'\\\\\\ the beginning of summer (1918) an epidemic of dysentery
and diarrhea sprang up in the forestry camps to the south of Bor-
deaux and afterwards spread throughout practically the entire base
section. A constructive campaign was begun and carried out for
the elimination of all breeding places of flies and tlie safeguarding
against the possibility of contamination. As was to be expected, this
was carried out with varying degrees of efficienc}' in different areas,
but its immediate result Avas the diminishing of the incidence of
dysentery and diarrhea and the aAvakening of all officers in the base
section to the need of certain sanitary principles which had not been
considered of sufficient importance during the winter months.
Urology. — The first matter of urological interest in this base was
the establishment of a prophylaxis station at headquarters in Bor-
deaux on September 22, 1917. Arrangements were made with the
French military laboratory about October 1, 1917, for Wassermann
2038 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
examination of blood for members of the American Expeditionary
Forces.
Measures wliich the department endeavored to carry out Avere:
1. Familiarizino- all new units with (leneral Orders Nos. G and 34,
and information as to the prevalence of venereal disease in Bor-
deaux.
2. The establishment of prophylactic stations in and about Bor-
deaux; a standardized equipment for the stations and method of
proiDhjdaxis ; distribution of cards bearing the location of stations
to all new units.
3. Cooperation with the French civil authorities.
4. Standardization and oversight of the treatment of venereal dis-
ease in camp infirmaries and dispensaries.
The success of the efforts described above is reflected in the vastly
lowered venereal rate of the base section; the highest rate for any
one week was February 28, 1918 (325 per 1,000 per year), and the
lowest, after some time had permitted the w^ork to bear fruit, that
of September 11, 1918, at 39. The average rate per month is as
follows: April, 150.30; May, 153.57; June, 82.08; Julv, 71.76; Au-
gust, 60.42 ; September, 51.28.
Once a month the commanding general publishes a list of high
venereal rates, and a plan is being devised to punish organizations
with high rates either by confinement to camp, including officers, or
shortening pass privileges to three hours and compulsory prophy-
laxis.
Early in April there appeared in many parts of the base an acute,
highly infectious fever of three days' duration, variously styled
"Spanish flu," " three-day fever," " influenza," and " Pappatacci
fever." Influenza not being at that time a reportable disease, the
exact number of cases was unobtainable. In many organizations,
however, 25 per cent of the men were affected within three weeks.
The outl)reak was reported from Rest Camp No. 4, beginning April
8 and ending May 20. At St. Sulpice there were two outbreaks, the
first beginning May 6 and ending June 3, the second beginning July
15 and ending September 30. The second, though coming shortly
after the first, was marked by longer duration of the disease and by
a considerable per cent of complicating pneumonia, with a mortality
of about 35 per cent. From Mimizan there was reported an epidemic
on July 22, Of the three places where this epidemic prevailed —
Pleyers, Lamanche, and Mimizan — Pleyers showed a much milder
type of disease than elsewhere — fever from 3 to 14 days, prostra-
tion, slow pulse, and marked bronchitis. From Lamanche, in addi-
tion to these symptoms, a marked elevation of fever was noticed
after the temperature had been normal for a day or two (with
delirium), syanosis, and patchy consolidation of one or more lobes
of the lungs. The base epidemiologist considered that there were
two distinct epidemics in this region, one of so-called influenza, the
other of broncho-pneumonia. The latter was j^robably the former
with a secondary infection. There were eight fatal cases, of which
five were autopsied at the base laboratory. All of them showed
extensive consolidation of the lungs, usually patchy in character.
From the lungs of six gram-negative diplococci and streptococci
were isolated. They were morphologically and culturally identical
with meningicocci. The cultures from four of these cases aggluti-
A. E. F. — BASE SECTIONS. 2039
nated with polyvalent antimeningicoccus serum and not with normal
horse serum. The organisms typed were C and B. Of 17 blood cul-
tures taken from patients sick with the disease, 2 only showed any
growth — a gram-negative diplocdccus in pure culture. Thirty-six
nasopharyngeal cultures from early acute cases showed in 36 per cent
a gram-negative diplococcus. Conclusion is drawn that the probable
cause of " Spanish influenza " is a gram-negative diplococcus of the
meningitis gi'oup.
C. BASE SF.CTIOX NO. :{.
A.' HOSI'ITALIZATIOX IX KNCLAND.
The problem of American hospitalization in England has pre-
sented a number of interesting features. Until the German offensive
of March. 1018, it had not l)een intended to evacuate American sick
and wounded from France to England. Previous to that time, the
hospitalization scheme contemj)lated merely the providing of suffi-
cient camp ho.spitalization to care for the sick from troops passing
through England en route from the I.^nited States to France. AVhen
it was decided to brigade American trooi)s with the British as combat
units, it threw an entirely new aspect on the problem, since it ])ecame
inevitable that considerable numbers of American sick and wounded
would be evacuated from tlie Britisli line to England. Authority
was granted to stop a certain numl)er of base hospital organizations
en route through England (four were actually stoj^ped) and the
problem became one of providing suitable sites and buildings for
hospital purposes.
The general scheme for hospitalization adopted in June. 1018, pro-
vided for a total of 25,000 beds. The capacity of the buildings ex-
isting on the various sites enumerated above Avas only about 0,880,
so that a considerable hospital construction program had to be car-
ried out. This was accomplished through various channels. At
C'amp Efford the reconstruction was in the hands of the royal engi-
neers. At Knotty Ash. Liverpool, the ( onstruction of the camp
hospital of 500 beds, entirely new construction, was also in the hands
of the royal engineers. Construction at Mossley Hill. Romsey. and
Sarisbury was handled by the American Red Cross and that at Dart-
ford, Tottenham. Poi-tsmouth. and ITursley Park, at each of which
l>h)cks of new pavillion wards were contemplated, was in the hands
ot the Corps of Engineers. United States Army. For the new blocks
at the live base hospitals, a uniform type of Avard building, contain-
ing GO to 100 beds, Avas adopted. The general scope of the hospitali-
zation program and the progress made up to December 1. 1018. is in-
dictated in Table I. A glance at figure 2. Avhich shoAvs graphically
the total cases sick in hosjiitals in England, both in Amei'ican and
British hospitals, together Avith the capacity of the American hos-
pitals. Avill shoAv to Avhat extent hos))italization kept pace Avith de-
uiand for hospital beds.
The second i)hase of the problem, namely, providing hospital ac-
commodation for sick and Avounded from France, began Avith the ar-
riA'al of the base surgeon on May 18. 1018.
The British Army made two offers. One the conversion of a camp
at Fort Efford, near Plymouth, into a hosjiital. The other the ex-
pansion of the hospital at Hursley Park. Avhich previously, as noted
2040 REPORT OF THE SURGEON GENERAL OF THE ARMY.
above, had been to all intents and purposes a camp hospital, into a
base hospital, by converting a group of camp buildings close by into
wards. Botli offers were accepted. Xo base hospital organization
was ever se<?ured for Hursley Park, but the staff of Unit I was in-
creased by the addition of casual ])ersonnel. and the! hospital was
designated as Base Hospital Xo. -204: on September -24. The Efford
Hosi)ital was never opened for patients, although at the time the
armistice was signed the reconstruction was progressing favorably.
The personnel of Base Hospital Xo. 37 were there from the* time
of their arrival in England, June 4. 1918, until July 18, 1918, and it
was originally planned to ke'ep them there, but tlie reconstruction
was progressing very slowly, and hence they were moved to Dart-
ford, where they could receive patients at once.
Civilian British bodies have been the greatest service to the Med-
ical Department. The splendid Portsmouth Borough Asylum was
handed over, rent free, for use as an American war hospital. This
was taken over and operated by the personnel of Base Hospital No.
33. from Albany, X. Y. In a similar way the metropolitan asylums
board gave the use of two contagious-disease hospitals, near London,
also rent free to the United States. The first of these, the Upper
Southern Hospital, at Dartford, Kent, has been operated by Base
Hospital Xo. 37 from Kings County Hospital. Brooklyn, and the
second, the Xortheastern Fever Hospital, Tottenliam, has been op-
erated by Base Hospital Xo. 29. from Denver, Colo.
Another base hospital project was that at Sarisbur}^ Court, Hants,
an estate of about 170 acres. This was purchased outright by the
American Red Cross and the construction of a 3,000-bed hospital was
undertaken by them, to be turned over to the Army for operation.
The 3,000-bed project was reduced to 1,200 on the signing of the
armistice, and the personnel of Base Hospital No. 40, from Lexing-
ton. Ky.. having been stationed there, began to receive patients from
September 4, 1918.
In addition to the base hospital the two military Red Cross hos-
pitals— Xo. 4. at Mossley Hill. Liverpool, and Xo. 21, at Paignton,
Devonshire — fulfilled the functions of base hospitals. The American
Red Cross Officers- Hospital at Lancaster Gate, Hyde Park, and St.
Katherine's Lodge, Regent's Park, London, were taken over by the
American service, and in so far as the medical and surgical care of
patients was concerned were maintained as wards of Base Hospital
No. 29 at Tottenham. St. Katherine's Lodge was loaned to us.
A hospital project was also under way, under the auspices of the
British Red Cross, at Richmond Park, where the}' were constructing
a 500-bed hospital, which was to be given to the American Red Cross
upon completion. It had not progressed very far on December 1,
1918. and had not been turned over to the American on that date.
In the matter of convalescent hospitals and camjDs nothing very
much was ever accomplished. The casual camp at Winchester was
used as a convalescent camp to a certain extent, and a portion of the
rest camp at Standon. Hants, was used as a contact camp through the
summer of 1918. An excellent officers' convalescent hospital was
run under the auspices of the American Red Cross, and a convales-
cent home for nurses was run by the American Red Cross at Putney.
A small and most excellent convalescent home for soldiers was pro-
vided.
A. E. F. BASE SECTIONS. 2041
About half of the authorized beds were actually ready for occu-
pancy on November 11, at the tmie of the signmg of the armistice,
when most construction was stopped and the balance in sight, and
would have been ready in a few weeks' time. From the time of the
first reception of patients a larger number of beds could have been
in operation on November 11 had it been possible to secure personnel,
but the greater need in France prevented this. The Menston hos-
pital could have been occupied in the early fall and other buildings
could have been requisitioned for hospital purposes, had personnel
been available. Base Section 3 has had at all times as many beds
ready for patients as the available personnel could properly operate.
At the time the armistice was signed 20,000 base hospital beds
had been authorized in England, new construction was about 50
per cent completed, and could have been wholly finished in about two
months more. The total number of beds available at the time were
as follows:
Available
emer-
gency.
Total beds in base hospltab 6, 600 1, 250
Total beds in camp hospitals 1, 420 500
Total
Grand total normal and emergency beds
The Menston Asylum in Yorkshire was offered by the trustees
through the board of control, as a war hospital, and had hostilities
not ceased, would have been taken over.
Figure 2 shows that up to September 30, 1918, the suppl}" of
American hospital beds generally met or exceeded the demand.
From September 30 to December 2 it did not, and considerable num-
bers had to be sent to British hospitals. This was largely due to
the influenza epidemic. At other times a certain number of cases
have found their way into British hospitals, but this was due to
causes other than the lack of American beds.
Bl. EVACUATION TO THE UNITED STATES.
Shortly after the signing of the armistice orders having been
received to transfer certain cases to the United States, the emptying
process began. As very few hospital ships were available patients
had to be sent on transports as opportunity for their proper care
arose. The majority embarked at Liverpool. ]Most of the trans-
ports could accommodate a few. The large shipments were as
follows :
On December 4 the Leviathan embarked from Liverpool 1,425
patients, of whom lOG were litter cases.
On December 15 the Sasconia was fitted as a temporary hospital
ship and embarked 1.345 cases, of whom 160 were litter cases from
Till)ury.
On December 23 the Maurctania received 327 patients, including
156 litter cases, in Southampton.
2042 REPORT OF THE SURGEON GENERAL OF THE ARMY.
On January ^^ a real hospital shij) became available for the first
time, and 'Jl.") of the worst litter cases fit for transportation were
embarked at Plymouth.
D. BASE SECTION NO. 4.
October 3, 1917 : This day marked the opening of medical activities
at this base.
March 5, 1918 : About this date the surgeon's office was moA-ed from
the main headquarters building to annex at Xo. 48 rue Lord
Kitchener.
April 1, 1918: Hotel des Xegociants ( Y. M. C. A. hotel for enlisted
men) opened this date with medical sergeant installed as attendant
in prophylaxis room.
April 2 to July 1, 1918: This period saw the establishment of
infirmaries and prophylaxis stations in Camp No. 1-B, motor recep-
tion park and military police barracks.
July 1, 1918: At this time this office was exercising medical super-
vision over the permanent garrison stationed in and around Havre
and the casual troops passing through this port. There were eight
prophylactic stations and dispensaries in charge of Medical Depart-
ment personnel located in the various camps and central stations in
town. The permanent garrison then consisted of approximately
1,000 men Avith a daily casual inflow of 5,000.
August IG, 1918: Through orders from headquarters. Services of
Supply, all American hospitals serving with tlie British in this base
section were put under the administration of tliis office for disciplin-
ary purposes, thereby increasing the scope of its work.
August 23, 1918 : Barracks at Park No. 3 for about 300 men, mostly
checkers on the docks, were occupied, thus creating a new disi^ensary
and infirmary with its attendant needs. At the same time a bakery
company was put in operation in the same camp.
August 30, 1918: About this date three new additions to the Medi-
cal Department have been authorized for this base port, viz, camp
hospital, base supply depot, and base laboratory. At the present
time all these are in the embryo stage, though the necessary construc-
tion, remodeling, etc., will be started.
September 30, 1918: The Frascoti hospital has been taken over
from the French as a location for the American camp hospital au-
thorized for this port. It is expected that we will be able to formally
take over and occupy this building by the middle of October. The
2)ersonnel and equipment have both been requested and should arrive
about the time the French have finally evacuated. At this time it is
certainly badly needed as the influx of sick and wounded is growing.
October 30, 1918 : On this date, although the formal transfer of the
Flotel Frascati has not been accomplished, the hospital was organized
as Camp Hospital No. 82. This action has been taken with a view to
expedite the actual opening. The personnel has been ordered to re-
port and should be here within a few days.
November 18, 1918: The section surgeon on return from consulta-
tion with the chief surgeon at Tours, in Avhich it was indicated that
all possible retrenchment in activities should be made, immediately
took steps to this end. The project for base medical supply depot,
plans for which had been made and approved, was definitely dropped.
A. E. F. BASE SECTIONS. 2043
" Ecole de Piedfort," which had been authorized as extension to
Frascati hospital, was turned back to the French. Fortunately no
papers had been signed as to taking it over. Contract had been made
by the Red Cross for construction of 80,000-franc amusement build-
ing in the yard of Frascati hospital and this contract was dropped.
Plans for construction of barracks to house enlisted personnel of tlie
hospital had been made and approved but fortunately the work not
started and this was canceled.
December 16, 1918 : Camp No. 1-B was closed as an American camp.
Medical supplies and personnel taken in and the hut abandoned.
December 23, 1918 : Camp Xo. 1-A Avas closed as an American
camp and turned over to English. ^Medical supplies and personnel
taken in and hut abandoned.
E. IN BASE SECTION NO. 5.
The history of all these activities falls naturally into two periods,
one the period before the armistice, when Brest and Cherbourg, were
ports of debarkation, and the other the period since signing of the
armistice, with the direction of troop travel reversed and Brest the
largest port of embarkation in the American Expeditionary Forces.
From being in the beginning a small French port, Brest has
grown until at the present time troops to the number of 150.000,
and great quantities of supplies are handled monthly. The per-
sonnel for handling troops has increased from 1,200 to 1,300, until
at the present time it numbers about 30,000, including stevedores,
engineers, (luartermaster troops, large numbers of military police.
Medical Department soldiers, etc. From hospitalization in the small
French hospital, which could accommodate about 50 patients, the
hospital facilities of the base have accommodated as high as 6,200 at
one time, and more than 70,000 sick and wounded have been handled
altogether.
These increases in such a short time have necessitated many
changes in the methods of administration and division of labor, but
the most pressing difficulty that was encountered in the prearmistice
period was the lack of sufficient supplies and personnel. Since the
armistice this has been remedied and now the embarkation camp,
the hospitals, and infirmaries have, been brought as nearly to a state
of perfection as climatic conditions will permit. The greatest draw-
back to Brest as a port or location for base hospitals is the almost
constant rain and consequent mud, due to the passing of thousands
of men, motors, and animals daily.
Aecount of early activltiefi of hose surgeon's office. — The personnel
for the opening of Brest arrived November 11, 1917. The Medical
Department personnel consisted of one medical officer and one en-
listed man recently recruited. At this time the hospitals that were
operating in Brest were Xavy Base Hospital Xo. 5, to serve the per-
sonnel on American naval transports based on this port, and the French
marine hospital, which served the same function for the French
naval forces. Arrangements were made with the commanding
officers of these hospitals for the care of such sick and wounded as
might be among troops arriving. Xavy Base Hospital Xo. 5 had a
total capacity of about 40 beds and was in process of moving to a
larger building, where the capacity became about 400. All these
2044 REPORT OF THE SUEGEON GENERAL OF THE ARMY.
beds -were not available for the Army, but as many as could bo
spared were freely oiven and the heartiest cooperation was rendered.
The number of beds available at the French marine hospital was
between lt)0 and 150.
On XoA'ember, 1917, the first convoy, consisting of the U. S. S.
America, Againeinnon, Mount Vernan, and Yon Steuben, arrived,
brinoing about 12,000 troops. With the help of the Xavy a small
o])en speed boat was obtained for the transfer of the sick ashore.
Two Xav}' ambulances were available to transfer these cases from
the dock to hospitals. The French marine hospital Avas used for
infectious diseases. The sick on the first convoy consisted of cere-
brospinal meningitis, mumps, measles, pneumonia, and other less-
serious infections. The same type of diseases prevailed on all sub-
sequent convoy's with diphtheria and scarlet fever added. During
the winter months pneumonia cases were prevalent. Owing to the
fact that at this season it rains constantly and that there are no
available docks for big vessels, which must anchor in the open road
some distance from shore, pneumonia cases just prior to, during, or
just following the crisis, were left aboard the transports for return
to the United States. This procedure served two purposes, first,
the patient was not subjected to the danger of excessive and diffi-
cult handling with its concomitant excitement and, therefore, under
the conditions had the most favorable opportunity for recovery;
secondly, these cases would have required a long convalescence and,
judging from cases developing ashore, a large percentage had a
complicating empyema and were eventually returned to the United
States without having been physically fit for any service in the
American Expeditionary Forces.
The sick were cared for in the above-mentioned hospitals by the
personnel of these institutions, the sick and wounded records being
kept in the office of the base surgeon.
Xo camp was available for the debarkation of these first and
many subsequent-arriving troops. Instead of transporting troops
ashore and placing them in shelter tents in the cold, rain, and mud,
they were retained aboard transports, where there were appliances
for cooking and disposal of sewage and waste. As soon as trains
were availalde troops were debarked directly from boats to trains.
This delayed the unloading of transports, but it is believed was for
the best interest of the health of the troops.
During the month of December, 1917. Xavy Base Hospital Xo. 1
was established in a building (Petit Lysee) in the city of Brest.
The capacity of this hospital was about 417 beds. The personnel
was Xavy, and the unit was loaned to the Army, and cared for
Army patients.
Late in December, 1917, or early in January, 1918, with a limited
commissioned and enlisted personnel, a hospital later designated as
Camp Hospital Xo. 33 was established at Pontanezen Barracks.
This hospital had a capacity of about 200 beds, which was gradually
increased to 500 beds.
As far as possible noninfectious cases were sent to Xavy Base
Hospital Xo. 1, and infectious cases to Camp Hopital Xo. 33. With
cases in Xavy Base Hospital Xo. 5 and the French marine hospital,
which were gradually emptied through discharge, and with the
knowledge that these hospitals could be used as a reserve in case of
A. E. F. BASE SECTIONS. 2045
emero-ency, the available beds were sufficient for the estimated
capacity and contemplated use of Brest as submitted by the board
which investiofated the port — i. e.. 20.000 troops and 5.000 tons of
freight per month — the number of enterino; troops rapidly exceeded
the orioinal estimate, and Avliile the hospital facilities were at times
strained patients Avere given efficient treatment.
The removal of sick and wounded from transports to hospitals
ashore, and vice versa, has been accomplished by small launches.
In view of the fact that litter cases, because of safety, must be
carried on stoked litters and on the suiall boat transferred to an
Army litter, the evacuation is slow. During the winter months
there is considerable rain, and because the larger transports anchor
in the open road the patients are exposed to a rough sea. This
makes the evacuation of cases, especially litter ones, more difficult
than would be the case were it possible to have had dock facilities.
Brest was and is deficient in sanitary appliances. Without a
sewerage system, it was and is still necessary to use the bucket type
of latrine. The })uckets were emptied by contract with the French.
This arrangement, because of dual control, was not satisfactory.
Tlie AVater supjdy was limited and the quality not safe for drink-
ing. The water for drinking purposes was chlorinated and stored
:n Lyster bags. Becsiuse of limited amount of water, bathing facili-
ties were reduced. This condition was improved l)y storage of the
water in the Penfield River. This source was also contaminated and
required treatment in Lyster bags.
Aecounf of early days of hose. — Brest became a port of debarka-
tion for the American Expeditionary Forces November 12. 1917.
when a convoy of four transports, the American. Mount Venwn,
Agamrmnon. and Von Sfeuhc/i. arrived. These ships were all con-
verted interned German liners, and this was the first convoy of in-
terned (xeruian ships to cross the Atlantic with American troops
aboard. The total number of troops to arrive on this convoy num-
bered approximately 11,000. The Anwrlcan carried more troops
(5,1:00) on this trip than on any other later voyage. Her passenger
list included five companies of the 301st Stevedore Regiment.
The liealth of the troops aboard ship was good. Tavo deaths oc-
curred among the stevedores, one due to cerebrospinal meningitis.
Mumps, measles, and influenza of a mild type were the prevailing
diseases aboard ship.
Of the troojjs of this convoy, only three companies of the 301st
Stevedore Regiment were held at this port. On the morning of No-
vember 13 the surgeon of the 301st Stevedore Regiment went ashore
with a detachment of Medical Corps for the purpose of inspecting,
cleaning, and disinfecting quarters to be occupied by the stevedores.
These three companies totaled approximately 550 men. In addition
there was a Hospital Corps detachment of 2S and a nont-ommissioned
white staff, making the total about 000. They were disembarked
later that day and (juartered in the barrack building of Quartier
Fortress, occupying quarters vacated the day before by Portuguese
troops. French troops were at the same time occupying quarters in
this building not used by stevedores. The base connnander. Col.
Bash, and a part of his staff had only arrived on November 10, so
that the organization of the base has scarcely begun.
2046 REPORT OF THE SURGEOlSr GENERAL OF THE ARMY.
The weatluT coiulitions were typical of Brest for the season — it
rained practically all the time. There Avere many difficulties that
stood between the first service organizations stationed at this port
and the ordinary necessities and sanitary comforts of life. There
Avas no means of transportation, no trucks, so that Ave Avere entirely
dependent for such necessities as Avell as fuel upon the French, Avho,
it appeared, did their utmost Avith the spirit of Avillinfrness to help
our })eople to overcome these difficulties. They furnished expert
mechanics, as far as possible, and divided Avith our troops their lim-
ited supply of fuel.
At the time of our arrival Naval Base Hospital No. 5 was partly
organized for the purpose of caring for patients of the Navy. Navy
Base Hospital No. 1 Avas being organized for Army sick and wounded.
During the first three weeks after our arrival, cases of contagious and
infectious diseases were transferred to the French naval marine hos-
pital. This hospital cared for this class of patients until the estab-
lishment of Camp Hospital No. 33 at Pontanezen in January, 1918;
all other patients Avere transferred to NaA\v Base Hospital No. 1. It
is safe to make the assertion that from the A^ery beginning there Avere
ample and excellent hospital facilities at this base; the ambulance
service of NaA^y Base Hospital No. 1 was especially satisfactory.
At this time the city Avas patrolled by sailors, though a small de-
tachment of marines was doing guard duty on the docks. A part of
this detachment Avas quartered at Port du Commerce, and the rest of
the organization at Pontanezen. The stevedores Avere the only serv-
ice detachment in the port. There was scarcely enough water for
drinking and cooking purposes. The supply was insufficient for
bathing, and thei'e Avere no bathing facilities.
Fuel Avas scarce, and in consequence the heating of the squad rooms
Avas inadequate. The officers billeted at hotels and private apart-
ments became accustomed to doing without heat. Many of the steve-
dores came OA'er Avithout woolen clothes, some Avithout overcoats.
None had been issued rubber boots, and the consequence was that
most of them had colds as a result of loAvered body resistance, caused
by Avet and chilled bodies and feet, and the climatic conditions. All
this Avas conducive to diseases of the respiratory organs and their
accessory sinuses.
On November 29, 1917, the three companies of steA'edores moved to
Casemates Fautras, a more modern garrison in every respect, though
smaller in barrack room and much more limited in campus space.
After moving to Casemates Fautras the organization of the command
became more tangible. French soldiers Avere still in this garrison
and occupied the two upper and most hygienic floors of the barracks.
They did not A'acate for about tAvo weeks. This necessitated the
croAvding of the stevedores into the loAver squad rooms. These j-ooms
Avere later, in April, 1918, divided by floor partition into an upper
and loAver floor, thus increasing the floor space and at the same time
diminishing the air space, and im])airing ventilation and obstructing
entrance of light. Antiquated coal stoA^es Avere placed in these rooms,
but scarcity of fuel made their operation infrequent for some Aveeks.
The open straddle bucket latrine, sheltered, preA^ailed at that time,
and has ever since. The contents of these bucket containers were
daily removed by the French until the summer of 1918 when it was
taken over bv the Americans.
A. E. F. BASE SECTIONS. 2047
Food for the entire c-onimand Avas cooked at one small kitchen.
This was abundant, substantial, and usually well prepared. There
was no mess hall, and the men ate in the cliilling rain, very frequently
standino^ in deep mud.
The water at the hydrant was turned on for 2 hours every morn-
ing, during which time enougli had to be drawn and stored to last '24
hours. Laboratory tests shoAved that the water contained colon
bacilli. The health officer of Brest admitted that the presence of this
organism in the city water proved that the water was contaminated
by human excreta, but stated that it had been demonstrated to be too
attenuated to have any j)athological significance. The drinking water
was cldorinated from the beginning.
The stevedores were unseasoned and undisciplined, but amenable
to discipline. They came largely from the extreme southern States,
and as might be expected Avere especially sensitive to the chilling
dampness that they experienced here. They all had coughs, with
free expectoration, and they had the spitting habit, but soon became
accustomed to the use of expectoration cups or sand boxes. For
the first six weeks they marched to and from their Avork on the
docks, usually singing. Their hours Avere long and arduous. They
were uncomplaining, in fact their morale Avas excellent. Later on
they Avere transported to and from their Avork in trucks.
When convoys arrived, as a I'ule, a company of stevedores Avent
aboard the larger ships and remained there several days until they
were unloaded of cargo. These shi]) details, not infrequently, intro-
duced into the ])ost infectious diseases and body lice. Facilities for
combating the latter Avere indeed poor, there being no baths. Flat
irons Avere purchased in the open market, and lice-infected clothing
were ironed Avith hot irons by members of the hospital corps, AAhile
the men were given Avarm sponge baths and sponged off Avith gaso-
line. A number of French atomizers Avere also purchased in the
open market and the practice of spraying upper air passages of the
members of the command Avith Dobell's solution Avas inaugurated
and has been continued ever since. During the first months of the
establishment of this post it was routine to spray the throats Avith
Dobell's solution, believing that the phenol contained in this prepa-
ration Avas sufficiently germicidal to combat many strains of bac-
teria. Avhilc the alkaline effect of the soda, Avhich it contains, by
producing an anemia of the mucus membrane, makes it less vul-
nerable.
During the Avinter months daily sanitary inspections revealed too
many insanitary' conditions to enumerate. Drainage was entirely
overground; mud Avas A'ery deep throughout the grounds. Roads
Avere cut up by trucks and eventually Avell-nigh impassable. The
barracks Avere poorly policed. likeAvise the grounds and latrines.
Xeai'ly all of the company officers Avere away from the post all cla}'
attending to duties elscAvhere, and the post commander saAV the state
of affairs tliat existed very seldom indeed, being otherAvise engaged
or interested. When police details Avere requested or room order-
lies suggested, the reply Avas that they could not be spared, and that
the conditions that existed though insanitary Avere to be regarded
as the exigencies of Avar. The great delays in having improA'cments
made after they had been reconnnended during the early months of
the establishment of this base Avas, no doubt, due to the lack of
2048 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
material and man power. It Avas recommended that Avater shortage
be overcome by either sinking- an artesian well or devising a means
Avhereby rain water could be utilized. The latter suggestion was
np})rovetl during February, and a means was devised by which rain
water from the roof of the barracks building was collected into tank-
ards (large wine casks). "Weather conditions favored this ])lan dur-
ing the winter and early spring. Bathhouses and showers were con-
structed and by practicing economy there was, at all times, water on
hand sufficient to keep 12 Avarm shower baths in operation. An
effort was made to have each company given a half day off each
week to devote to their personal hygiene, to laundrying, and airing
of clothes. This recommendation was denied on the ground that
time could not be spared. Men, especially stevedores, up to the time
of the establishment of bathing facilities, suffered from pain, due
to callous formations and accumulation of dead skin on the soles of
their feet. This complaint now ceases. In ]March a portable steam
sterilizer was procured so that clothes and bedding could be sterilized
at the post, instead of being sent to a hospital for sterilization as
formerly.
The history of the hospitalization of tiiis base, which also em-
braces the medical history, is a history of many obstacles overcome
and of long hours of hard work by an insufficient personnel.
At the opening of the base, Xovember 12, 1917, there was no Ame]'i-
can hospitalization available, and French hospitals were utilized for
a short time until Xavy Base Hospital Xo. 1 was opened for the care
of Army sick, being operated by Xavy personnel. Xavy Base Hos-
pital Xo. 5, a purely naval institution, aided in the care of the sick
before Xavy Base Hospital Xo. 1 commenced operations.
This hospital is located in a building known as the Petit Lysee,
in the city of Brest proper, and has a capacity of 450 beds, but this
capacity in times of stress has been expanded to nearly TOO.
In January', 1918, there was established at Pontanezen Barracks^
now known as Camp Pontanezen, a small hospital which it was
thought would care for the sick from troops passing through, since
the}' would be there only a short time. This hospital of about 200-
bed' capacity was taken over by a unit known as Camp Hospital
Xo. 33, made up from personnel withdrawn from organizations pass-
ing through en route to the front. It was located in what was
former!}' a French hospital, a stone building situated near the east
wall. To this was added Adrian Barracks as material could be
obtained, and, as this hospital had to care not only for the sick from
the troops in camp, but also for the accumulation of sick from the
voyage across the Atlantic, for those left behind by organizations
going to the front, for the sick from the permanent troops at Brest
and Pontanezen, and for the accommodation of sick and wounded
being returned from the front for evacuation to the United States,
it Avas necessary to expand it to many times its then capacity.
In May, 1918, at the time the present base surgeon assumed his
duties, he recommended and had constructed a hospital to care for
contagious diseases which was situated outside the walls of Ponta-
nezen Barracks but made an integral part of Camp Hospital Xo. 33.
It was proposed to establish at Landerneau, about 30 kilometers
from Brest, a base hospital with a capacity of 12,000 beds and in
June. 1918, as a nucleus for this organization, there was established
A. E. F. BASE SECTIONS. 2049
in a convent at Landerneau a hospital with a bed capacity of 250,
known as Camp Hospital Xo. 46. Due to the armistice, this capacity
was not increased, and the hospital has been used as a convalescent
hospital for troops sent back from the front and from the hospitals
in Brest and vicinity. Durino; the epidemic of the fall of 1918 it
was necessary to use this hospital for the care of influenza-pneumonia
patients taken from transports, because all other hospitals were filled.
After the armistice this hospital continued in service until March 31,
when it was closed and the buildinir returned to the French. During
the last few months of its service this hospital was used as a venereal
hospital for the accomuiodation of complicated cases of venereal
disease requiring hospital care, and due to its isolated location it
Avas an ideal place for this purpose.
It was the intention to establish at Kerhuon, about 5 kilometers
from Brest, on the hill overlooking Brest Harbor, a hospital for the
evacuation of sick and wounded, with a capacity of 12.000 beds.
Construction was begun in August, 1918, of a 4,000-bed unit at this
l)lace, but before it was ready for occupancy it was forced to receive
large numbers of patients from transports, and on September 25 it
commenced operating by receiving 625 cases of influenza and pneu-
monia and has operated ever since. The present capacity of this
hospital is 4,000 beds and it is used as an evacuation hospital, caring
at the same time for a very few of the permanent troops of the base.
From September 25, when this hospital opened, until after the sign-
ing of the armistice, this hospital cared for large numbers of sick
and wounded arriving on transports, but since the armistice this hos-
pital has functioned as the evacuation hospital for the port. Here
patients are received from hospital trains and every preparation
made for their comfort Avhile en route, their pay, e(iuipment, etc..
before being put on ships.
The hospitalization at the port of Cherbourg has been taken care
of by the British under the agreement by which duplication of hos-
pitalization by the Allies has been avoided. Four medical officers
and 21 Medical Department soldiers were located there. This port
was closed December 27, 1918. and medical records forwarded to the
office of the chief surgeon. American Expeditionary Forces. In all.
179,911 troops were landed there.
Owing to the discontinuance of the French military hospital at
St. Malo, it became necessar^^ on April 1 to establish a hospital there
to care for the hospitalization necessary in the Brittany lea\'e area.
This hospital is located in the building known as the Maison Mathias.
St. Servan, Hie et Yillaine. This hospital is called the Brittany
leave area hospital, and is at present in operation Avith a capacity of
oO beds.
By the 1st of November, 1918, the epidemic of influenza-pneu-
monia had definitely subsided at this port. The usual pneumonic
aftermath of empyema cases were soon the only reminders of the
terrible experience. As rapidly as could be the hospital was thor-
-oughly cleaned, blankets disinfected, and preparations made for tlie
reception of sick and wounded en route to the Tnited States. The
first hospital train from the forward areas was I'eceived October 26,
1918. The hospital staff had been considerable augmented by the
acquisition of several groups of casual medical officers, mostly of
2050 REPORT OF THE SURGEON GENERAL OF THE ARMY.
poor (luality. and now the character of the inconiino- cases compelletl"
a readjustment of the staff on a surgical basis. Whereas up to this
time the cases were ahnost wholly medical, they now became almost
wholly surgical.
The evacuation of patients to the transports presented wholly new
problems, and there was no precedent for the methods to be cm-
ployed. The vast majority of the patients arrived with very meager
data, and inadequately equipped for returning to tlie United States.
Their evacuation was imperative, however, for trains of patients
were arriving daily. For example, 1,-592 were received from hos-
pital trains on November 21, 1918. Unquestionably many cases were
evacuated to transports who should not have been transferred to this
center from the base hospitals of the forward areas. This urgent
transport of sick and wounded was a grave error of policy, which
was soon discovered and corrected. Several base hospitals evacuated
their patients " en bloc '* to Kerhuon, where they arrived after a
journey of three or more days. Many of these cases were such as to
render daily dressings necessary, and these were apparently not done
on the hospital trains. All in all, however, the movement of patients
into the hospital by ambulances from Kerhuon station or Brest, and
thence to the boats, has been accomplished with less trouble than w^as
anticipated, considering the miserable condition of the roads and
walks. Xine thousand two hundred and fifty cases have been evac-
uated to the United States up to the present day (Jan. 1-1, 1919).
The inadequate provision of the building plan for administrative
quarters and the operation of base hospitals as units has made the
functioning of several hospital units a matter of difficulty. l)ut it is
with some satisfaction that the personnel of all hospital units realize
that the past months of strenuous labor have been unmarred by a
single instance of lack of teamwork and that the service that has
been rendered in caring for the sick while in hospital and in evacua-
tion to transports has been conducted in a satisfactory manner.
The problems of sanitation in this base have been particularly
acute, l)ecause of the extremely disagreeable and dangerous climatic
conditions and the customs of the French people, which render
pollution of the water supply practically certain and the problem
of housing a difficult one.
Men were working in the rain and mud most of the time, and it is
extremely difficult to find fuel for fires and practically impossible
for troops to use tents for shelter, because the ground is practically
never dry. The water supply is constantly receiving the washings
from the field fertilized with human feces, and in consequence all
the water must l)e treated before being drunk. Every field fertilized
in .this way furnishes an ideal breeding place for flies, and conditions
necessitate the use of elaborate apparatus for the sanitary protection
of troops, very little of which was available while hostilities were
still in progress.
Early in September Cftses of influenza and pneumonia began to
arrive on the transports. The numbers continued small up to Sep-
tember 12, when the Kroonland discharged 6 cases of pneumonia and
117 of influenza. Many of these latter were questionably pneumonia.
From that time the numbers of cases of both diseases rapidly in-
creased up to about the middle of October. Since then they have
A. E. F. BASE SECTIONS. 2051
been decreasing, but even from the last transports arriving in October
a number of cases of influenza were taken.
During this period very few ships arrived without cases of either
of these diseases. The total number of cases of influenza arriving
during the months of September and October were 4,187, and of
pneumonia 913. Too much stress can not be laid on the exactness
of these figures, for many of the cases called influenza later proved
to be pneumonia; nor do they give an adequate idea of the number
of cases actually occurring on the ships, for many cases of influenza
went to duty before they reached port. Xor do these figures include
those that died en route, of which there were no less than 479, nor
those that, having been infected on board, developed the disease in
Pontanezen rest camp and either recovered or diecl. The total num-
ber of deaths occurring after landing here, from pneumonia alone,
has been about 1,217.
This infection, of course, arose from sources in the United States,
and the tremendous number of cases followed as a direct result of
the very great crowding together of the troops on shipboard. As
near as can be figured, the mortality rate in this pneumonia has been
about 40 per cent. As there have been about 1,696 deaths, it follows
that the number of pneumonias has been well over 4,000. These cases
have occurred among a total of about 218,000 troops transported.
The laboratory findings in these cases here shows the bacillus
influenza, diplococcus pneumonia, and streptococcus hemolyticus.
The pneumococcus infections have been very virulent, many of the
cases dying within a day or two after incidence.
The handling of this large number of arriving sick has strained
our facilities to the utmost. Practically all these cases have had to
be unloaded by means of lighters from ships some distance out in the
harbor, and carried by ambulance 3 or 4 miles to Camp Hospital Xo.
33, at Pontanezen, or the Base Hospital Xo. 65, at Kerhuon. This
has all been affected by a totally inadequate number of ambulances,
operated by the personnel of Ambulance Company Xo. 105. In
addition, this organization has also accomplished the evacuation
from hospital trains to transports of over 6,000 sick and wounded
class D patients bound for the United States. This service has been
expeditiously and efficiently handled, without complaint of any kind.
The nursing and treatment of these seriously ill men has thrown a
great burden on the hospital personnel of Xavy Base Hospital Xo. 1,
Camp Hos]:)ital Xo. 33, and Base Hospital Xo. 65. The latter organi-
zation was compelled to take large numbers of dangerously ill men
long before it was adequately prepared for their reception. Its per-
sonnel, adequate for the care of 1.000 cases, toolv possession of un-
completed l)uiklings on the hospital site on September 14 and began
to receive cases on September 25. On October 8 it had over 2,200
seriously ill patients.
Camp Hospital Xo. 33, originally designed to care for not over
300 patients, has at times carried 1,900, using tents and comman-
deered barrack buildings, and has in addition had to carry on numer-
ous sick calls, and an extensive dispensary service for many thou-
sands of passing troops.
Nature of ra.^es an'ivinff op fi'ansporfs. — The greater number of
cases arriving at this port from the United States for over a period
of 14 m()ntli> proved to be contagious diseases. At the very start
1423(37— ] 9— VOL 2 :68
2052 REPORT OF THE SURGEON GENERAL OF THE ARMY.
iiiiiiiips seemed to rank supreme. Measles also were very prevalent,
and many of these c ases complicated by broncho-pneumonia. Menin-
gitis occurred sporadically and diphtheria was also prevalent, espe-
cially Avhere crowding of transports was practiced. Scarlet fever
cases appeared occasionally, but in small numbers. In one instance
only was an epidemic of scarlet fever on board. In this case the
entire command on board was placed under quarantine in a deten-
tion camp at Pontanezen, and the patients were transferred to Camp
Hospital Xo. 33. In case of meningitis and diphtheria it had been
the ruling of the poit to obtain contacts, usually the troops in the
immediate vicinity of the patient — that is, three deep on each side,
front, and rear, or in one compartment — were isolated and cultures.
This, in some cases, was done on the boat; in other cases the con-
tacts were transferred to either Xavy Base Hospital Xo. 1 or Camp
Hospital Xo. 33 for culture. In this ]nanner carriers were often
discovered. In the cases of measles troops in the same compart-
ment were usually isolated. It has been noted during my experience
as port officer that overcrowding, as well as the time limit of the
voyage, had much to do with the amount of sickness on board of
a transport. The Northern Pacific and Great Northern seldom had
many patients. These two transports usually made the voyage in
seven days, whereas the President Grant had much sickness on board
at all times. The length of time of the voyage was just double that of
the Northern Pacific. Another interesting observation was noted
that the Tenndores entered this harbor repeatedly with practically
no sickness on board. The troops were permitted to sleep on deck,
which apparent^ had much to do with the lack of disease. Later,
when this practice was abandoned during the winter months when
the condition of the weather would not permit sleeping on decks,
the number of cases usually increased. Spraying of the walls and
ceiling, swabbing of decks with cresole solution, repeated spraying
of the troops, the use of gargles seemed to have a beneficial effect
in preventing contagious diseases.
In^uenza. epidemic. — The influenza epidemic began during the
month of September and practically proved to be uncontrollable.
The first transport to arrive at this port with an epidemic of in-
fluenza on board was the U. S. S. Kroonland. There were about 200
patients on board. Then there was a lull until October 1, when
transport after transport arrived with over 966 patients on board
and about 85 dead.
Pneumonia 'patients. — In the early part of the development of this
port it had been customary to transfer all sick to hospitals. This
latter was modified by an order from the base surgeon, stating that
patients suffering with pneumonia would not be transferred prior to
the crisis unless the patient was within the first two or three days
of his illness and the condition of the patient permitted transfer, or
that the patient had passed his crisis by at least three days. This,
however, was modified in so much that foreign ships v.-ere cleaned of
all patients, owing to the lack of medical personnel on board. Trans-
ports that landed at the docks were usually cleared of their sick, pro-
viding the condition of the patient permitted transfer. This, how-
ever, was discontinued after March 28, 1918, when I addressed a
letter to the chief surgeon, American Expeditionary Forces, quoting
the following facts :
A. E. F. BASE SECTIONS, 205B
The U. S. S. Aeolus was docked at pier 5. There were some 38
cases of pneumonia on board, and prior to their transfers to Xavy
Base Hospital Xo. 1. the ship surgeon and myself selected the pa-
tients suitable for transfer, leaving seven of the most seriously sick
on board. In spite of this fact, one of the cases developed an acute
dilatation of the heart while being moved, and died on board the
transport shortly after. This brought forth a rigid order that no
more pneumonia cases could be transferred until past the crisis.
Ho.sp/fal hofff.- - Aitev six months of deltarkation work, during
which time the French authorities had furnished boats to debark the
sick, and owing to the great increase of the number of transports
arriving at this port, it was impossible to cope with the situation any
longer without proper harbor facilities. On June 21, 1918. I ad-
dressed a letter to the base surgeon, requesting that a suitable hospital
boat be assigned to this port: I also requested that this boat be
equipped with Stokes litters. This matter was inmiediately taken up
with the Army Transport Service, who agreed to assign the V. S. tug
Smeaton for this purpose, and the litters were requisitioned. Stokes
litters not being available, snowshoe litters were sent instead. On
August 3, 1018, another letter was addressed to the base surgeon, re-
questing that the U. S. S. Smeaton be inclosed, as patients suffered
unnecessary exposure. After several weeks this boat was partially
inclosed, but was not exclusively used for the transfer of sick, being
also used for transferring troops on account of the lack of water
transportation, and therefore was seldom available when needed. On
September 12. 1018. another letter Avas addressed to the base surgeon,
requesting that the U. S. S. Snicaton or similar boat be permanently
assigned to the Medical Department for the purpose of transferring
sick and wounded. On account of the congested hospital conditions
it was necessary that every effort be made to evacuate wounded in
this base. On September 22, 1918, I addressed a letter to the com-
manding general of this port, reporting the fact that the U. S. S.'
Smeaton^ which had been designated as a hospital boat of this port,
was not available: furthermore, that it was impossible to secure a
messenger boat for the puri:)ose of visiting transports and giving
pratique. This brought forth a letter from the base adjutant, dated
September 24, 1018, demanding cooperation on the part of the Army
Transport Service and all concerned on account of the lack of harbor
facilities, and not until the armistice was signed was the U. S. S.
Sriwafon properly inclosed and suitablv fitted up as a hospital boat.
From this time on the Smeaton has been used exclusively for the
transfer of sick and wounded, excepting when the Medical D^q^art-
ment was not in iieed /^f her.
flf)sj)}f<i] tidins. — Beginning in Juno. 1018. hospital cars l)egan to
arrixo at this base; these cars usually arrived at night. Patients were
transferred to Xavy Base Hospital Xo. 1. where they were fed,
bathed, and their wounds dressed, and after a restful night they were
transferred, by means of the hospital boat, to the transports in the
harbor. Fvery available ambulance was used, and in some instances
trucks had to l)e resorted to on account of the lack of ambulances at
this base. Xeedless to say that only convalescents were transferred
in trucks. On August 27, 1018, the first hosjjital train arrived at this
port. In this case, if I remem])er coi-rcctly. the patients were de-
trained directl}' to the hospital boat and from there embarked on a
2054 REPORT OF THE SURGEON GENERAL OF THE ARMY
transport in the harbor. This custom was followed thereafter, and
only in extreme emergencies were patients transferred to hospitals,
which was usually clue to the fact that there were no transports in the
harbor at the time Avhen the hospital train arrived. Later, upon the
completion of Kerhuon hospital, all trains were evacuated to this
hospital, which is the custom at jjresent.
EVACUATION OF SICK AMJ WOUNDED.'
This port has been used as a port of evacuation of sick and wounded
since the month of June, 1918. and the difficulties in evacuation are
practically the same as those for receiving- sick and Avounded from
transports. Patients were received on hospital trains at night and
were evacuated in most cases the following day. All patients had
to have their dressings changed and receive food after reaching the
hospital and before going to sleep. This necessitated large increase
in the bed capacity of the hospitals, especially Xavy Base Hospital
No. 1, which was used principally because it is nearest to the docks
and trains.
Early in July, 1919, in order to relieve the congestion of patients at
Savenay. the first patients of any number arrived at this port for
evacuation to the United States. At first they were sent in small
detachments on the regular train, which was due to arrive here at
9.50 p. m., but which generally did not reach here until well past
midnight.
As the number of patients increased and the space available on
transjwrts for the return to the United States increased, a regular
type of French car was added to the train. Increased numbers
brought new problems, and in a short time a regular hospital car was
added to the train. This arrangement continued for a time, but the
constantl}^ increasing number necessitated additional cars until even-
tually^ a regular hosiDital train was added to the service. This plan
worked well, the patients going direct to the transports. Due to the
uncertainties of war conditions, the sailing and arrival of transports
could not be definitely known, so a plan to hold patients in consider-
able numbers was made and put in use. This evacuation of patients
was going on all the time, and at the same time the arriving troops
were constantly increasing.
Transportation and hospitalization were the two sources of greatest
trouble. At first few ambulances were available, and various types
of trucks, etc., were used to handle the ambulatory cases, and with
the arrival of a hospital train it was the rule and not the exception to
find all hands working well into the wee small hours of the morning,
as the schedule of trains was such that these trains always arrived
during the night.
The bed capacity of the hospitals was taxed to the utmost, and too
• much credit can not be given to Navy Base Hospital 1, for they never
failed to meet any emergency, many times having double their normal
bed capacity. Last, but not least, every patient had his dressing
changed and some hot liquid food was supj^lied to all before they
were placed for the night. If the patients were taken on board the
following morning, this necessitated hard work and long hours.
Gradually with the course of time more ambulances and better hos-
pitalization were realized, until now, in looking back, one can realize
A. E. F. BASE SECTIONS. 2055
liow well the patients were handled with a limited and overAvorked
equipment and personnel.
At present this base has perfected its organization of ambulances so
that large numbers of ambulances are available for the use of sick and
wounded at any time. The Red Cross maintains a rest station on pier
5, where the patients are held before being loaded on a tug, with
mclosed deck, which makes the trip to the transport. All patients are
supplied with hot chocolate, cake, and other good things to eat by the
Red Cross, and the sick and wounded are well and tenderly cared for
from the moment they leave their base hospital until their safe ar-
rival back in the United States.
F. BASE SECTION NO. 7, SERVICES OF SUPPLY.
The medical history of Base Section No. T commences with the
arrival of a detachment of Company A of the 17th Engineers on
October 24, 1917; arriving from St. Xazaire and stationed in the
nouvelle gare, a now but incompleted railwav station at La Rochelle.
The medical personnel consisting of one medical officer, one sergeant,
and one private. On the same day of arrival the medical officer estab-
blished a prophylactic station in this railroad station, which also
was used as an infirmary and for quartering the detachment.
A desolate, snow-covered, and wind-swept area of ground, in the
center of which stood this large massive structure of stone, uninvit-
ing, and incompleted as a railroad station. The site of the ground,
uneven, with no other buildings on it, was the first camp for the
American troops in this section. No water for drinking or bathing,
no latrines, no heating facilities of any kind, was the lot that befell
these first troops in the midst of a cold and severe winter, necessitat-
ing the overcrowding of the men in what available rooms that were
fixed for their use as (juarters.
About the middle of the winter, however, an epidemic of influenza
broke out, spreading throughout the connnand; but with no develop-
ing complications. Bronchitis was quite prevalent at the same time.
On December 26, 1917, Troop B, 3rd United States Cavalry, arrived
in La Rochelle, accompanied by one private, first class, and one pri-
vate of the Medical Department. This .detachment being quartered
in an old French barracks in this city, and on the afternoon of their
arrival a prophylactic station was opened and also used for sick call.
On JanuaiT 3, 1918, one battalion of the 35th Engineers arriAed
in La Rochelle.
Shortly after the arrival of the 35th Engineers, 12 cases of measles
broke out, necessitating the sending of these cases to the Aufredy
hospital in La Rochelle for isolation'and treatment; one case of which
developed a broncho-pneumonia and terminating fatally. Three
cases of cerebrospinal meningitis developed during the Avinter
months, all of Avhom recovered.
The first bill of health to an ^Vmerican transport Avas issued on
January 23, 1918, by the cauq? surgeon, Avho on February 20 was
assigned as surgeon of La Pallice and medical superintendent of
transportation at that port.
In the early part of P'ebruary negotiations Avere entered into with
the French for a site for a camp hospital, having in mind a capacity
of about 250 beds Avith all modern hosjutal conA-eniences.
2056 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
No buildings being available for an infinnary at La Pallice, the
camp surgeon re(iuisitioned a building, Avliicli after its arrival was
taken over by the 35th Engineers for officers' quarters, and thus de-
laying the opening of the infirmary, which was much needed. This
camp grew by leaps and bounds, expanding in all directions, and
after considerable effort a small bidlding hnally was secured through
the courtesy of the depot engineer, which was remodeled so as to give
room for a four-bed infirmary and an operating room.
The first patient was admitted to this infirmar}^ on April 20, 1918.
On March 4, 1918, the third detachment of the 35th Engineers
arrived at La Rochelle accompanied by 1 medical officer and 10 en-
listed men of the Medical Department. On March 7, 1918, a pre-
liminary agreement was made with the owners of the chauteau at
Perigny for the leasing of the building and the grounds for a camp
hospital. The necessary surveys were made by the 35th Engineers.
About the last week in June preparations were made for the separa-
tion of the La Rochelle, La Pallice, and Rochefort area from Base
Section No. 2, and during the first week in July, 1918, the Province
known as the Charente Inferieure became officially designated as
Base Section No. 7.
The chateau at Perigny, located on the outskirts of Perigny and
about 2^ miles distant from the city of La Rochelle, having already
been taken over for a camp hospital, became the immediate center of
activity of the Medical Department.
The necessary surveys having been made by the 35th Engineers, a
water main was laid from the city waterworks to the hospital
grounds, a distance of about 800 feet, by the corps of the 35th Engi-
neers. The water was turned on in the building about the 31st of
July, 1918.
On July 29, 1918, Camp Hospital No. 39 received its first patients,
6 of whom were removed from the French hospitals and 2 from the
commands, and the following day brought the arrival of 6 more, and
on the 31st of July 10 additional ones, making a total of 24 within
three days.
It soon became evident that with the increasing number of troops
and with the establishment of new camps throughout this section,
and that the site of Camp Hospital No. 39 would not permit of un-
limited expansion, the chief surgeon of the base therefore began
planning for other hospitals at the different camps with lesser bed
capacity than that of the camp hospital, and acting upon the coming-
needs, which later proved to be justifiable, hospitals were being started
at La Pallice, Rochefort, Aigrefeuille, and Aytre. At Pons and
Saintes two French barracks were taken over for camp hospitals and
designated Nos. 69 and 88, respectively. Camp Hospital No. 69 at
Pons having a capacity of 175 beds, and which operated about two
months; Camp Hospital No. 88 at Saintes, having a capacity of 350
beds, this hospital never having been operated, though completely
fitted with the necessary supplies and personnel. Both these hos-
pitals presented innumerable difficulties before, during, and after
being made ready for occupancy.
During this same month of October, 1918, the camp infirmary at
La Pallice and Aigrefeuille were opened up, the former with a
capacity of 50 beds and the latter of 75 beds — the La Pallice camp
infirmary at Aigrefeuille. These two last named hospitals were
A. E. F. BASE SECTIONS. 2057
built as modern as field service in the American Expeditionary Forces
would ijermit, having electric lights, running water, shower baths,
flush toilets, modern operating rooms, etc.
G. BASE SECTIOX NO. 8, MANTOVA, ITALY,
During the spring of 1918 a number of aviators were sent to Italy
and located at Foggia, with one medical officer and seven enlisted men
assigned for attendance to these troops. In June, 30 sections of the
United States Army Ambulance Service, with accessory administra-
tive personnel, arri\'ed at Genoa for duty with the Italian Army on
the same status that the sections of the Ambulance Service working
with the French Arm}^ In July the 332d Eegiment of Infantry
arrived in Italy from France, having attached its authorized medical
personnel, and the 331st Field Hospital, and in August Base Hos-
pital No. 102 arrived for duty with the Italian Army on the same
status as the Ambulance Service.
On October 17, 1918, the Chief of the United States Army Ambu-
lance Service with the Italian Army was designated by order from
General Headquarters, American Expeditionary Forces, France, as
deputy chief surgeon American Expeditionary Forces for Italy.
Shortly afterwards an order was issued organizing Base Section Xo. 8.
the territorial limits of which included all Italy, in command of the
chief, American military mission. Most of the staff officers of the com-
manding general Base Section No. 8 were the officers who were also
on duty at the military mission. The deputy chief surgeon American
Expeditionary Forces for Italy was designated also as surgeon Base'
Section No. 8. The connnanding general of Base Section No. 8 was
placed in command of all American troops in Italy, except those
troops which were serving directly with the Italian Government, and
was given such supervision and jurisdiction over these troops as
could be exercised without interference with the Italian command.
The administrative machinery thus provided was scarcely in working
order when the Italian offensive extending from October 24 to No-
vember 4, terminating active hostilities in Italy, was inaugurated.
The part plaj^ed by the American troops in Italy on the Italian front
was therefore about as previously had been arranged. The regiment
was held in reserve during most of the offensive and had few casual-
ties. It was under fire once and lost one man killed and eight
wounded.
From the portion of the hospital acting as an evacuation hospital
the sick were sent to Base Hospital No. 102, which was engaged prin-
cipally in working with the Italian Army.
The cessation of hostilities caused the regiment to be concentrated
at Trevico, and one battalion with two medical officers and appropri-
ate enlisted personnel was sent with Italian troops to Cattaro. Dal-
matia. Another battalion was sent to Fiume, Istria. with two medi-
cal officers and enlisted personnel, while headquarters and the remain-
ing battalion stayed at Treviso and base hospital continued to func-
tionate at Vicenza. The ambulance sections followed the armies into
the newly acquired territory. The close of the year of 1918 finds the
several organizations in the positions last indicated, awaiting orders
as to their withdrawal bv the American Government.
2058 EEPORT OF THE SURGEOISr GENERAL OF THE ARMY.
It is thus seen that the activities of Base Section No. 8 covered
practically only the months of November and December, during Avhich
period there has been nothing of particular moment to record. There
have been no serious epidemics, Avith the exception of influenza, and
that has not been as severe as in France.
8. ]MoBiLE Hospitals.
A. MOBILE HOSPITAL XO. 1.
Left Paris June 13, 1918, for Coulonuniers, France, in compliance
with telegraphic instructions, headquarters, American Expeditiorary
Forces, dated June 10. 1918. Operated there as attached to Evacua-
tion Hospital Xo. 7 from June 13 to July 29, during which time
2,795 operations were performed on patients in Mobile Hospital No.
1. Included in this total are several hundred operations performed
upon patients of the evacuation hospital which was without surgical
equipment the first week or two at this station. Two thousand two
hundred wounded patients Avere admitted to the beds of Mobile Hos-
pital No. 1, of which 2,145 were evacuated to the rear and 55 died. In
making the move from Paris to Coulommiers, the first convoy of
equipment with half the personnel left Paris by motor transportation
on the morning of June 12 ; the balance of the equipment and person-
nel left on the morning of June 13, and on the afternoon of June 14
wounded patients were being received and operated upon in this
hospital. All the surgical work at this station was done under
the direction of ^Mobile Hospital No. 1. The connnanding officer
of ^Mobile No. 1 was director of surgery for Evacuation No. 7 as well
as his own organization.
Left Coulommiers, France, for Chierry, France, 3 kilos east of
Chateau-Thierry, July 29, per telephonic instructions, chief surgeon,
Paris group, G^, daled July 27, 1918. Operated there as attached
to Evacuation Hospital No.' 6 from July 29 to August 20, during
which time 1.711 operations were performed on patients in Mobile
Hospital No. 1. There were 900 admissions to beds of this hospital,
of whom 850 were evacuted to the rear and 50 died. At this station,
all surgery of l)oth Evacuation No. 6 and ISIobile No. 1 was under di-
rection of commanding officer Mobile Hospital No. 1. Also all
surgery was done with equipment of Mobile No. 1.
At both of these locations the evacuation hospitals rendered con-
solidated reports of patients for both hospitals. Left Chateau-
Thierry August 20. moving by rail to Neufchateau where a period of
six daj's was spent awaitin,": further orders.
B. MOBILE HOSPITAL NO. 3.
The commanding officer arrived in Paris from Evacuation Hos-
pital No. 1 on July^l, 1918, and at once began to take over the mate-
rial from the French. As soon as a camp was assigned at the polo
grounds. Bois de Boulogne, the trucks and camions were assembled
there. Besonneay tents were erected, and a complete inventory was
made and compared with French lists.
The hospital left Paris for the Toul-Lorraine sector by train Au-
gust 21, 1918, arriving on August 22, and was assigned to the First
A. E. F. MOBILE HOSPITALS. 2059
Arni3', teniporarily attached to Evacuation Hospital Xo. 1. The
tent liospital of 200 beds was set up and a Besonnea}' tent was
equipped for an operating room, with eight tables, which was in-
spected by both the chief surgeon American Expeditionary Forces
and former Surg. Gen. Gorgas, who were pleased with its" appear-
ance. The St. Mihiel offensive began September 12, 1918, and be-
tween that date and September 15 2,750 wounded passed through
F^vacuation Hospital Xo. 1 and Mobile Hospital Xo. 3, eight surgical
teams working smoothly in eight-hour shifts. Orders were received
to move to Royamieux. but these were rescinded and we were ordered
to relieve Field Hospital Xo. 359, which was operating a hospital
for medical cases in French barracks at Rosiere-en-Haye, 8 kilome-
ters south of Douilard.
AVounded men were received from the divisions holding the sector
north of Thiaucourt and Pont-a-Mousson. From September 24 to
Xovember 12 Mobile Hospital Xo. 3 exercised its true function as
a central concentration station, handling only serious, nontrans-
ferable surgical cases, all others being evacuated at once to evacua-
tion Hospital Xo. 1, 6 miles south. About 200 cases were handled
during the first Uxo weeks, the mortality being heav}^, as many pa-
tients died before the}' could be operated upon, the wounds being
mostly high-explosive (long-distance bombardment). Four tables
were in use, with six surgical teams. Enemy aeroplanes came over
constantly, but did not harm us, nor did any shell fall within half
a mile.
On the evening of October 9 fire started in the X-ray room and
the hospital was destroyed in spite of all efforts to subdue it. There
was no loss of life but all the instruments and nuich valuable mate-
rial was destroyed. The tents were saved, and by strenuous efforts
lost articles were replaced and the hospital was ready for work in a
week, in tents as originally planned. Many of the records were
burned, so that it is impossible to give exact data in regard to the
number of wounded, operations, and results. From Xovember 12 to
December 20 the hospital (now under the Second Army) remained
at Rosieres, ready to move to Germany, but it was not needed there.
On December 20 Ave moved back to Evacuation Hospital Xo. 1. and
camped in tents until Januar}' 20, 1919, when we moved to Le Mans
and were directed to proceed to Alencon and operate as a camp
hospital of 200 beds, to serve the 37th Division, billeted in and neai-
there. From February 7 to ^larch 28, when that division moved to
Brest, we handled 300 surgical and medical cases, covering the area
between Beaumont and Alencon. This area being abandoned, pa-
tients were evacuated to their units or to Camp Hospital Xo. 52, Le
Mans, April 7, to maintain a 500-l)ed camp hospital in this area.
On April 11 Mobile Hospital Xo. 3 was made a " skeletonized unit."
C. MOBILE HOSPITAL NO. 11.
Mobile Hospital Xo. 11 was organized in France during the month
of October, 1918, at the instruction and assembly park for mobile
units, situated at the Pare de Prince. Porte St. Cloud. Paris. This
command had to function under extreme conditions as an almost
self-sufficing organism, with its Ijed capacitv of 200, its own lavuulry
on two trucks, its own operating room, sterilizing truck. X-ray truck,
2060 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
its own body to feed as well as its patients, its OAvn electric lighting,
and its own construction work to perform, etc.
Toward the close of October the command Avas complete in per-
sonnel and ready for the field. It Avas not until the day of the arm-
istice. Xovember 11, 1918. that the command was ordered from Paris.
Upon the afternoon of that day it was entrained, together with
Mobile Hospital Xo. 10. for transportation to Joinville-en-Vallage,
Haute Marne. the United States Medical Department concentration
area.
Period of activiti/. — Xovember 20 : The hospital moved from Join-
ville to Donjeux, Haute Marne, a distance of 9 kilometers, to act as a
camp hospital for the 18th Training Area. Owing to its proximity
to Joinville (not in the 18th Area) it Avas arranged that it should also
hospitalize the sick of the Medical Department concentration area,
there situated. It, therefore, was to serA^e those medical units sta-
tioned at JoinA'ille. as well as the heaA'v artillery regiments, Avdiich
at the time, and for seAeral months folloAA^ing. occupied the 18th
Area. In addition there AAere the smaller detachments, such as the
Motor Transport Corps park, the Engineers, the military police, etc.,
to serA'e. XoAember 22 : Mobile Hospital Xo. 11 reports itself open'
to receiA'e patients Avith a capacity of 200 beds.
The hospital AA-as situated on a gentle sloping ground, in a spacious
field, and at least 300 yards from the nearest l)uilding of the toAA'n of
Donjeux. Thirteen Bessonneau tents and 10 Tortoise tents AA-^ere set
up.
During the Aveek of December 16. 1918. the first patients Avere re-
ceiA'ed. From that date till April 10. 1919. Avhen the hospital Avas
ordered closed, a total of 853 cases AAere cared for. AA'ith 26 deaths.
An epidemic of typhoid fever treated at Mobile Hospital Xo. 11
Avhile stationed at Donjeux. Haute Marne. France (supj)lement to the
history of Mobile Hospital Xo. 11). During the last days of Decem-
ber, 1918. there began to come into this hospital a feAv patients from
the A'illage of Curel, complaining of headache, diarrhea, and general
prostration. As these symptoms had been Aery common ones, ap-
pearing in large numbers of patients admitted to the hospital, but
little special attention was paid to them for tAvo or three days.
Within a feAv daA'S after the entrance of the first cases, blood cul-
tures were taken, resulting in the isolation of the typhoid bacillus
in each one of these cases. This fact caused the hospital staff to or-
der a culture from the blood stream of each indiA'idual coming in
from Curel showing intestinal symptoms or general constitutional
symptoms. By the end of the second Aveek of January, 1919, there
were 62 cases admitted to the hospital from Curel. showing sA^mptoms
indicating a seA-ere infection.
Of the three cases entered as unknoAvn all were in a semicomatose
condition, and no history could be obtained from them. In the com-
plete gToup of 62 cases positive blood cultures for the typhoid
bacillus were obtained in 44. In all of these the diagnosis was con-
firmed by the agglutination test. The blood cultures Avere made as
soon as possilile after the patients entered the hospital, but as the
facilities of the laboratory were somewhat limited it took a longer
time than Avould ordinaraily be the case to run through the work.
There Avere eight cases which gaA-e negative blood cultures (at least
two cultures being taken), but in whom the typhoid bacillus was
A. E. F. MOBILE HOSPITALS.
2061
subsequently recovered from the urine or stools — four from the urine
and four from the stools.
There were five cases in whom all the laboratory findings were
negative, but who ran a typical typhoid-fever course clinically and
are included amongst the total list of cases. All of these cases
showed typical rose spots on the trunk and one had a palpable spleen.
There were no deaths amongst this subgroup.
There were five cases of paratyphoid fever (B), the organism be-
ing recovered in each case from the stools, the day of the disease on
which the organism was found varying from the 24th to the 29th.
There was no mortality in this subgroup.
All the cases, being soldiers in the American Army, had received
the protective inoculations against typhoid fever and paratyphoid
fever. In no case had the inoculation been given more than 12
months previously, and in the majority of cases it had l)een given
within six months. Tlie newer vaccine (triple lipo) had l)een given
in 21 cases, and the saline (3 doses) in 38. In three cases the data
was not obtained. The length of time that had elapsed since inocu-
lation is shown, as follows :
Months elapsed since inoculation.
1
2
3
4
0
6
7
8
9
10
11
12
Number of patients:
Triple lipo
3
0
2
0
8
1
4
6
1
3
3
15
0
2
0
3
0
6
0
0
0
0
0
Saline
9
As for the cause of the outbreak, it seems clear that it was a water-
born affair. Upon the arrival of the troops to be billeted in Curel
it happened that for a period of several days no chlorinated lime was
obtainable for use in making the water potable. In this whole area
no water had been found that was safe to drink without chlorination.
But by some misunderstanding one well in Curel was declared pota-
ble, and this water was drunk by the men with greater or less
freedom and must have contained overwhelming doses of typhoid
bacilli. Effect quickly followed cause in this instance, for the epi-
demic soon resulted. That the outbreak was promptly dealt with
once it was known aliout is shown by the fact that only 16 days
elapsed between the entrance of the first and last of the 62 patients
into the hospital.
The total mortalit}' amongst the 62 cases was 16 (25.8 per cent).
Post-mortem examinations were made on all. Of this number 14
died with pneumonia as either the chief or complicating cause of
death. Pneumonia was undoubtedly the principal factor in the
high death rate.
Three cultures of stools and urines of all patients were taken at
six-day intervals previous to discharge in order to detect any pos-
sible typhoid carriers. No such carriers Avere encountered.
n. MOHILE HOSPITAL NO. 12.
Mobile Hospital No. 12 was organized at the instruction and as-
sembly park for mobile units, A. P. O. 702, September 26, 1918.
On November 11, 1918, when the armistice was signed, Mobile
Hospital No. 12 was getting its equipment together at the instruc-
2062 KEPOKT OF THE SURGEON GENERAL OF THE ARMY.
lion and assembly park under orders to oo to the Belgian front as
soon as possible. AVith the signino of the armistice, however, work
for mobile hospitals at the front ceased to exist, and as this com-
mand was the only unit tlwn at the park it was kept there so as to
function as a labor unit to take care of the necessary routine work.
Mobile Hospital Xo. 12 left Paris on January 21, 1911). and re-
ported to the chief surgeon of the American embarkation center,
Le ^lans, for duty in that district, taking with it the full equip-
ment of the mobile hospital as used by similar organizations at the
front. Under orders from the chief surgeon, American Expedition-
aiy Forces, the organization proceeded to 8t. Corneille. Sarthe, to
function as a camp hospital for the Montfort area of the district and
took over a small chateau on the outskirts of the village.
It was decided that the chateau at St. Corneille should be utilized,
so TO beds were placed in the chateau and the 13 Bessanneau tents
of the mobile hospital equipment were put up.
On February 14, 1919. the hospital Avas declared ready to receive
patients. The total number of patients received by Mobile Hospital
No. 12 from the date of its opening, on February il, 1919, to March
26, 1919, was 34. Since March 26, 1919, in accordance with the or-
ders from the embarkation center, no patients have been received
in the hospital. Mobile Hospital Xo. 12 became Camp Hospital
Xo. 117 April 22. 1919.
9. Camp HosprrALS.
A. CAMP HOSPITAL NO. 1.
Located southeast of Bar-le-Duc, about 50 kilometers, Gondrecourt
lies opposite the quest sectors of the battle line from the S^viss border
to the Belgic coast. Because of its proximity to the Argonne forest,
St. ]Mihiel salient, and other so-called impregnable portions of the
Hindenburg line this town and vicinity had been little disturbed by
aid raids and other German activities.
•The middle of June. 1917. found the 1st Division here and its
training inaugurated, and to Field Hospital No. 13 w^as delegated
the duty of establishing a hospital for the care of the sick and
wounded of the division.
During the time the 1st Division was under training in this area
Field Hospital No. 13 continued to operate the hospital, but in the
latter part of October and early in November, the division having
finished its training, was ordered to the front, and Field Hosi)ital
No. 13 was relieved by Field Hospital No. 12. On X^ovember 12 Field
Hospital No. 12 was" in turn relieved by Field Hospital No. 1, and
about this time the hospital became a permanent organization and
was designated as Camp Hospital No. 1.
The three barracks taken over from the French were large, well-
lighted wards, with capacity of 40 beds each, but the hospital was
during the winter crowded to its utmost capacity.
Fro^n the middle of July to the middle of August the number of
patients showed a steady, though not large, increase. On August 18
the 3d Division began to move into this area, after being relieved
from the Chateau-Thierry drive. Their coming marked a sudden in-
crease in the number of patients. The log book shows that on August
A. E. F. CAMP HOSPITALS. 2063
19, 50 patients were admitted, by far the greatest number admitted
in am' one day up to that time. The following day 71 more came into
the hospital, making the total of patients more than double what it
had been tAvo days previous. Xumerous aeroplane accidents occurred
at this time, also, as a result of training aerial squadrons near here
in preparation for the St. Mihiel drive. These cases were also brought
to us for treatment.
During the month of October five neAv buildings were erected, one
for officers ciuarters, two for contagious diseases, and two for influ-
enza and pneumonia. When tlie 33d Division was added to those
already in the area the hospital Avas completely filled, and it was
necessary to evacuate many of our patients to tlie hospital center at
Bazoilles.
Until after the signing of the armistice the work of the hospital
was carried on entirely by men, except for some volunteer aid from
the welfare workers. On December 24, 10 members of the Xnrse
Corps reported for duty. Shortly after their number was increased
to 16, and they remained with ns until the hospital was discontinued.
Medical service. — By far the most serious work the hospital was
called upon to perform was during the severe epidemic of flu. with
its complications, particularly broncho-pneumonia, which came upon
the area with great intensity during the latter part of October. 1918.
The hospital was soon taxed to its utmost capacity. At that time
there were no nurses on duty, and the entire care of the patients fell
u])on the enlisted men.
The water supply is abundant, being pumped from a large spring-
near tlie river. There are many of these springs just a little above
the water level of the riA er, with an enormous out])ut of clear, beauti-
fully appearing water, but only in the occupation of the area of the
Americans the supply was found to be badly contaminated. Great
care has been taken to chlorinate the water before using. Some time
ago a .system of chlorinating by chlorin gas at the source was in-
stalled. This process has proved most satisfactory, as all water sup-
plied at the hospital for all purposes is comparatively safe.
The hospital vwas discontinued May 12, 1919. The patients were
evacuated to Base Hospital Xo. 91 at Commercy, the Xurse Corps
transferred to Vannes preparatory to return to the States, the unit
awaiting orders to an embarkation area.
F. CAMP HOSPITAL NO. 2.
The camp hospital was organized and the first patients admitted
December 21. 1917. The hospital at this time consisted of 2 wards,
De Sante type barracks, 30 beds to each Avard: 1 ward for white and
1 ward for colored enlisted personnel.
The following type of cases were treated from December 21, 1917.
to about May 14, 1918: Bronchitis, tonsillitis, influenza, and other
acute minor illnesses, venereal cases, and minor surgical cases.
February 1, 1918, the 302d Stevedore Regiment moved into the
camp and about the same time an epidemic of mumps broke out. At
this time they used an additional barracks as a mumps ward: prior to
this all infectious cases were transferred to the base hospital. Feb-
ruary 10, 1918, a hospital tent was used as a veneral tent.
2064 EEPOKT OF THE SURGEON GENEEAL OF THE ARMY.
Two additional wards, American portable barracks, were opened
March 15, 1918, and April 1, 1918, respectively; bed capacity, 30 beds
each.
From May 15, 1918, to date 24 cases of pneumonia were treated
with no deaths. Five cases were transferred to the Base Hospital
No. 6, three of these cases developed a basal effusion after the crisis,
and the other two were sent for the purpose of determining the type
of pneumonia and for the benefit of the serum treatment.
Practically all the surgical work is done here, including hernia,
abdominal work, hemorrhoids, and traumatic work.
October, 1918 : Influenza and Spanish flu were the diseases chiefly
met with during the month, from 1 to 25 cases admitted daily; the
last 5 days of the month with an average of 10 each day, a total of 300
cases for the month ; 20 of the above cases developed penumonia, as
a complication, with 9 deaths, about one-half of these cases were trans-
ferred from the American docks and outlying camps. Eight of the
deaths were white soldiers transferred from other commands.
November, 1918 : Influenza was practically the only communicable
disease admitted during the month, with a marked decrease over pre-
vious months. Average daily admittance of flu cases during the
month were eight ; most of these cases were transferred from Bassens
dock area and outlying camps. Flu cases admitted from command
were gratifyingly few. Eleven cases developed pneumonia from flu,
with six deaths, all white.
C. CAMP HOSPITAL XO. 3.
Camp Hospital No. 3, situated at Bourmont, Haute Marne, France,
began to function on July 4, 1918.
Very little trouble was experienced in getting under way, and as
heretofore stated, the hospital began to work on July 4, 1918, with
tlie arrival of the 37th Division in this area.
During the past few months, while no division was in the area,
tlie hospital lias been furnishing medical and surgical treatment to
the 2Gth and the 29th Divisions, located in areas contiguous to this
command.
From July 4, 1918, to the present date, the hospital has cared for
2.332 patients, beside holding sick call daily, furnishing medical
tieatment to various Labor and Engineer Detachments that have
been located in the neighborhood since the arrival of this command.
The records of this hospital can be summarized as follows: Of the
2.332 patients who entered the hospital, 2,037, or 87.4 per cent, were
returned to duty; 280, or 12 per cent, were transferred to other hos-
pitals, and 15, or 0.6 per cent. died.
D. CAMP HOSPITAL NO. 5.
By order of camp commander, December 8. 1918, this organiza-
tion was designated entrance camp hospital, Bordeaux embarkation
camp. As such it continued to function independently of Camp
Hospital No. 5, permanent camp, Bordeaux embarkation camp.
Camp infirmary opened December 17, 1917.
Jurisdiction to include Rest Camp No. 2, and when necessity
arises, to take in this vicinity.
A. E, F. —CAMP HOSPITALS. 2065
From camp infirmary to Camp Hospital Xo. 5, per memorandum
office of chief surgeon. Base Section Xo. 2, Services of Supply, Amer-
ican Expeditionary Forces, dated February 27, 1918.
Eight wards, three barracks (one for dispensary, operating room,
and admitting office, and two for Cjuarters of personnel) in addition
to kitchen. Garage, per authority chief surgeon, headquarters Serv-
ices of Supply, American Expeditionary Forces. France, was erected
between Xovember 1 and Xovember 25, 1918.
E. CAMP HOSPITAL XO. 7.
The beginning of Camp Hospital Xo. T is veiled in obscurity, no
authentic history of its construction being available by the writer of
this outline. It was built some time in February. 1918. by a detach-
ment of the 107th Engineers.
On June 3 Evacuation Hospital Xo. 4 arrived and remained for
a short time and was then ordered to the front.
For 10 days with empty buildings and nothing to do this small
company of three officers and six enlisted men guarded the camp,
explored the surrounding territory, gave medical attention to the
French civilian population, and Avondered what would happen next.
About July 20 Field Hospital Xo. 310 arrived.
Patients soon arrived and the real history of Camp Hospital Xo.
7 as a working organization began about this time.
On August 30 Field Hospital Xo. 310 was ordered to report to divi-
sion headcjuarters. This left the hospital very short of personnel.
Sanitary Squad 53 arrived on September 2 and Sanitary Squad 47
on October 8.
Camp Hos[)ital Xo. 7 consists of 10 medical wards for enlisted men.
1 surgical ward, 1 officers" ward, 1 Y. M. C. A. tent, 1 storeroom, 1
receiving ward and bathhouse. 1 barrack for hospital personnel,
officers' quarters, administration building, an electric powerhouse,
and garage. The buildings are mostly wooden structures about 100
feet long b}' 22 feet wide. The hospital has a capacity for about
400 patients.
The camp is situated on a knoll just on the outskirts of the village
of Humes, about 3i kilometers north and slightly west of the city of
Langres. near the River Marne. within the valley of that name.
Since the hosj)ital has been opened for the reception of patients,
from Jidy 27. when the first group of cases arrived, up to the time of
this Avriting, Xovember 10, there have been 1,305 cases in hospital.
All but 251 have been discharged or died.
The large number of cases of pneumonia during this period was
due to the epidemic of influenza, which was the cause of most of the
illness in the hospital. Very few of our own personnel developed the
influenza, due probably to rigid cleanliness and timely use of gauze
masks by both ward men and attending surgeons.
During the third week of January we reached our high-water
mark for patients, having on one day 355 in our Avards. It was neces-
sary to evacuate 115 to Base Hospital Xo. 53 in Langres in order to
make room for the new patients coming in. Most of these were from
the 2C)th Division, which was stationed at and around Montigny le
Roi. The Demonstration Battalion at Humes moved awav on Janu-
2066 EEPOET OF THE SURGEOX GEXERAL OF THE ARMY.
arv 27. With the schools at Lnngres closinc:- and the troops moving
out of the area, it looked as if the hospital Avould soon outgrow its use-
fulness. Up to date 2.000 patients have passed through the hospi-
tal, all but -250 of these since September 20. 1918.
The month of P^ebruary was noted for a short but severe epidemic
of influenza, complicated by a severe form of broncho pneumonia,
which proved fatal to 10 of our patients. During the second week
the hospital was filled nearly to cajiacity by soldiers from the T7th
Division. Most of those entering the hospital Avere suffering from
influenza. On the last day of the month there were remaining in
the hospital 95 patients — 19 surgical. 13 contagious, and the remainder
medical.
The history of Camp Hospital Xo. 7 as an active institution came
to an end on March 17 when the 16 convalescent patients remaining
in the hospital were transferred to Base Hospital Xo. 53.
From the opening of the hospital in June. 1918. to its close in
March. 2.978 patients passed through its doors, all but 66 recovering.
r. CAMP HOSPITAL XO. 8, MONTIGX Y-LE-ROI, HAUTE MARNE.
Ten medical officers and 60 enlisted men. Medical Department,
were ordered to Montigny-le-Roi, Haute Marne, France, for duty
as comprising the personnel of Camp Hospital Xo. 8. Thev arrived
at that station June 26, 1918.
The hospital was opened with a bed capacity of 300, and received
its first consignment of patients July 8, 1918, and has continued to
function without interruption to date of permanent closing April 30,
1919. The first 200 or 300 cases admitted came through Base Hos-
pital Xo. 15, at Chaumont, and consisted largel}' of wounded from
the front. The remainder of the patients were admitted largely
from military organizations temporarily or permanently stationed
in the 8th Divisional Area. The divisions that have successively
occupied the area are the 83d, 91st, and the 26th. The period of
greatest activity was during the latter part of Xovember and the
Avhole of December, 1918. when influenza was existing in the 26th
Division. During that period Field Hospitals Xos. 101 and 103 were
established on the hospital grounds and cared for the sick, which
exceeded the camp hospital's capacity.
The total number of cases of influenza treated was 573. Of this
number, 427 cases were admitted as such; the remainder were admit-
ted for other causes and developed influenza after admission. Of
the total number of cases treated, 80, or 13.9 per cent, developed
broncho-pneumonia, with 26. or 32.50 per cent, deaths; 36, or 6.2 per
cent, developed lobar pneumonia, with 3, or 8.3 per cent, deaths.
There were but 49 admissions from the personnel, 43 from the
detachment. 3 from the nurses, and 3 from the officei's. Thirty-one
of these total admissions were for transmissible diseases developing
as a result of contact with patients.
The water supph* was derived from a spring on an adjoining farm
and pumped to storage tank at hospital. This water was used un-
treated from date of opening, July 8. 1918, until Xovember 19, 1918.
when a Wallace and Freiman chlorinating apparatus was installed,
and has been working satisfactorily since.
A. E. F. CAMP HOSPITALS. 2067
Hospital was closed at midnight April 30, 1919, with all of its
patients evacuated to Base Hospital Xo. 53. Langres.
Instructions have also been received to the effect that the organiza-
tion will ship its supplies to supply depots in France, and that it
will be sent to the States as a unit at an early date.
O. CAMP HOSPITAL NO. !t.
Camp Hospital No. 9 was formed at Blois, France, on June 23,
1918, per Special Order Xo. 99. paragraph 34, Chief, Ordnance De-
partment, Services of Supply, June '2'2. 1918.
At this time it consisted of 12 officers and 80 enlisted men. Very
few of these officers and men had known each other previous to this
time, as all were taken from casuals.
Leaving Blois on ^Monday. June 24. 1918, the organization arrived
at Chateauvillain (Haute Marne), France, at 7.45 p. m., on June 25,
1918.
Our barracks had been constructed and partially equipped as a
hospital. These consisted of 19 wooden barracks, 20 by 100 feet, and
the usual outbuildings.
We were all impressed by the ideal location, the camp being but
a short distance from the town and railroad station, resting on a
gently sloping elevated portion of a beautifully cultivated valley,
the whole inclosfnl on three sides about a mile distant by hills whose
slopes were covered by vineyards.
The camp was sup])lied Avith adecjuate water in the barracks, good
sewerage, and hot and cold shower baths, besides one tub bath.
None of us were familiar with the paper work of the American
Expeditionary Forces, and no general order memoranda or bulletins
were found here, so that during our first few weeks there was some
confusion over the many reports that were required.
Stringe)it methods were instituted, forbidding all gambling and
drinking in camp. The results have been most satisfactory since,
but one instance of gambling and none of drinking in camp haying
been observed. A speedy court-martial for the gambling apparently
frustrated all further thoughts in that direction. There have been
but 136 take venereal prophylaxis, and no cases of acute venereal
disease haA'e developed in this command during the entire 9 months
here.
At this time there have been 2.897 cases admitted to this hospital,
with 44 deaths, giving a death rate of 1.51 ])er cent. There were 688
cases of influenza, 73 cases of pneumonia. 21 cases of typhoid fever,
and 45 of nephritis.
H. CAMP HOSPITAL NO. 10.
Official history of Camp Hospital No. 10, Prauthoy, Haute-Marne,
France.
Training Area No. 10 of the advance section. Services of Supply,
commences on its southern boundary a])out 7 miles north of Ts-sur-
Tille. which is the advanced depot base of supply, and from this
point extends north some 25 kilometers. It is 40 kilometers across
from the west to the east boundary lines.
142367— 19— VOL 2 69
2068 REPORT OF THE SURGEON GENERAL OF THE ARMY.
There are two railways and one canal that intersect the area, and
the village of Pranthoy is situated on the main line, some 12 miles
north of Is-snr-Tille, and in the western middle of the area and on
the main road to Langres. The divisional headquarters are located
at this village when the troops are occupying the training area.
Access to the whole area is well maintained hy numerous roads
which lead through all the villages. These roads are built of hard
gravel af the white sandstone type and are chiefly maintained by
the American Engineer Corps.
The villages are of the ancient stone building type and are very
old, and the sanitation of the very narrow streets is only comparable
to the barnyard of a farm at home, cow manure being spread pro-
miscuously over the streets, and each abode has a manure pile at the
front door. There is surface drainage by glitters, and when raining
the streets are covered by the blackish water so familiar in the barn-
yard at home and the distinctive odor is the same.
The water for household use is taken principally from piped
springs and very old stone wells, usually adjacent to the manure
pile, which gives it a flavor.
Cows, pigs, horses, and chickens are kept under the common roofs
of the dwellings and in the basements of the same, and the fodder
lofts are usually contiguous to the upper bedrooms, making very
nice accommodation for the vermin.
Cooking is done in a common dwelling room as a rule in this sec-
tion.
Every village has a public laundry, consisting of a stone ti'ough
some 18 inches deep and 2 feet wide, with coping stones that are used
for rubbing boards. These troughs are supplied with water from a
small running spigot or faucet, the overflow running in the surface
gutter along the main street. This laundry is usually centrally
located and is sometimes covered by a roof, and is the common prop-
erty of all.
Bathing facilities are buckets at home, and during the warm
M^eather for the men the public laundry is of common use.
Outdoor latrine, or privy, is the rule and kept in the most wretched
and filthy condition, with promiscuous urination in every nook and
crook in the public thoroughfare and against the walls.
Camp Hospital No. 10, of a 300-bed standard type of portable,
wooden buildings, has been provided for this area with a permanent
personnel of 9 doctors and 60 enlisted men. This hospital was built
at the bottom of a hillside about a half a mile from the station of
Prauthoy, on the western boundary of the village, some few hundred
feet from the roadside. It is a very good location, with good surface
drainage, sloping to the valley about 1 mile across.
The water supply to both the hospital and the village is obtained
from a spring, which has been covered by American Engineers, and
which is located in the hillside above the hospital. The water is very
good and well protected, and the troops in the village are not com-
pelled to drink the water from wells or use any doubtful water at
this station. However, for extra precautions against willful pollu-
tion Lister bags and chlorine are used for the drinking.
The hospital was occupied during the month of April and May,
1918, by the 32d Division.
A. E, F. CAMP HOSPITALS. 2069
Following the 32d Medical Staff came Evacuation Hospital Xo. 5,
to be temporarily quartered at the hospital while awaiting orders to
move up to the front.
On June 28, 1918. 10 medical officers and 60 enlisted men of the
Medical Department took over the hospital on July 1, 1918, and the
hospital was opened up for service to the area for the 29th Division,
which was just arriving by sections.
After 15 days, and on account of the pressure to the northwest
by the German drive of July, 1918, the 29th Division was ordered
out before they had time to even get settled for practice work.
The division surgeon had no means for the disposal of his in-
quarters cases other than to turn them over to the care of Camp
Hospital No. 10.
August 1, 1918: The 79th Division moves into the area with the
approximate estimate of 25,000 command.
Pneumonia cases coming in, accident cases (trains, cars, and
wagons) : dysentery, three cases rapidly fatal, very strict methods
adopted for the green troops to stamp out the epidemic; very good
results; cases not so severe, no more deaths; four deaths of pneu-
monia, this disease combated and kept well under control.
September 1, 1918: One hmidred and sixty-five cases in hospital;
80 per cent epidemic grippe (flu) , sent in the last 48 hours. Register
shows that since July 1 to September 1, 672 cases of all kinds have
been admitted to the hospital. All bronchial cases are placed to-
gether ; all contagious cases are in segregation, no cases of spreading
disease have occurred in the hospital to date and none of the
enlisted personnel have contracted any disease or been sick in hos-
pital to date. No cases of venereal disease among the personnel to
date and only three syphilitic and two gonorrheal cases have been
in the hospital to date. The prophylactic station is practically out
of commission, only 10 treatments given in two months; bimonthy
inspections very rigid.
September 8 and 9 : The 79th Division evacuating the area all sick
and those unable to march ordered to Camp Hospital No. 10; 350
cases in hospital: pneumonia following la grippe very severe; 28
cases, 7 deaths : IGO cases bronchial la grippe ; 5 female nurses arrive
from Camp Hospital No. 21; Sanitary Squads Nos. 51 and 52 report
for duty for the emeigency.
October 15 : Receiving overflow cases, 75 from Langres and 200
from Is-sur-Tille, most of them being Spanish flu and pneumonia.
Considerable sickness among the inhabitants of the villages, few
deaths, mostly Spanish flu, with complicated pneumonia. Calling
for doctors every day and our medical officers are attending the
worst cases.
October 25 : Sickness in the area is abating some ; not many deaths
among the inhabitants. Colored labor battalions and construction
troops in area, hospital receiving pneumonia and influenza cases
from these.
November 18: 82d Division marches into area, after 14 days
marching from Grand Pre, Argonne route, 29 days continuous
fighting in the line: men run down, lousy and dirty, hospital used
as a cleaning station and delousing center; 650 cases of minor and
general ailments cared for in the course of two weeks, no serious
sickness at present.
2070 KEPORT OF THE SURGEON GENERAL OF THE ARMY.
Deconiber 1 : The period Xoveniber 18 to December 1 found a
pronounced i)hysical reaction in the men and officers of the 82d
Division, apparently due to their continued fiiihting at the front, fol-
lowed by their lon<>- hike froui (xrand l*re to Prauthoy. The nervous
and physical tension was broken by their new environment and the
sick rate increased. December 1 found Camp Hospital No. 10
carrying 325 bed cases, practically every one " class " before becom-
ing sick, and this in addition to continuous daily evacuation to base
53, Langres, and base 17, Dijon. Pneumonia of a virulent type fol-
lowed the influenza and gastrointestinal casL^s increased. Middle-
ear complications were rather frequent after influenza also.
I. CAMP HOSPITAL NO. 11.
Camp Hospital No. 11, was established by paragraph 15, Special
Order 71, headquarters Base Section Xo. 1, elated March 12, 1918,
at the port of St. Xazaire, France.
At first the location was the old so-called troops infirmary, and it
was operated by the medical detachment of the Seventeenth Engineers.
At this infirmary. Camp Hospital Xo. 11 held sick call for all troops
arriving in Camp Xo. 1, transferring all hospital cases to Base Hos-
pital Xo. 101, located at the edge of the city adjacent to Camp Xo. 1,
and continued to do so until May -1, 1918, when the records and equip-
ment on hand were transferred to the present site. On September
3, 1918, Field Hospital Xo. 44, with 6 officer and 83 enlisted men,
arrived at Base Section Xo. 1 from Brest. The men were detailed for
fluty at Camp Hospital X"o. 11 from the middle of September
throughout the influenza epidemic and have remained since.
During the influenza epidemic, Field Hospital Xo. 39 pitched its
tents adjacent to the hospital and functioned as a fiekl hospital in
connection with Camp Hospital Xo. 11 for the reception of influenza
patients. They remained l:)Ut a few days when they were ordered to
the intei-ior of France.
The hospital is located at the northwestern edge of Camp No. 1,
about '2^ miles from the center of St. Xazaire, and was housed in
17 frame buildings 20 by 100. The standard building, 20 by 100,
under ordinary conditions, will contain comfortably 35 hospital
beds and the capacity of the institution was at this time approxi-
mately 350 medical and 35 venereal cases.
On July 23, 1918, the first venereal segregation camp of the Ameri-
'^an Expeditionary Forces in France was established at Camp Xo.
1, immediately adjacent to this hosj^ital.
Prior to this, acute venereal diseases were cared for at Base Hos-
pital Xo. 101 and Camp Hospital No. 11, but without specially trained
men detailed for the purpose. After the order establishing this camp
a specialist in nro]og\\ venereal diseases, and diseases of the skin
was assigned to duty at Camp Hospital Xo. 11, and the patients sent
to the segregation camp were treated by the urological department
of this hospital.
The development of the department of genito-urinary and skin
diseases has been most active and important, and from its original
single building for office, ward, and treatment, as has been stated, it
has grown to its present size of 9 wards of 315 beds, as follows :
Two wards, 70 beds for cases of chancroids and syphilis.
A. E. F. CAMP HOSPITALS.
2071
Five Avards. 175 beds for gonorrhea and its complications.
One ward, 35 beds for officers suifering with venereal diseases.
One Avard for diseases of the skin, including scabies.
No more interesting, acute, or terrible work has been performed
than Avhat was done during the epidemic of influenza in October,
1918, wliich may be said to have burst over this hospital with almost
the force of a thunderbolt. There had been a fair number of influenza
cases admitted when, on October 4. 1918, the surgeon of Base Section
No. 1, at St. Xazaire, received a message b}' wireless that a convoy
of 24,000 troops would arrive two days later with many cases of
influenza. One thousand five hundred hospital beds Avere ordered to
be held in reserve, and these Avere obtained by cA^acuating 1,5.00 pa-
tients from Base Hospital No. 101 in St. Nazaire and from Camp
Hospital No. if to Base Hospital No. 8 at Savenay, IG miles away.
On Sunday evening. October 6, 1918, this convoy arrived. Within
two hours influenza patients were being sent to this hospital, and
throughout the night the officer of the day and his assistants were busy
W'ith their reception and in assigning them to their wards and direct-
ing treatment. By morning the influx began in all severity and con-
tinued almost unabated for the next 10 days. Within tAvo days the
hospital Avas filled to maximum capacity, every available space and
building being occupied by beds, and the entire force was Avorking
practically da}" and night. So great w^as the pressure that another
evacuation of the less serious transportable cases to SaA-enay became
necessary. The hospital continued to run filled to its emergency
capacity, and 1,200 patients were cared for during the Aveek at the
height of the epidemic. In addition to the patients in the hospital
tAvo " sick calls '' Avere handled each day by the officer of the day
and his assistants. This call of patients Avas so great that the officers
were on duty in the dispensary from 7 a. m. until 10 p. m.
In general, it may be stated that the course of the fatal cases Avas
the usual terrible one of sudden oncoming Aveakness to prostration
and body pain, with the rapid extension of an acute pulmonarj- con-
gestion and broncho-pneumonia, involving, in most instances, prac-
tically the entire area of both lungs; this process, accompanied by
fever as high as 103 to 104.6, rapid and failing and frequently ir-
regular heart action, cough Avith a blood}' expectoration, engorge-
ment of the right side of the heart, coma, and death.
Our hospital figures show the following, from Avhich it can be
seen the sudden work which was throAvn upon it :
AA'eek ending —
Total ad-
mitted.
■ Trans-
'■ hospitals.
Duty.
Total
treated
in wards.
Sept. 30
293
615
826
216
13 i 153
4 25
75 1 301
24 : 5S
9 i 202
112
776
Oct. 7
214 615
Oct. 14
154 i 1,198
Oct. 21
125 1 884
Oct. 28
201
269
878
It Avas unfortunate that during this epidemic there Avere no female
nurses attached to the hospital, and the entire nursing, care, and
attention devolved upon the enlisted staff.
2072 EEPOET OF THE SURGEON GENERAL OF THE ARMY.
In the latter part of December, 1018, the wards were ajrain over-
crowded, and to make room, on December 24, 76 mnmp patients
were transferred to one of the barracks buildings in the near-by
isolation camp.
These wards each held 96 patients, the men sleeping in the double
deck, double wooden cots, which, although not as comfortable as hos-
pital beds, yet with hospital mattresses made a perfectly good series
of wards. At this time there seemed to be a spread of niumps, and
in January we had over 210 cases at one time.
J. CAMP HOSPITAL NO. 12.
The hospital is situated in the Camp du Yaklahon, a permanent
French Artillery camp, about a mile from the village of Le Valdahon
(Doubs), in the foothills of the Jura Mountains. The post is on the
summit of a hill at an elevation of about 50 meters. The camp is
about 1 mile in length and one-half mile wide, with an artillery range
to the north. It consists of substantial brick and stone barracks for
officers and men, kitchens, and wooden mess halls. It has a water
supply and a sewerage system, the latter designed to £are for drainage
from kitchen sinks and lavatories, surface water from the streets, and
about a dozen flush water-closets in the officers' barracks.
The camp was built as a summer camp and was used during peace
times for artillery maneuvers, consequently all water pipes were laid
close to the surface of the ground, and the facilities for the disposal
of sewage were not extensive. Latrines, except for a few in officers'
barracks, were of the French type, a platform with cans underneath.
They were consistently jDlaced in close proximity to the kitchens and
had no protection against flies.
One barracks building, smaller than the rest and slightly different
in its interior arrangement, had been used by the French as a hospital.
This building, E-1, was situated at the extreme northeast corner of
the camp, close to the stables. In addition to this a group of buildings
at the south edge of the camp had been built especially for hospital
purposes. These buildings were of more modern construction, one
story in height, and were provided with running water, baths, and
latrines — bucket tvpe in building 1 and flush type in building 2.
On August 19, i917, the 1st Field Artillery Brigade of the 1st Di-
vision arriA'ed at Valdahon from the United States.
As the brigade had nothing but combat medical equipment, and as
there were a number of more or less serious cases of illness in need of
hospital care, the brigade surgeon, after a conference with the brigade
commander, decided to establish a provisional hospital.
On August 23, 1917, building E-1. which had been used as a hospital
by the French, was taken over, with all its hospital equipment.
Aliout August 31 the brigade surgeon received instructions from
the chief surgeon American Expeditionary Forces to take over all hos-
pital buildings and sanitary equipment in Camp Valdahon from the
French. This w^as completed about September 5.
The designation of the hospital was " Camp Hospital, 1st Field
Artillery Brigade, American Expeditionary Forces," until October
12, 1917. On that date it was officially named by general headquarters
American Expeditionary Forces " Camp Hospital No. 12." The hos-
pital remained under the jurisdiction of the division surgeon 1st
A. E. F. CAMP HOSPITALS. 2073
DiAision until Janiitiry 4, when it was transferred to the lines of
communication.
The 1st Brigade had left the post by the 1st of Xoveniber and only
about 40 cases Avere left behind. This number decreased to about '20
and remained so until the arriAal of the 2d Brigade, about the 1st of
January, 1918.
As the 2d Brigade AAas composed of troops fresh from the States
the long journey from the port of debarkation in the bitter cold of
midAA^nter in troop trains aa as a Aery seA^ere strain, and seAeral cases
of pneumonia deA^eloped on the first day. Pneumonia did not proA'e
to be a Aery serious feature, only 2 deaths occurring. HoAAeA^er, the
daily admissions increased rapidly until February 8, when the maxi-
mum of 305 patients was reached. About January 8 the first cases
of measles Avere adniitted and the number increased to about -40. The
disease Avas of a A'erj?^ seAere type, usually accompanied by a severe
bronchitis, and numerous complications AA^ere recorded, chiefly
broncho-pneumonia, 20 cases of Avhich occurred, with 6 deaths re-
sulting.
On June 1 word AAas receiAed that a few wounded men were being
sent here from one of the French hospitals at Belfort. It was learned
that tAA-o American Bed Cross nurses were on duty at St. Jacques
Hospital at Besancon, but that there Avere no American patients
there. The serA'ices of these two women was requested from the
SerA'ice de Sante and they were sent here for temporary duty.
The 5th Artillery Brigade ai-riA'ed in the post on June 19, and the
6th Brigade established itself in the A-alley of the Loue soon after.
This made about 10,000 troops to hospitalize, in addition to those in
the lumber camps from Etalans to the Swiss border and south to the
Mouthe.
Early in July there was an increase in the number of admissions
for acute respiratory disease from troops stationed in the post. This
infection proAed to be of a mild type, with practically no complica-
tions. During the last few days of July the amount increased, and
early in August the disease assumed epidemic form. All aA-ailable
hospital beds were rapidly filled, yet patients continued to arriA^e.
Extra beds AA^ere set up AA'hereA'er possible. Building 6 was opened
as a ward and tents were pitched on open ground near Building 1. A
small portable building AAas obtained from the mill at Ornans, oper-
ated by the ciA'ilian relief department of the American Bed Cross.
The crest of the epidemic was reached on August 15, with 32
patients admitted. In response to telephonic request two medical
officers reported for temporary duty on August 17. Eight nurses had
arriA'ed on the 11th from Camp Hospital No. 24 and the enlisted
force of Sanitary Squad Xo. 10, with 4 sergeants and 19 priA'ates,
Medical Department. At this time there were about 200 patients in
the hospital.
The month of August proAed the most critical period in the history
of the hospital. The rapid expansion threw a scA'ere strain on the
small personnel, who had had no preA'ious experience with work
under pressure. Shortage of medical personnel in the American
Expeditionary Forces and heaAy disorder in the forAAard areas made
the obtaining of reinforcements difficult, but eA-ery possible assistance
was rendered by the surgeon of the advance section.
2074 REPORT OF THE SURGEON" GENERAL OF THE ARMY.
The 5tli Brigade left the post August 23. An effort was made to
keep the 6tli Brigade from entering, but there was an increase in the
incidences of respiratory disease, and within a week this epidemic
assumed alarming proportions. Admissions to the hospital jumped,
in 10 days from 4 or 5 daily to 141 and for 13 days fell below 75 but
once, with a total of 1,215 patients admitted during this period.
The normal capacity of the hospital at this lime was 21}() beds.
In September the hospital faced a new and severe epidemic, with-
176 beds in the isolation group, and with 350 cases of influenza already
in hospital. The limit of expansion had been reached in the use of
tents, storerooms had been converted into wards, and al] venereal
patients evacuated to the base.
The Y. M. C. A. buildings had been closed for several weeks on
account of the epidemic. They seemed the logical^ buildings to take.
The 10th of September the adjutant asked the Y.' jM. C. A. to give
up the building at the east end of the camp. A definite answ^er was
refused. Two days later a second verbal request Avas refused. A
letter followed by a personal conference 'with the chief of the
Y. M. C. A. and urgent appeal was made for the vacant building,
but the Y. M. C. A. refused. After some discussion the Y. M. C. A.
officials finally stated that since they felt that the buildings would
probably be taken over by requisition, they would give them volun-
tarily. Five hours later 70 patients were admitted to this buildings
and within 18 hours it contained about 140. The next day verbal
request was made for the two buildings at the west end of the post,
and these were occupied 24 hours later. On vSeptember 14 about 240
patients were being taken care of in them.
September 19 Barracks Y was taken for hospital purposes and
about 300 patients admitted. Barracks X-12 Avas taken on the 23d
and Barracks X-4 on the 24th. As it was impossible to provide food
from a central kitchen, field ranges were set up in the vicinity of
each barracks and cooks assigned to duty.
Patients were admitted in groups of from 10 to 40. It was obvi-
ously impossible for them all to come through the receiving ward, so
arrangements were made by telephone. Patients were sent to each
building in rotation, whenever possible, in order to avoid swamping
the ward personnel.
The ambulances available were not able to transport even the
lying patients, but trucks were supj^lied by the Motor Transport Com-
l)any Xo. 375. All patients who were able to walk did so.
The maximum daily admissions was 141, on September 16. The
maximum number of patients in hospital was 1.335. on September
29, 1918.
About October 1 the general idea of separating influenza patients
according to the type of throat organisms present was considered and
worked out.
1. Early diagnosis and innnediate segregation and masking in
the barrack or billet.
2. Immediate admission to the hospital, to an observation ward.
3. Sending of " clean " and " unclean " cases, bacteriologically
speaking, to separate wards. (" Clean " cases, where throat culture
showed no organisms or bacillus influenza ahme: "unclean" cases,
where streptococcus or pneumococcus were present in addition or in
other combination.)
A. E. F. CAMP HOSPITALS. 2075
4. Se]3aration of cases accordino; to specific clinical indication.
5. Absolute isolation in the hospital cases.
6. The sending of convalescinfr patients to a convalescent ward as
soon as practicable to reduce chance of reinfection.
The second objective was to be attained by graded exercises and
hikes for convalescents. The establishment of this plan required
several steps. In brief they consisted of:
1. Obtainino: a census of'patients to show (a) patients in bed, (h)
patients recently up, and (c) convalescing patients.
2. The determination of the throat organisms of bed patients. It
was impracticable to examine all patients.
3. The separation in their original wards of patients into groups,
" clean "* and " unclean " bed patients, ref:ently up patients, and con-
valescent patients.
4. The final distribution to "clean." "unclean." and convalescent
wards. The groups of recently up patients were retained — segre-
gated in their original wards until ready for the convalescent ward.
The plan was put in operation on October 6. The new cases other
than surgical or clean medical went to the observation ward. After
culture report and observation over an average period of 48 hours,
they were distributed to the " clean " or " unclean " wards. The
scheme was found to be quite practicable with one exception, namely,
that with a high admission rate, when several cases were admittecl
to Barracks Y without passing through the observation ward, one
of the latter was insufficient. Therefore, it was planned to open a
new observation ward. With two, alternate receiving and distribut-
ing days would be made possible, greatly facilitating the examina-
tion of patients and their distribution, and reducing considerably the
strain on the personnel.
At this point, however, October 18, the beginning of a meningitis
epidemic, with its swamping of our already overworked bacteriolo-
gists, put an end to our plans.
During the period from October 6 to October 18, 256 cases were
admitted to the observation ward, cultured, and then assigned to the
wards indicated by their clinical condition and the bacteriological
report.
Early in October meningococcus meningitis began to appear in the
post in epidemic proportion. The 6th Brigade had moved out and
the 156th, Avho had been through the meningitis epidemic at Camp
Jackson, had come in. Before October 20, 18 cases of meningitis had
occurred, two on the 19th, among patients in hosiDital. In view of
this last fact discharges and transfers were immediately discontinued.
Further cases developed among patients in several wards; 12 more
appearing before the end of the month. By very thorough isolation,
observation, and culturing contacts for carriers, bj^ separation of car-
riers and by strict segregation of patients from regiments known to
be infected, the outbreak was controlled by the end of the month,
only three further cases developing thereafter.
T^v October 28, the epidemic was under sufficient control to permit
the discharge of patients, who numbered at this date, 1,059. This
number rapidly dwindled until by November 4 it was 585. On No-
vember 10, patients numbered 433. On November 21, patients in
hospital numbered 233.
2076 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The influenza epidemic had ceased by this time and the hospital
assmued its peace time basis, and kept tliis till the end of the year.
On December 31, 1918, the hospital consisted of (1) main hospital,
(2) isolation group with 2 stone and 11 wooden buildings, (3) a
sterilizing plant, (4) a morgue, (5) a laboratory, situated in one
of the stone barrack buildings. The number of patients in hospital
on December 31, 1918, was 141.
REPORT UPON AN INVESTIGATION OF AN EPIDEMIC OF INFLUENZA OCCURiUNG AT
CAMP VALDAHON DURING JULY AND AUGUST, 1918.
This report deals Avith an investigation of a respiratory infection
which occurred in epidemic form in the camp of Valdahon during
the months of July and August, 1918. The investigations covered
the period August 16 to August 30.
The camp of Valdahon is a permanent artillery camp of the
French Army. The nearest town where troops are billeted is from
1 to 2 kilometers distant from the post. There is some opportunity
for the troops occupying the post to come into contact with those
occupying billets, owing to tlie fact that the former are permitted
to visit the towns on pass and the latter to come to the post in order
to attend functions in the Y. M, C. A. The post hospital. Camp
Hosi^ital No. 12, receives patients from all the organizations in the
post, as well as those in the surrounding billeting area, so that it
hospitalized approximately 15,000 troops Avhen one brigade is oc-
cuj^ying the post and another is billeted in the nearby towns.
A respiratory infection, diagnosed as influenza, was prevalent
among the troops in the post during the months of July and August.
During these months the post was occupied by the 5th Artillery
Brigade, in addition to detachments constituting the permanent per-
sonnel of the post. The disease was chiefly prevalent among troops
belonging to the 5th Artillery Brigade. Thus, out of a total of 75
cases of influenza admitted to the hospital during the period July
1-26, inclusive, 66 occurred in organizations belonging to that
brigade, notably the Headquarters Compan}", the 5th Trench Mortar
Batter}', and the 20th Field Artillery. The epidemic was said to be
relativeh' mild at this time. It is impossible to state where the 5th
Brigade acquired the disease. Influenza was prevalent among the
civilian population of Besancon, 30 kilometers away, and the troops
of this command were allowed to visit that city.
During the month of Julv, while the 5th Brigade was in the post,
the 58th Brigade, comprising the 122<:1. 123d. and the 124th Field
Artillerj; Kegiments, the 108th Trench INIortar Battery, the 108th
Ammunition Train, and the 108th Motor Ordnance Repair Shop.were
located in the surrounding towns. This brigade was not using the
ranges and had no cases of influenza during that time.
On Julv 25 or 26 the 5th Brigade left the post, and on July
27 the 124th Field Artillery began to enter the post. The 123d
Field Artillery began to enter the post on July 29. In each case
about three days were consumed in getting the entire personnel
of these organizations housed in the post. The 122d Field Ar-
tillery did not enter the post, but remained billeted in a town 2
kilometers distant. The sanitary officer of the post at that time
considered that the 5th Brigade left the barracks in an unsanitary
I
A. E. F. CAMP HOSPITALS. 2077
condition and submitted a written report to that effect "which was
in turn i-ef erred to the general officer commandino- that brigade.
The Litter, in his reply, stated that one of his officers characterized
the report as " absurd."'
The total number of cases of influenza admitted to hospital from
these organizations of the 58th Brigade located in the post, during
their staj^ there, approximately four weeks, amounted to 109.
The total strength of these same organizations was approximately
3,000 on August 1, so that from July 27 to August 23, when the
brigade had left the post, 6.5 per cent of the troops of the 58th
Brigade that were exposed to infection were admitted to hospital
with that disease. In some of the organizations. ]iotably the 124th
Field Artillery, the rate was even higher. The greatest incidence
was in Battery E of the 124th Field Artillery amounting to 16.5
per cent. A glance at figure 1 shows a drop in the number of cases
on August 17 and 18 with a subsequent rise. This decrease can be
explained on the basis of the fact that the brigade was expecting to
leave the post on the 20th and the men, who surmised as much, were
loath to report sick for fear that they would be left behind by their
organization. On being assured that provisions had been made for
returning men to their OAvn units, the men either reported sick of
their own accord or were unable further to dissemble their illness so
that the curve again showed an upward tendency.
MeasuTes taken to conibat the ejndemic. — When the facts elicited
above had Ijeen collected and correlated, a conference was held with
the regimental surgeons of the 123d and 124th Regiments in regard
to the situation. The question of recommending that the barracks
be vacated at once and that the men be put under canvas was con-
sidered. The regimental surgeons deemed it inadvisable to make
such a recommendation in view of the fact that the brigade was
under orders to move and was expecting to leave on August 20.
The recommendation was therefore not made. The post surgeon
had already advised that the rooms of the Y. M. C. A. be closed
and that all classes of instruction be conducted in the open air
wherever possible. On August 19. the Y. ]SI. C. A. rooms and the
French canteen were closed by order of the DOst commander.
Attention was then directed toward the prevention of an outbreak
of influenza amongst the troops of the 6th Brigade, which had no
cases of the disease: it was billeted in the surrounding towns and was
waiting to enter the post when it should be vacated by the 58th
Brigade. Representations were made to the post commander on
August 18 by the post surgeon, who stated the situation and recom-
mended that no barracks be occupied by incoming troops without
a preliminary cleaning of the same.
On August 22 the 124th Field Artillery vacated their barracks,
and on the same day fatigue parties from the 3d Field Artillery
of the 6th Brigade began to clean the barracks vacated by the
former regiment. The 123d Field Artillery left the post on August
23. Both of the outgoing regiments swept out their barracks before
leaving.
The cleansing meavsures instituted in the we=Jtern group of barracks
were as follows: All beds, bedding, and movable fixtures were taken
out into the sunshine and left there for several davs. The walls
2078 REPORT OF THE SURGEON GENERAL OF THE ARMY.
were washed with soapy water applied with brooms, the fiooi^ were
then scrubbed with soap and water, and after drying some of the
rooms were wliitewashed. The cleansing process was greatlj^ ham-
pered by lack of sufficient water, as the water supply of the camp
Avas scanty and the water was turned on onh^ for a few hours of the
day. No chemical disinfectants were resorted to because of the dif-
ficult}' of sealing the rooms. Chief reliance was placed upon clean-
ing and sunshine.
On August 24 the 6th Trench Mortar Battery, which occupied
Barracks X8 and had had one case of influenza, was moved into
billets in Valdahon, 2 kilometers distant. Several cases subsequently
appeared in this outfit.
A number of cases of influenza made their appearance in the 800th
Squadron during this period. This organization was located about
1 kilometer from the main barracks and numbered about 60 men.
On August 27 the 6th Brigade commenced to enter the post. From
that time to the present, cases of influenza have been admitted from
the organizations constituting that command.
During the months of July and August a number of cases of in-
fluenza or acute bronchitis were admitted to Camp Hospital No. 12,
and it seems altogether likely that there were more than this number
of cases in camp for the reason that some of the milder cases were
not sent to hospital by the regimental surgeons; for example, it is
known that one regimental surgeon was not sending liis cases to hos-
pital unless they had a temperature of 101° by mouth. The regi-
mental surgeons of the 6th Brigade were urged when their respective
regiments came into camp to send their cases to hospital at the first
appearance of the first symptom, in order to remove the infected
men from the barracks as quickly as possible and thus prevent dis-
semination of the disease by patients in the first stages, for there
can be no question that the causative agent of the disease in this epi-
demic i^ossessed a high degree of infectivity.
K. CAMP HOSPITAL ^'0. 13.
Camp Hospital No. 13, American Expeditionary Forces, opened
officially on November 13, 1917, and 45 patients were admitted. Most
of these were transferred from the brigade hospital, which up to this
date had been functioning as sucli. Init was found to be entirely inade-
quate both in bed capacity and equipment.
The hospital consisted primarily of 17 service de sante type bar-
racks, previously built for and occupied by the Russians in 1916 and
adjacent to the present French hospital, which has long been in exist-
ence at this French artillery camp at Mailly (Aube).
During the first month the hospital opened admissions were of
diseases such as are commonly seen in our civil hospitals in the
United States, but with a preponderance of mumps, which was epi-
demic all through the winter months.
Influenza of a peculiar type started on May 26, 1918, and from that
time on has been epidemic, severe while it lasts, but of short duration,
usually 24 to 48 hours, and attacking whole batteries in a very com-
plete manner.
A. E. F. CAMP HOSPITALS. 2079
December 11, 1917, a fire, of unknown origin, completely destroyed
the barracks occupied by the medical officers, and witli it all the per-
sonal effects of the latter.
The following statistics, taken from the sick and wounded reports,
convey a fair resume of patients treated in this hospital from Novem-
ber 13, 1917, to June 1, 1918 :
Total maxiniiim strength of coiinnand from which adinissious came 8, 000
Total luunber of case'? admitted 1,653
Total nuinher of intdical cases . 643
Total nuinlier of surgical cases 1,010
Total imiiilter of epidemic diseases 595
Total iiiuuiier of venereal cases (new and old) 116
Total number of major surgical operations 189
Total number of deaths 7
Normal conditions continued until June 14, 1918, on which date
we admitted our first battle casualties. All were serious cases and
had been transported long distances and were in very poor condition
on entrance. One patient had died 15 minutes before arrival at this
station, after liaving been to three French hospitals, but admission
refused on account of lack of beds. Influenza epidemic practically
over on the 7th of June.
Normal conditions existed until July 15, at which time we received
cases, battle casualties and convalescents, from hospitalized forma-
tions nearer the front. All night we were busy admitting cases, and
about 3 a. m. a German aeroplane was heard and soon after dropped
a bomb which struck about an eighth of a mile from the hospital.
Admissions continued all night, and from this date on we were ex-
ceedingly busy up to and including July 28. Our greatest nmnber
of patients was reached about the 17th. and on the 18th we evacuated
250 to the base. Admissions continued, many slightly gassed, and
a few battle casualties which were moderately severe, until the 28i]i,
at which time we had again reached our capacity and evacuation by
train was again accomplished.
July 17 a severe hailstorm destroyed much property, viz. the roofs
of all barracks being tar papered were pierced by the stones and many
windows broken. Tliis allowed rain to pour througli and into the
wards and barracks occupied by personnel and patients. Eepair of
above will take at least a month.
The month of August was a comparatively quiet month, except for
a slight epidemic of diarrhea.
Normal conditions existed until the 12th of the month, when ad-
mission, of influenza increased markedly.
These cases were particularly notable on account of the severity of
the infection, the tendency to be complicated by pneumonia Avhich
was attended by extremely high mortality. Most of these pneu-
monias were of the l)ronchial type, the organism found in sputum
being chiefly the streptococcus hemolyticus.
The course of the disease varied from a few days to three weeks,
and various complications, viz, pneumonia, empyema, pleurisy, and
otitis media followed. Our mortality since the 12tl'i of September
has been about 50 per cent in these cases of pneumonia following in-
fluenza.
2080 EEPORT OF THE SURGEON GENERAL OF THE ARMY.
xVbout the Stli we commenced to receive many severely wounded
patients from the Champagne sector, chiefly from the 2d and 36th
Divisions.
Month of October: This entire month has been the busiest from
llie ^tanvli)oint of admissions and serious cases. Influenza increased
oiadually during the first 10 days, Avith a corresponding proportional
number of deaths from pneumonia, and held at its maximum until
the beginning of the last week, at whuh time a gradual decrease in
disease has been noted.
Our mortality fro)n pneuuionia following influenza was about 40
per tent, and admissions of battle casualties increased gradually up
to October 30, most of which have been extremely severe, badly in-
fected gunshot wounds with connninuted compound fractures.
Montii of November: Normal conditions existed relative to admis-
sions and epidemic disease up to November 15, at which time there
was a marked falling off in admissions.
On account of the falling off of admissions, the total number of
patients in hospital the latter part of the month had dwindled to
around 80.
Surgeon, advance section, Services of Supply, visited this hospital
on November 27, and advised cutting our bed capacity to 150 beds,
also packing up unnecessary supplies and material in anticipation of
early closing of this hospital.
Month of December: This month witnesses the gradual disinte-
gration of the persojmel and equipment of Gamp Hospital No. 13,
leading up to its final closing on December 31, 1918, in pursuance to
instructions received from the surgeon, advance section. Services of
Supply. On this date there were six patients remaining in hospital.
Three of these were able to be returned to duty and the other three
were transferred to Base Hospital No. 83.
L. CAMP HOSPITAL NO. 14.
Camp Hospital No. 14, third aviation instruction center, American
Expeditionary Forces, was officially born October 15, 1917.
The equipment of the embryo hospital consisted of 3 medical and
surgical chests, 1 venereal chest, 1 Royal typewriter, 2 empty buckets,
1 bed pan, 1 urinal, 1 wash pan, 1 galvanized chamber, 12 bedsteads,
and a hot-water bottle. This equipment was housed in one of the
Red Cross buildings, about 25 by 60 feet, generously donated by the
American Red Cross. During the time this building was occupied
construction on the present surgical building and ward 13 was being
done with as much haste as circumstances permitted.
Early in the winter mumps and measles put in an appearance and
it became imperative that a contagious ward be built; consequently a
shack was constructed, which was capable of holding 8 or 10 patients.
As these cases increased tents were erected to accommodate them. The
overflow was transferred to Base Hospital No. 9, Chateauroux, with a
General IMotorg Co. ambulance, which had been added to the hospital
equipment.
In October, 1917, flying was begim on field 1, which is now field 2.
A medical officer and two corps men with an ambulance were detailed
for duty on the field each day. Since then, as a new field has been
A. E. r. CAMP HOSPITALS. 2081
opened, a medical officer with corps men and an ambulance have been
permanently detailed for duty.
Adjutant General headquarters order was issued to double-deck all
bunks because of the scarcity of lumber in France, and that more men
could be housed under the same roof. To prevent the rise and spread
of respiratory diseases, which were inevitable apparently, partitions
were built between adjacent bunks from 18 to 24 inches high, so that
carriers of communicable respiratory diseases could not cough or
sneeze the infection into the face of his sleeping neighbor. This sys-
tem proved its worth in an epidemic which developed later.
AVell Xo. 1, which supplied practically all the water was, without
the consent of the medical authorities, placed where it was liable to
be contaminated with surface water from the whole camp. So effect-
ively was the camp drained that it was possible to use the water from
this well at all times. The water was examined regularly for con-
tamination, and the squadrons were advised to chlorinate their drink-
ing water. Precautions were so complete that there has not been a
single case of dysentery, or any other water-borne disease, developed
at this center.
Prominent in the history of this service appeared the epidemic in
September and October, 1918, of influenza with many cases of pneu-
monia following. Beginning the second week in September the num-
ber of patients admitted for disease jumped from 63 the previous week
to 127 the first week of the epidemic. This ran as high as 240 some
weeks, and lasted through the month of October. During this time
there were admitted for disease 1,289 cases; for injury 42 cases. Of
the 1,289 cases for disease, about 85 per cent suffered with influenza
of varying degrees of severity; 53 developed pneumonia, and 39 of
these died. There were no deaths from disease except those from
pneumonia.
It may be said that during this epidemic there was a similar epi-
demic in the 39th Division, which was billeted near by. Many of
their cases were complicated with or following measles, making them
more severe. Some of the cases reached this hospital in a moribund
condition following transfer varying from 25 to 40 miles.
As far as possible patients with respiratory diseases were isolated
and masked, attendants and nurses were masked. On all fields where
the partitions between bunks had been removed they were replaced,
the men were ordered to sleep head to foot, and the ventilating regu-
lations were enforced. These precautions caused the epidemic to rap-
idly subside.
Since the opening of the hospital there were admitted approxi-
mately 6,841 cases.
M. CAMP HOSPITAL XO. 15.
Camp Hospital No. 15 was opened in October, 1917. It is part of
Camp Coetquidan, an old artillery training camp taken over from
the French. The hospital at the beginning consisted of three large
stone buildings, which had been used as barracks by the French, and
five Adrian barracks. On November 1, 1917, when the hospital
really commenced to receive patients, the personnel consisted of 1
2082 REPORT OF THE SURGEON GENERAL. OF THE ARMY.
medical ollicer, in addition to the commanding otticer, and 37 en-
listed men.
A severe epidemic of influenza commenced about the 15th of No-
vember and measles and scarlet fever soon made their appearance
among the troops, necessitating the addition to the staff of more
officers and enlisted men, and the staff was further augmented toward
the latter part of the month by 12 Arm}^ nurses. During the month
of December more medical officers and nurses were added. The
building of a large kitchen and several Adrian barracks was started
during the month of November and completed in December. Early
in December, 1917, several cases of epidemic cerebrospinal meningitis
appeared, and since then the hospital has had cases of this disease
nearly all the time.
On November 1, 1917, there was 1 patient in the hospital and on
January 1, 1918, in two months, there were 327.
A prophylactic station had been established at Rennes, the nearest
A well-equipped bacteriological laboratory had been installed.
During the winter of 1918 several Adrian barracks had been com-
pleted and the three stone buildings were being used for hospital
wards in addition to the several Adrian barracks used for contagious
diseases. The capacity of the hospital was 675 beds, which could be
increased to 850 during an emergency. There were at this time about
20,000 troops in camp; toward the end of March tvv^o brigades had
left the camp, and as a result the number of hospital patients had
materially decreased. There was very little sickness in the camp
from April 1, 1918, to July 1, 1918, when several cases of so-called
three-day fever appeared. At that time there were 13,868 troops
in camp, but the hospital was taking care of troops from Rennes,
Phelan, Messac, Redon, Guer, and several other adjacent towns, so
that by September, when a severe epidemic of influenza broke out,
the hospital was really taking care of about 40,000 troops and had
904 patients.
This was the largest number of patients in the history of the hos-
pital, and during this time the hospital was especially active and
crowded to its capacity.
Pneumonia was very prevalent and several cases of meningococcus
pneumonia were discovered. There was also a severe epidemic of
cerebrospinal meningitis, and again, as in the previous year, several
cases of measles and mumps.
Early in September a venereal segregation camp was established in
the camp as a part of the hospital.
During the month of August, 1918, 263 convalescent wounded were
admitted to the hospital, transferred from Base Hospital No. 8.
Since then the staff has gradually been decreased, many of the officers
having sailed for the States. The patients are being evacuated
rapidly and most of the troops have left camp. There will still re-
main April 1, 1919, about 6,000 men to take care of, made up of Labor
Battalion, Quartermaster Corps, and prisoners of war and casuals.
N. CAMP HOSPITAL NO. 19.
At La Courtine (Creuse), France, on December 23, 1917, an
infirmary was opened hj the medical detachments of the 116th Engi-
neers and the 116th Field Signal Battalion. On January 8, 1918,
A. E. F. CAMP HOSPITALS. 2083
the 164th Field Hospital Company took charge of the infirmary and
began the conduction of the hospital.
In April, 1918, the Camp Hospital No. 19 detachment was begun
and maintained by transfers from difi'erent organizations in training
in the camp and from former patients in hospitals.
On July 5, 1918, the camp hospital office was moved from the
Laval hospital to the building formerly used by the French as a
hospital, and the Laval hospital building was used for contagious
and infectious diseases.
The total number of buildings maintained by the hospital was
eight and equipment for a 500-bed hospital. During the early part
of December the use of the large medical building was discontinued,
and both the surgical and medical patients were treated in the main
surgical building. From the establishing of the hospital to the
present date — April 15, 1919 — there have been 3,025 patients treated
in the hospital. Two epidemics of influenza were contended with,
one in October, 1918, and one in February and March, 1919.
O. CAMP HOSPITAL NO. 20.
(a) Inception of organization: November 11, 1917.
(b) The size of the camp, so far as strength is concerned, has
increased from 50 at the time of inception to an average strength of
20,000. Its jurisdiction has increasecl from that limited by the con-
fines of Camp de Souge to various areas, such as the aviation field,
Second Aerial Observation and Balloon Schools, distant 3 to 5 miles
from the camp, and several billeting areas — Le Taillau, St. Laurent —
distant 25 to 30 miles.
(c) From about September 15 to October 31, 1918, the camp was
visited by an epidemic of influenza. During this period there were
3,714 cases of the disease, the general mortality from which was 2.8
per cent.
Carnp Hospital No. 20, Camp de Souge, American Expeditionary
Forces.
January 26, 1919 : The size of the camp has varied since last report
from an average strength of 20,000 to 8,000, occasioned by a cessa-
tion of hostilities and a consequent stoppage of the training. Its
jurisdiction continues to cover Camp de Souge proper as well as
other areas, such the aviation field, Second Aerial Observation and
Balloon Schools, distant 3 to 5 miles from the camp, and several
billeting areas — Le Taillau, St. Laurent, Gironde — distant 25 to 30
miles.
January 31, 1919: The population of the camp during January
has averaged between 8,000 and 9,000.
The health of the camp has been generally excellent. There have
been a few cases of influenza and respiratory disease (catarrhal) but
no approach to an epidemic.
r. CAMr HOSPITAL NO. 21.
Shortly after the United States was declared to be in a state of
war with the Imperial German Government the Allegheny General
Hospital of Pittsburgh, Pa., voluntarily offered its services to the
142367— 1»— VOL 2 70
2084 REPORT OF THE SURGEON GENERAL OF THE ARMY.
United States Govenuuont for any purpose that the Department o*T
War mioht deem necessary. Immediately the otfer was accepted
and the staff was requested to oro-anize a Red Cross Hospital Unit.
Such units were entirely new in the military service and the nature
of the work to be performed was indefinite.
On the 1st of May, 1917, the staff of the Alleoheny General Hos
pital Red Cross Unit was organized. The staff as constituted was
accepted by the Red Cross connnission and the unit was to be known
as Hospitcil I'nit "L." Shortly after this, following the plan for
federalization of all the various military organizations for war pur
poses, the unit was made a part of the military forces under the
supervision of the War Department.
March 4 the officers, men, and equipment were on board a special
train for Ciimp ]Merritt, X. J. Other units accompanying us were
Cavalry and Infantry.
At 2 p. m. March 6 we reached Camp Merritt, N. J., which we
found to be a military " transfer " camp or embarkation camp where
soldiers were continuously coming and going.
The unit embarked from Hoboken Sunday, March 24, on H. M. S.
Mauretonia.
After lying in a i:)ort until 6 p. m. March 25, 1918, we saded out
of the harbor, everyone inside, all doors to the decks and portholes
closed.
Debarkation. — In the afternoon of April 3 our Cunarder docked
at Liverpool. It was not until the next morning, however, that we
disembarkech After a short march and wait we entrained at noon
on a special train for Southampton. At 9 p. m. we detrained at
Southampton and were given quarters at an anglo-American camp.
Tuesday evening, April 5, the officers boarded an English Channel
boat, Londonderry, which had been pressed into service for a troop-
ship during the emergency. With us were other American and a
few English officers, and a large detachment of Tommies, who were
making their initial trip to the war front.
With the officers of Base Hospital Xo. 116 our officers were tal?:en
by truck through Le Havre to a " rest camp " on the hill beyond the
city. The men marched up to the same camp. The nurses were
quartered in a hotel.
Our trip across Franc<> began Sunday evening, April T. on a train
consisting of third-class coaches and wagons, cars renowned through-
out the American Expeditionary Forces for their capacity of carry-
ing "40 hommes'' or "8 chevaux." In the former the officers rode
two to a compartment; in the latter the men rode, with their pack
and barrack bags. No heat was provided: as a result the night
proved to be a most uncomfortable and a sleepless one. From that
time on provisions were made for such emergencies and the trip
proved to be an interesting if not a comfortable one. From Le
Havre the route took us just to the north of Paris, passing the
famous Seine and Oise Rivers, through Troyes and Chaumont,
arriving at Langres the morning of April 9. A stop of several
hours was made at this city, enabling us to visit the places of interest
and our men to procure a much-needed bath. In the afternoon our
train moved on to Vitrey-Vernois, where we passed the night. While
waiting at this station a train carrying the nurses overtook us and
through a misunderstanding passed on, later to follow us to Bour-
bonne-les-Bains, a town of 4,000 on a branch railroad from Vitrey-
A. E. F.--CAMP HOSPITALS. 2085
Vernois. At the station we were met by the former commandant of
our hospitah We were agreeably surprised to find a beautiful mod-
ern buildinof. known as Camp Hospital Xo. '21. for our use.
Early in September calls came from hospitals for medical and
nursing assistance. At Camp Hospital Xo. 21 the medical officers
found sufficient Avork to keep them busy continuously from morning
until late in the evening. Each was in charge of one or more build-
ings in which the majority were influenza patients, numbering from
60 to 150 per building.
Man}- meuibers of the hospital personnel became ill, and two mem-
bers succumbed to the complication of pneumonia.
The number of influenza cases reached the maximum in October
and again in December, 1918 — 216 in each month. In the uncom-
plicated cases the disease varied in symptomatology and physical
findings in the various epidemics. In the first epidemic occurring
in May-June, 1918 (the so-called "three-day fever'"), the onset was
very acute with intense headache, conjunctivitis, pharjmgitis, and
luuibar muscle pain: lung complications of any sort were very rare.
Xo deaths occurred from the disease in this epidemic. In July, 1918,
a second and more severe epidemic became prevalent, in which the
complication of pneumonia was comparatively frequent, and death
accordingly resulting in some cases. In September-October a third
and still larger epidemic occurred in which the number of uncom-
plicated influenza patients approximated 65 per cent of all admis-
sions, and influenza complicated by pneumonia 12 per cent.
The number of meningitis cases have fortunately been small — 12
in all, from January. 1918, to March 15, 1919, with a mortality of
practically 58 per cent, including two cases whose death might prop-
erly be attri])ute(l to a complicating lobar pneumonia. All cases were
treated with antimeningococcus serum, an injection always being
given at the time of the first lumbar puncture. Most cases were given
serum intravenously also. Some of the cases were violently delirious
on admission. These fulminating cases invariably ran a bad course.
The prevailing disease has been influenza, which existed as an
epidemic during September, 1918, to February, 1919, with the
fre(inent complication of broncho-pneumonia. Every effort was made
to ])revent spread of influenza and other " respiratory " infections
among patients in the hospital. Screens were used wherever indi-
cated between beds on the medical wards; gowns and gauze masks
were worn by attendants on the medical cases.
I'p to the present no venereal disease has been reported from the
persoimel of this organization.
The building occupied by Camp Hospital Xo. 21 was erected in
1914 as a hotel for sunnuer visitors who cauie to Bourbonne-les-Bains
for hydrotherapeutic and vacational purposes. The hotel was in
operation for five or six weeks when the outbreak of the Great War
necessitated its closing. It was thus without occupanc}' until rented
and taken over by the United States Government as Camp Hospital
No. 21.
llisfonj of Hospital Unit L {supplemental^ report).
There is little additional to be reported in this supplemental his-
tory of Camp Hospital Xo. 21 as the data for most services were
given up to the 1st of March. 1919. All patients were evacuated by
April 20, and none were admitted after that date.
erl
i
2086 REPORT OF THE SURGEON GENERAL OF THE ARMY.
Q. CAMP HOSPITAL NO. 2 2.
Camp Hospital No. 22, situated at Langres (Haute-Marne) , Army,
Post Office 714. American Expeditionary Forces, was opened miderj
the designation of Camp Hospital "A," with a detachment ^fro
the sanitary unit, 9th Infantry, on or about November 15. 1917.
The hospital was taken over January 5, 1918, with personnel con
sisting of a detachment from the 163d Field Hospital. The designa-
tion from Camp Hospital "A" to Camp Hospital No. 22 was made
on or about January 15, 1918. From January 5, 1918, to June 11,
1918. the hospital was operated on a basis of 100-bed capacity.
On June 11. 1918, the 163d Field Hospital received orders reliev-
ing the unit at Langres and the hospital was closed. The buildipg
was used as an infirmary until June 26, 1918, by a detachment from
the 163d Ambulance Company.
On June 26, 1918, the hospital was reopened as such, with per-
sonnel from the May replacement draft, with a capacity of 100 beds.
On November 3. 1918, orders were received to increase the capacity
to 200 beds. Work on barracks to provide the additional space was
started, but was discontinued after the signing of the armistice,
November 11, 1918.
Orders were received February 15, 1919, to prepare to close the
hospital, and the last patients were transferred or returned to duty
February 18. 1919, the hospital records were completed, and the hos-
pital officially closed February 28, 1919.
This building is of stone, two stories and an unfinished third floor,
used as a squad room for the enlisted personnel. A barrack or hut
building was constructed in the rear as a kitchen and mess hall. The
building was steam heated, and an electric lighting system was
installed by the Engineer Corps and operated from the central sta-
tion in the barrack's. The water supply was originally from the
French system, later supplemented by a pipe system, installed by
the Americans, giving running tap water in kitchen, operating room,
washrooms, and toilets.
Practically no major surgical cases were admitted or treated, as
Camp Hospital No. 24, in Langres, had been designated to treat
surgical cases from the area.
The great majority of the patients admitted were under this serv-
ice. Cases of influenza, with its complications, were very numerous,
especially cluring the height of the influenza epidemic. The last
three months the hospital was in operation under instructions cases
of pneumonia and other grave medical cases were not admitted, and
those developing in the hospital were transferred to larger hospitals.
The general sanitation of the area was carried out by a sanitary
squad. Including the delousing of large numbers of troops coming
through from the front. Only the sanitation of the building and
grounds of the hospital was under the supervision of the hospital
staff.
B. CAMP HOSPITAL NO. 23.
History of Camp Hospital No. 23. August 15, 1918.
When th.e Army schools were opened in the Langres training area
in November, 1917, the nearest hospital was Base Hospital No. 17,
at Chaumont.
A. E. F. CAMP HOSPITALS. 2087
A small hospital of 100 beds was opened at Turenne Barracks, just
outside the town of Langres. It soon became apparent that this hos-
pital would be inadequate to care for both the enlisted men and offi-
cers, as it was contemplated that of the 20,000 anticipated as the
probable personnel of the area about 3,000 would be officers. There-
fore, in order to provide a small number of beds, where officers could
be hospitalized, especially for minor sickness that required rest in
bed for three to five days, which hardly justified the discomfort and
danger, in certain cases, of ambulance transportation a distance of
50 kilometers, especially in view of the approaching- winter, a build-
ing was obtained from the French and the hospital vv-as equipped
during January. 1918.
The building secured was part of the College de Jeune Filles,
which was occupied by the Hospital Complimentaire (Physiothe-
rapic) No. 2, of the French Service de Sante. It was turned over
to the United States Army for the joint purpose of service as quar-
ters for the Anny sanitary school and the officers' hospital.
The personnel for the hospital was secured from the 163d Field
Hospital and lG3d Ambulance Company, which were sent to the
school area in January, there being no casual medical personnel
available in France at this time. The staff consisted of 5 officers
and 60 men.
The first patient was admitted to the hospital February 1, 1918.
We averaged about -to patients throughout the six months that the
hospital was in operation. During the second week of March, 11
nurses joined the hosj^ital, having been detached from Hospital Unit
H (Fordham Hospital Unit).
During the operation of the hospital there were three deaths. Two
were gunshot wounds — one of the head and the other of thorax and
abdomen; both were moribund on admission. The other was a case
of septicemia, due to hemolytic streptococcus which followed a
tonsillectomy.
The hosi)ital had 100 beds. This was expanded to an emergency
capacity of 250 in May.
During July the Langres Hospital center was opened. This, to-
gether witli Camp Hospital Xo. 24, at Langres, made the existence
of Camp Hospital No. 23 no longer essential. Consequently, when
the plans of the Armv sanitary school were elaborated it was obvious
that the building was more needed for the school than the hospital,
so the hospital was closed August 15, 1918.
The hospital was originally named " Hospital B. Army School,"
but later was named " Camp Hospital No. 23 " by the chief surgeon's
office.
S. CAMP HOSPITAL NO. 24.
Organization of Hospital Unit " i7."— During the winter of 1917
the writer undertook the formation of a hospital unit at Fordham
Hospital, New York City.
As the result of correspondence Avith the director general of military
relief of the American Eed Cross the unit was officially designated as
Unit " H."
During the month of September the organization was rounded out
and completed and by the end of that month the muster roll, contain-
ing the names of 12 officers, 21 nurses, and 50 enlisted men, was com-
2088 KEPORT OF THE SURGEON GENERAL OF THE ARMY. jH
l)loto(l. Tlio unit was accepted by the Red Cross as satisfactory and
Avas imniedirttely turned over to the ISIedical Department of the
United States Army. From that time its existence as a Red Cross
unit ceased.
The enlisted men Avere called together at Fordham Hospital De-
cember 22, 1917, were liiven two days of intensive training in the ele-
ments of drill, and left Xew York Christmas Eve, 1917, at midnight
en route for Atlanta.
Arrived at Atlanta; intensive training was at once begun.
After a stay of a little over five weeks Unit " H " received orders
to proceed to "the port of embarkation for service overseas. They left
jNIcPherson with the proud distinction of being the last to arrive at
the training station and the first to leave, after a period of a little
over five Aveeks, during whicli time they Avere completely equipped,
had learned hoAV to salue. and could proceed en masse from one place
to another Avithout knocking anything doAvn.
February 1. 1918, Unit "H" arrived at Camp Merritt. At Camp
Merritt the overseas equipment of the unit Avas completed; the chance
was given for men and officers to see their families again.
February 16, 1918. Unit "H" set sail for service overseas. A
short stop was made at Halifax and then, in company of many ships
and escorted by warships, the journey across the submarine-infested
Atlantic was begun.
On March 4, 1918, the Carmanm, carrying Unit " H " and some
other troops, dropped anchor in Liverpool Harbor.
The trip across England to Southampton Avas quickly made, and
the introduction to a rest camp was inflicted upon the outfit. It was
at this place that the members of Unit "H" discoA^ered how cold
Avater could get without freezing, and how thick and heavy a blanket
could be Avithout being warm.
After one or two false starts Ave left Southampton :March 9, crossed
the Channel swiftly, escorted by the patrol, and arrived without dis-
aster at HaA-re, March 10, 1918.' A stay of 24 hours in the rest can>p
at Havre, during wdiich stay the commanding officer was billetted in
the middle of a" railway yard, still left us in condition to proceed,
March 11, at 2,30 a. m., to our station.
En route to Langres, the train was held up in the station of Noisy-
le-Sec to permit the Hun avions to bombard the train from the sky.
The train was narrowly missed, there were no casualties, and there
was no physical damage done other than the tearing up of the tracks
and the partial demolition of the railroad station. The rest of the
trip Avas accomplished without incident, and on the morning of March
13 Unit " H " found itself at its station, in the advance section of
the Services of Supply, at Langres, Haute-Marne. Upon reporting to
the surgeon of the advance section, the unit was assigned to Camp
Hospital No. 24. at that time being conducted as a 42d Division Hos-
pital by a field hospital of that division.
The "water supply was inadequate, frequently failing us entirely
for days at a time and nearly ahvays being lacking for many hours
each day. This Avas a matter'which was ncA'er corrected, and we were
assured bv the engineers that everything that could be done was be-
ing done.' It was a constant source of difficulty and annoyance, and
always made more difficult the always hard task of policing the build-
ing. In addition to its inadequacy the water was polluted. This was
A. E, F. CAMP HOSPITALS. 2089
corrected by chlorinization, all water being treated in Lyster bags,
of which there were many, disposed throughout the building. Orders
were issued that onh^ water which had been treated in Lyster bags
was to be drunk, and the care exercised had its good fruits in the total
absence of enteric disease (infectious) in the command,
A complete mastoidectomy was done by the commanding officer
on the night of the taking over of the hospital. Xo light was avail-
able except that afforded by candles and lanterns pressed into service,
and the use of a pocket flashlight held by an assistant. Tliere were
no means of sterilizing instruments because of the failing of the gas,
and this sterilization had to be done in the kitchen, located over a
hundred feet away in a separate l^uilding. Special instruments were
not at hand. A complete radical mastoid operation, together with
removal of a clot from the sigmoid sinus and the removal of the in-
ternal jugular vein from its junction Avith the innominate to the
base of the skull was done under these trying conditions.
A little later a motor-cycle accident apparently hopelessly crushed
the leg of the driver, and this man was brought to Camp Hospital
No. 24 for amputation. Amputation was not done, but under exactly
similar conditions as a])ove noted the commanding officer did an
open reduction, removed many pieces of splintered bone, cut and put
in place a bone graft, bridging the gap of about 2 inches between
the upper and lower fragments of the tibia, completed the debride-
ment of the wound, and returned the patient to bed in good condition.
The patient has since been discharged from the service, walking with-
out a limp. Lack of electric power, incidentally, made the use of the
motor saw impossible and the work of drilling and fashioning the
bone graft had to be done with hammer and chisel.
The total number of cases admitted during the functioning of
Camp Hospital Xo. 24 as an American military formation is ap-
proximately 6,289. Records prior to March 17, 1918. are incom-
])lote. but it is believed that the figure given is very close to the
actual one. The number of deaths was 137 (3 cases admitted to the
hospital dead are properly not included in figuring mortality).
This gives a total mortality of 2.17 per cent. This mortality is
divided roughly as follows :
Medical cases admitted 4,487
Medical deaths 119
Medical mortality l>er cent 2. 6-5
Surgical cases admitted 1,801
Surgical deaths 18
Surgical mortality : percent .90
The period just described, namely, from March 17 to June 1, 1918,
we have been pleased to term, in a somewhat broad sense, the " first
disease period," during which mumps and scarlet fever were the
prevailing condition; and from about mid- June to July 10, 1918, a
period a little over three weeks, the '' second disease period," during
wliich the three-day fever, or " Spanish flue," was the predominant
disease, and in addition a few scattered cases of a virulent and fatal
angina, commonly called " the septic sore throat."
The observations on this three-day fever which were made on our
cases are in keeping with those of the same condition as it obtained
throughout the greater part of the American Expeditionary Forces
at that time. Briefly, it ran the typical short course, was accom-
2090 REPORT OF THE SURGEON GENERAL OF THE ARMY.
panied always by considerable ]jrost ration, had a very low incidence
for complications, the chief of which was pneumonia of low viru-
lence, and the very infrequent occurrence of the usual and conunon
grippe sequelae, namely, otitis media and sinus disease. The ready
communicability of this type of respiratory infection was noted,
however, in that a very considerable number of the personnel on
duty, including officers, nurses, and enlisted men, were afflicted in
some slight manner from this condition at this time. The outstand-
ing feature in them was the Ioav grade of temperature that obtained,
the shortness of the acute stage, and the very unusual debility and
exhaustion which continued for some time thereafter, out of all
proportion to the duration and character of the attack. It is re-
grettable that no bacteriological evidence of the prevailing micro-
organism was obtainable.
A word in passing relative to the virulent and fatal type of
angina above referred to should be reported here. This unusual
symptom group briefly was as follows: Patient was admitted after
a very short illness, generally less than 24 hours, and in a highly
toxic state, and as a rule as observation for diphtheria. The fever
was extremely high, often 105° and over; pulse full, rapid, and
bounding; respirations increased and somewhat labored; and pros-
tration extreme. The throat when seen early showed a grayish-
yellow, sloughing membrane usually on both tonsils, with a fetid
odor strongly resembling the characteristic odor of diphtheria and
accompanied by great difficulty in swallowing. Pain in the throat
was marked, and the membranous condition and the sloughing
rapidly extended from the tonsils to include the uvula, the fauces,
later the pharynx, and finally, in one or two cases at least, to the
epiglottis and the larynx. The whole mouth and throat showed an
intense inflammation,"^ with rapid and extensive lymphatic involve-
ment and early softening and suppuration in the glands. Coinci-
dent with these local changes was a marked and devouring toxemia,
early cyanosis, a progressive collapse of the circulatory and vaso-
motor systems, and early death, sometimes within 48 or 72 hours
after the onset. In one case the acute stage was survived, but a
toxic mvocarditis resulted, and the patient died after a little less
than four weeks. Culturally these throats were repeatedly nega-
tive for the diphtheria bacillus and positive for a short chained
streptococcus. Diphtheria antitoxin, though administered, pro-
duced no effect and. in fact, no satisfactory response to any form of
treatment was obtained.
During the first 20 days of September there were 72 cases ad-
mitted with the diagnosis' of influenza and for the last 10 days 170
cases with the same diagnosis. Also during September 1 fatal case of
acute anterior poliomyelitis occurred. This was of the diffuse type,
involving first the right lower extremity and rapidly spreading to
include the left side, the upper extremities, and finally the respira-
tory centers, earlv death following.
the 20th of September. 1918, marks approximately the beginnmg
of the severe and fatal epidemic of influenza and pneumonia for this
hospital. This lasted throughout October, when it reached its height,
to about November 15, when there was a gi\adual lessening, both in
the number and severity of the cases. The medical admissions for
October totaled 695 out'of 886 cases admitted. Of this number, 367
A. E. F. CAMP HOSPITALS. 2091
were diagnosed influenza at the time of entrance, 56 as acute bron-
chitis, and 99 as pneumonia. Of this hitter group, 45 were of the
broncho-pneumonic type and 54 of the lo])ar tj'pe. In addition to
these cases where the diagnosis of pneumonia was determined before
admission, a veiy considerable number of those previously diagnosed
as influenza became pneumonia. Therefore a record of 17 deaths
from l^roncho-pneumonia and 28 from lobar pneumonia is not a true
index of the death rate for these cases. A not inconsiderable number
of the admission pneumonias were moribund cases, without the
slightest possibility of obtaining anything but a fatal result, and
death usually supervened within 24 hours — in one case 5 hours after
admission and in two other cases less than 14 hours after admission.
Accurate and trustworthy figures giving the actual death rate are
difficult to furnish, but these few facts are cited here because October
marked the greatest incidence of pneumonia and also its greatest
virulence. The influenza cases, uncomplicated, throughout the entire
period when this disease prevailed were never fatal.
The small group of septic sore throats were utterly beyond our
control and all died. The inflammation in these cases was a rapidly
progressing plilegmon, accompanied by a fulminant toxemia, which
overwhelmed these boys before there was any possibility of estab-
lishing a natural resistance.
The respiratory disease with which we are chiefly interested from
a surgical point of view is empyema following pneumonia. These
empyemata may be divided into three groups : First, those following
hemolytic streptococcus pneumonia; second, those following lobar
pneumonia ; and third, those following influenza pneumonia.
The types seen in the winter of 1917 were predominantly strepto-
coccus hemolyticus in origin. The operation for empyema in these
cases was attended by a large mortality, even as high as 50 per
cent. This latter fact caused a commission to be appointed by the
surgeon general to investigate this question. As a result this board
brought out several important points: First, not to operate as long
as the pneumonic proce&s was in existence ; second, to aspirate when
the quantity of fluid in the chest interfered mechanically with res-
piration ; third, to operate only when real pus had formed. The put-
ting into practice of these points resulted in a very great decrease
in mortalit}'.
The empyema following lobar pneumonia is rarely complicated
by metastatic infections or a necrotizing broncho-pneumonia as is
that following influenza. Tlie pus forms soon after the pneumonic
process has subsided, whereas in influenza the pus and physical signs
of same are delayed in their appearance long after the pneumonia
has subsided.
The exudates of the different types also differ: that of the strep-
tococcus hemolyticus is thin, grayish red, and contains small flakes
of fibrin. That of the influenzal empyema is thick and purulent,
exists in large quantities, contains large amounts of fibrin, and is
greenish j^ellow in color.
The operation of choice at this hospital is that known as the flap
operation, many improvements in which have been devised here. In
operating upon these cases we have applied and followed the rule
that exists in war surgery regarding operations upon the chest using
local anesthetics. We have been able to perform this operation pain-
2092 REPORT OF THE SURGEON GENERAL OF THE ARMY.
lessly and Avitliout discomfort or shock to the patients, and have had
one of the sudden deaths on the table which frecjuently occur during
a general anesthetic.
Tcchmc of operation. — The patient lies on the side opposite to the
empyema, the arm over the head to elevate the scapula away from
the operating site. The eighth rib is usually chosen as the one to
be resected. Starting at a point about 1 inch internal to the scapula
line and 1 inch above the eighth rib, the local anesthetic is injected;
cocaine being the only local anesthetic obtainable at this institution,
it was used in a one-tenth of 1 per cent solution. The infiltration of
the skin and cellular tissue is continued from the above-mentioned
point downward for a distance of 3 inches parallel to the scapula
line. It is then carried anteriorl}'^ parallel to the ribs for a distance
of 24 inches, and then upward parallel to the scapular line to a
point opposite the starting point. Fifteen minutes are allowed to
elapse before making the incision in order to permit the weak cocaine
solution to thoroughly infiltrate and anesthetize the tissue. An
incision is then made along the line infiltration cloAvn to the muscles;
the skin is then dissected from the underlying tissues, making a skin
flap: the muscles overlying the rib to be resected are incised. The
intercostal nerves above and below the ribs are injected with ^ per
cent cocaine. The periosteum is then incised for a distance of 1^
inches and separated from the ribs. A section of rib 1 inch long is
removed, the pleural cavity is opened, simultaneoush' the skin flap is
pulled down over the opening by the operator, the patient rolled over,
and the pus evacuated. A tube is then put into the opening, sutured
to the skin, and the skin flap sutured down except at its lower border.
Dressings are then applied. The patients are given a highly nourish-
ing diet, and at the end of the third day breathing exercises are
started. At the end of three weeks the cases are invariably healed
and show a decided increase in weight and betterment of general
condition. Although the number of cases operated by this method
is comparably small, it is interestmg to note that of 11 cases only
1 died, and the necrops}'^ on that case showed metastatic abscesses
in the lungs and kidneys.
Two of the cases were of the strepto type, one was of the lobar-
pneumonia type, eight were of the influenzal, the fatal case being
of the latter.
T. CAMP HOSPITAL NO. 2 6.
The nucleus of the enlisted and officer personnel of Camp Hospital
No. 26 was taken from the 161st Field Hospital and other medical
units of the 41st Division. Members of the Army Xurse Corps at this
station are either casuals or members of base-hospital units on tem-
porary duty.
The hospital is purely an American Expeditionary Force organi-
zation, therefore performed no duty as a unit in the United States.
Camp Hospital No. 26 was organized April 21, 1918, by the transfer
of Infirmary No. 1, Depot Division, First Corps, both patients and
personnel, from St. Aignan to the present location near Noyers,
France. This site had been selected and obtained by the division
surgeon. Fifteen barracks were complete at that time, all of the
Mora jam type, which accommodate about 32 patients each. These
had been built by a detachment of the 161st Ambulance Company.
A. E. F. CAMP HOSPITALS, 2093
Infirmary No. 1 had been operating in a French building in St. Aig-
iian, where, prior to the war. a sisters' hospital had been conducted
known as the Hospice de St. Aignan. At the time of the transfer the
intention Avas to aliandon this l)iiilding, but the great influx of troops
to the area and the attendant increase of sick made it necessary to
retain this place as an annex to Camp Hospital Xo. 26. It was used
for several month's as the neurological section of the hospital, since it
was an ideal building and location for handling patients of this na-
ture. When organized as a camp hospital there were 232 patients
under treatment.
This hospital has served the replacement organizations of the St.
Aignan area, originally the -tlst Division and known successively as
the Depot Division, First Corps, and the First Depot Division. From
the nature of the organizations of the area the chief function has
been the care of sick of every nature. Very few wounded or gassed
patients have been treated, and these in almost every instance were old
wounds and conditions which required rehospitalization after being
discharged to duty from other hospitals.
The hospital proper had a capacity of 1,200 beds at the end of the
year with a maximum of 1.400. This number includes the St. Aignan
annex, which has accommodated over 200. During September. Octo-
ber, and Xovember a convalescent annex was maintained at Pont-le-
Voy which could care for 500 patients. Overflow at all times was met
by keeping such patients as were in proper condition in hospital tents
equipped with regulation hospital beds.
The surgical work of Camp Hospital No. 26 was transferred at
Infirmary No. 1 at St. Aignan. It was the last department trans-
ferred to the new location, and the surgical cases were not moved until
the latter part of May, 1918. At St. Aignan in the beginning the
instruments at hand were incomplete field sets and an improvised
sterilizer. This sterilizer consisted of a can about 1 foot in diameter
and 36 inches high, with iron bars about 3 inches from the bottom.
Underneath these were electric bulbs. The temperature of the can
remained about 200° F. Sterilization of linen was accomplished by
baking in this receptacle for three hours. Instruments were boiled
over an alcohol stove.
At Camp Hospital No. 26 the north half of Barrack No. 16 was
first used as the surgery. Here a large, well-lighted operating room
had been prepared for septic cases and a smaller room for septic
cases. The linen was sterilized in an air-tight gasoline sterilizer
under 20 pounds pressure for one hour, the instruments being boiled
over an alcohol stove as formerly. A wood stove was provided for
preparing cans of sterile water. Cases at this time consisted chiefly
of herniotomies, hemorrhoidectomies, appendectomies, a great deal
of genito-urinary work and repair of primary shrapnel wounds, the
number of cases averaging 175 per month.
The growth of the hospital necessitated large equipment and
quartei"S for this service, and in August work was commenced on a
large barrack to be devoted solely to surgical section. A base hos-
pital sterilization equipment was obtained. This consisted of hot
and cold water sterilizer, instrument boiler, pan boiler, and auto-
clave. Up to this time there had been more or less trouble with su-
ture infections, usually superficial, but occasionall}'' they were deep-
seated. With the new equipment this invection was eliminated.
2094
REPORT OF THE SURGEON GENERAL, OF THE ARMY.
The new building was completed in October. It contains four large
operating rooms.
Wards 25 to 29. inclusive, are devoted to surgical cases, and also
wards 17 and 23. Three of these have been necessary to care for the
orthopedic cases, since many of the convalescent wounded who reach
the classification camp at this station are not of class A and require
further treatment of this nature before they can be returned to their
organizations. Ward 25 is devoted to empyema, the others to cases
of general nature. In August and September three cases of intes-
tinal perforation (typhoid) were operated, all of whom recovered.
Since the signing of the armistice work in the surgery has fallen to
an average of five cases a day, these being emergencies only.
The influenza was first recognized as an epidemic early in June.
It made its appearance in the troops of the area as a three-day fever.
At that time the chief of the medical service insisted that was a new
and entirely different form of infection than he had met with before.
At this time it was rarely serious, and the fever seldom lasted
longer than three days; after four or five days of convalescence the
patient felt little or no effects of his sickness. Whether the lighter
form of the disease at this time was due to an infection less virulent,
to the season of the year, or to the better physical condition of the
troops is a mooted question. A point of interest, though, is that
practically all troops in the area at this time were National Guards,
who had seen border service and several months in camp prior to
sailing. It was not until the latter half of August that pneumonia
commenced to develop in many cases. This is evident when the
deaths from pneumonia in July, August, September, and October
are compared. In July there were 4, August 7, September 65, and
October 144 who died of an uncomplicated pneumonia. The greatest
per cent of these deaths were either incident to or immediately
following influenza.
INFLUENZA.
Apr. 21 to 30.
May
June
July
Aiisust
September . . .
October
November...
December
Total .
Period.
Ad-
mitted.
3
45
1«2
158
414
1.048
1,099
617
504
4,070
Deaths.
PNEUMONLA..
Apr. 21 to -30.
May
June
July
Aueust
September...
October
November. . .
December
Total .
752
'
2
35 >...
35
4
23
7
233 1
65
351
144
25 i
18
44
12
Note.— In above tabulation same patient may be carried both, as influenza acd pneumonia if admitted
as influenza and developes pneumonia.
A. E. F.
-CAMP HOSPITALS.
2095
Influenza and pneumonia cases have been isolated in their respec-
tive wards by cubicle system, each patient being separated from his
neighbor by sheets suspended in the ward. The attendants are re-
quii'cd to wear gauze masks. There are no available statistics to
show, but it is believed that very few cases early in the season were
subject to a second attack.
No typhoid appeared until in August, and from August 1 to
September 30, 43 cases were admitted to the hospital. These were
with one or two exceptions from a Camp Cody replacement unit.
No other cases developed in the area. These were isolated in two
wards, a special kitchen maintained in one ward. The disease did
not spread and only two cases were lost.
Next to pneumonia, cerebrospinal meningitis, epidemic has caused
the heaviest loss. Most of these were isolated cases and developed
in replacement organizations either en route to the area or soon after
arrival. There has been no general epidemic.
U. CAMP HOSPITAL NO. 28.
Camp Hospital No. 28 was established on February 4, 1918, per
telegraphic instruction, office chief surgeon, Headquarters Services of
Supply, dated January 25, 1918. The building chosen for the use
of the hospital was originally used as a school building by L'Ecole
Normale d'Institutes, but at the time of the establishment of Camp
Hospital Xo. 28 it was used by the French Government as a military
hospital — Hospital No. 14.
The capacity of the hospital as originally planned was for 150
beds, but with increased number of troops in the neighboring camps
it was found necessary to lease an additional wing of the building,
therefore raising the capacity to 250 beds with an emergency ex-
pansion of 275 beds.
Camp Hospital No. 28 has served the troops at Nevers and in a
radius varying in extent from 20 to 40 miles. The troops served
were largely regiments of Engineers, forestrj^, motor repairs, labor
battalions, bakery, Signal Corps, laundry, and veterinary companies.
The remount station at Sougy, the motor transport school at Deceize,
and the 39th Engineers at Camp Marcy were also served by this
hospital. The number of troops has ranged from eight to fifteen
thousand.
Numhcr of patients admitted to Camp Hospital No. 28 from February 1, 1918,
to December 1, 1918.
Enlisted nion : Officers:
Feliruary 73
March 186
April 187
May 223
June 291
July 278
AuRUst 329
September 298
October 331
November . 241
December 379
Total 2, 816
February
Auirust
to
May
2.5
21
September
October __
—
15
33
Total .
94
British
120
Total—
3, 030
2096 REPORT OF THE SURGEOX GENERAL OF THE ARMY.
Hospital Unit " 8,"' representing the Vanderbilt School of Medi-
cine, at Nashville. Tenn., was organized by the American Red Cross
in May and June, 1917. On July 10 the officers Avere conunissioned
in the United States Medical Reserve Corps and the enlisted per-
sonnel were mustered into the service.
The officers of the unit were placed on active dut}- November 5,
1917, and on November 16 the unit was mobilized and ordered to
Fort McPherson, Ga., for training and equipment for overseas
service.
December 25, 1917 : Left Fort McPherson. Ga., for Camp Merritt,
N, J. ; December 28. 1917, arrived at Camp Merritt, N. J.
January 15, 1918 : Left Camp Merritt. N. J., and went aboard
transport Carpathia at Pier 55, Hoboken, N. J. The unit was joined
on the Car path ta hj the nurses who had been mobilized on December
2, 1917. and equipped at Ellis Island.
January 18 : Arrived at Halifax, Nova Scotia.
January 20: Left Halifax.
January 30: Arrived at Greenock, Scotland.
January 31 : Disembarked at Glasgow, Scotland.
From this point the nurses went by way of London, Folkestone,
Boulogne, and Paris to Base Hosj)ital No. 17, at Dijon, France, where
they arrived on the Gth of February. The officers and enlisted men
were sent to Winnal Downs Camp near Winchester, England, and
thence by wa}" of Southampton to Le Havre, France, where they
landed on February 4, 1918.
V. CAMP HOSPITAI. NO. 29.
NoAember 20, 1917, organization was incepted.
Camp, including hospital, A\as taken over by the United States
from French Government Februarv 19, 1918, and opened for occu-
pancy March 1, 1918.
August 1, 1918 : During the month of July, 1918, the hospital has
increased in size and activity by the receiving of two shipments of
convalescent gassed and a fcAv wounded, consisting of 186 and 149
each.
September 1, 1918: Since about August 10, 1918, an epidemic of
Spanish influenza has prevailed. This has taxed the hospital to the
utmost, and has demonstrated tlie need of additional buildings.
The personnel of tlie hospital, both commissioned and enlisted, is
totallj^ inadequate. The enlisted personnel should be more than
double; the commissioned personnel should be increased b}^ at least
three officers.
There were tAvo deaths during the month from pneumonia follow-
ing influenza.
October 1, 1918 : During the month of September, 1918, hospital
activities steadily increased, until on the 23d of September there
were 1,017 patients in hospital, approximately 50 per cent more
than had been handled on any previous date.
NoA'ember 1, 1918: A A'enereal company Avas organized in the
camp during the month.
December 1, 1918 : During NoA'ember hospital activities continued
to decrease.
\
A. E. F. CAMP HOSPITALS. 2097
March 1, 1919: All hospital activities terminated February 28
after exactly one year's operation as Camp Hospital No. -29.
W. CAMP HOSPITAL NO. 31.
Camp Hospital Xo. 31, Camp de Meiicon, is situated at Clianip de
Tir, on a departmental narrow-gauge railroad known as Compagnie
des Chemins de Fer d'Interest Local du Morbihan, in the Depart-
ment of ]\lorbilian, Brittany. This railroad connects it with the city
of Valines, which is about 1-2 kilometers away, on the Paris & Orleans
Kailroad.
The hospital occupies the site of what was formerly the old French
artillery training camp, known as Camp de Meucon, and was erected
to serve the needs of the new Camp de Meucon, an artillery framing
camp for the American Expeditionary Forces. The hospital site is
about 3 kilometers distant from the camp.
In the erection of the hospital the buildings already existing on
the site, and which had served as quarters for troops in training at the
old French camp, were rebuilt and converted to suit the needs of
the hospital. They consisted of 12 low, stone buildings, of barracks
type of construction, and various smaller buildings of wood and
stone. The 12 buildings referred to are now being used as wards
and have a capacity of 60 beds each.
A new surgical building of brick and stone houses also the phar-
macy, dental office, eye, ear. nose, and throat clinic, pathological
laboratory, and X-ray room. A second new building, of similar
type of construction, provides space for a sick officers' ward and
nurses" quarters, while a third provides quarters and mess for the
hospital staff. Three new, wooden buildings of barracks type serve
as contagious wards.
Tlirough energetic efforts the work of construction was hastened,
so that when the troops did arrive, on June 8. 1918, the hospital,
although far from completion, was ready to take care of medical
patients. The surgical building, however, was not completed until
about July 15. and up to this date it was necessary to care for surgical
cases in the French hospital of the city of Vannes.
The first jiatient arrived in an advanced stage of lobar pneu-
monia and died June 14.
Wlien the surgical wards and operating rooms were completed
about July 17 a great many surgical cases were awaiting treatment,
principally for liernia. appendicitis, etc.
About this time an epidemic of measles and mumps broke out
among the troops at the camp, but was checked before it had made
material progress. A great many casualties were resulting from the
inexperience of troops in the handling of horses. Many of these
were of a serious nature and would have resulted fatally l)ut for the
prompt attention of the surgical service.
On August 2G the arrival of the 54th Field Artillery Brigade
brought a severe epidemic of influenza, with complications of lobar
pneumonia, and in spite of every possible effort and precaution to
prevent its spread, it soon reached alarming proportions. The hos-
pital was taxed to the utmost to care for increased number of pa-
tients, and the regimental infirmaries took care of some of the milder
cases.
2098 REPORT OF THE SURGEON GENERAL OF THE ARMY.
In all. 042 cases of influenza were recorded before the epidemic
was checked. Of these, 14:4 resulted in pneumonia, and as a result
of the latter there were 57 deaths. The resulting pneumonia, in most
cases, was of the bronchial type, although some were pronouncedly
lobar. Laboratory analysis showed usually a mixture of Tj-pes T,
II, and III, pneumococcus, no one type predominating. The first
50 cases of post-infiuenzal pneumonia resulted in a mortality of 60
per cent, the second 50 dropped to 30 per cent, and the remaining
11.5 per cent.
On Septemlier 16, 17 Eed Cross nurses reported for duty to assist
in combating the epidemic, which was at its height. Their efficient
work was a great contributing factor in the final check of the dis-
ease, which was finally arrested about September 30.
The influenza epidemic had scarcely passed when a sporadic out-
break of meningitis, meningococcus, occurred. Prompt and drastic
measures were immediately taken to prevent its spread and met with
instant sucess.
The water system consisted of a large reservoir capable of holding
63,000 gallons of water, which was derived from three force-pumped
springs at Burgo, about 18 kilometers distant, Avhich supplied also
the artillery camp, the aviation camp, the balloon camp, and the
German prisoner-of-war camp. The reservoir that supplied the hos-
pital also supplied the German prisoner-of-war camp near by, but
for some unexplained reason the German prison camp seemed to get
water a great many times when the hospital could not.
This was a severe handicap for the hospital. Until late in Sep-
tember and all through the influenza epidemic, when the hospital
needed it most, there was not only a scarcity of water but a distinct
water famine.
Up to the 1st of February, 1919, the surgical service has handled
over 400 wounds, reduced 175 fractures, and performed over 300
major operations, mostly appendectomies, herniotomies, and vario-
celectomies ; also 9 f ractuies of the skull.
The most important feature in the history of this hospital is the
influenza-pneumonia epidemic of August. September, and Octolier,
1918. The incidence of pneumonia and its fatality picture the un-
favorable conditions which existed, lack of experience in preventing
cross-infection, and untrained personnel to do the nursing. Study
of the report of a board, as well as interviews with officers who saw
the epidemic, lead to the conclusion that broncho-pneumonia of the
streptococcus type was the usual cause of death and that unrecog-
nized empyema was by no means rare. The frequent finding of
meningococcus in the lungs has been apparently corroborated by
similar findings in other laboratories. It should be stated that tho
number of cases of cliincal meningitis was small.
X. CAMP HOSPITAL NO. 34, ROMSEY.
The American rest camp, Eomse}', is rather favorably located on
the chalk hills overlooking the broad valley of the shallow Test
River, at the edge of timber and divided by the green hedges so uni-
versal in England. Camp site was in use by the British during the
two summers preceding occupancy by the United States in December,
1917. The first troops arrived here December 26, 1917.
A. E. F. CAMP HOSPITALS. 2099
The hospital is located somewlmt apart from tlie camp itself, in
a field inclosed by hedges, along the road by which all troops liiarch
into camp. The hospital was not officially designated as snch until
March 20, 191S. The equipment consisted of one permanent build-
ing; British cookhouse, used as the office; and of four hospital
tents secured from the British. These tents were double-walled
with a colored lining and board floors, and of a capacity of about
14 beds. The tent was used as a combined dispensary and venereal
l)roi)hyhixis station. The other tents were used as wards. The one
Ford ambulance was British owned and driven, witli a capacity of
two stretcher cases. Patients were fed from their company messes,
their food being carried by men detailed for the purpose. This was
unsatisfactor}-, the food always being cold. There was a permanent
washhouse on the grounds, of concrete and galvanized-iron sheet-
ing. There were no showers and no hot water. The latrine was the
same as for the rest of the camp, a bucket system emptied twice
daily.
In January, 1918, 28 patients were entered on the register. All
cases of contagious diseases, except mumps and German measles, and
all cases of pneumonia were transferred to British hospitals at
Hursley, Winchester, and Chiseldon. There were three cases of
lobar pneumonia during this month.
There were a total of 134 patients taken into the infirmary during
this month. Of these. 57 were transferred to the American Hospi-
tal at Winchester. There were several cases of scarlet fever and
measles and three cases of lobar pneumonia.
In March eight additional hospital tents were secured and erected.
One portable hut was erected for use as an office and storeroom.
Separate mess for patients and the enlisted personnel was started.
A total of 193 cases were admitted, of which 11 were lobar pneu-
monia. There were two cases of broncho-pneumonia, two of tuber-
culosis (pulmonary), one of dementia prsecox, and numbers of
scarlet fever and scabies. The bulk of the cases was mumps.
There Avere 74 cases admitted during April, of which 11 were
lobar ])neumonia, one cerebrospinal meningitis, and one concussion
of the brain.
In July there occurred the first influenza epidemic. The camp
was empty at the time, only the permanent staif being affected.
Probably 80 per cent of the men were affected during a period of 10
days. Sixty-eight were admitted to the hospital, only one of whom
developed broncho-pneumonia. The duration of the attack was short,
ranging from 12 to 60 hours, average being 48 hours. Typical cases
began with sneezing and shortly developed aching and soreness,
headache and backache, with a temperature of 100° to 102°. Their
worst complaint was backache. The total number of cases admitted '
during the month was 177. Of these 68 were influenza cases just
described and 37 were cases of another sort of epidemic. The 4th
Casual Company, Camp Cody, was made up from troops at Camp
Cody and came to England by way of Camp Merritt. When the
organization arrived at Romsey it was necessary to take about 10
men direct to the hospital from the ti-ain. Others were picked up by
ambulances and motor vans as they fell out on the march to the camp.
Their complaints were that they were weak and exhausted, as some of
142867— 19— VOL 2 71
21(!0 REPORT OF THE SURGEON GENERAL OF THE ARMY.
them indeed were. Others reported at the hospitals immediately on
arrival at camp. Few of them showed a temperature ranging from
:L03° to 105°. Diarrhea was present in about 30 per cent. Several
had tvpanitied. Typhoid fever was suspected and precautions taken.
Several of the worst were transferred to Base Hospital -20-1: at Hurs-
ley as typ'toid suspects for laboratory diagnosis. Cultures showed
58 died, 74 remaining on UcJ^-'^^nd a total of 37 men were transferred
6 nurses contracted the disease i;?in9 secondary m feet ions. None of
use for influenza patients were is; ^f^nts of other organizations de-
hung upon wires. Medical officers, n. r<)f these patients show all to
and face masks while on duty. On f ^st part approximately a year
in hospital, which repre^'^'"^'^- "^^ '....-.-■r ^ ,.,
In the ix.„i.LVV"^t p total of. 204 cases were admitted, of which 20
erected at 6. lines, making a total" of ; ^itis. Numbers of cases of
breeze block foundation of an eighth h from Companies G and H,
bed capacitv to a maximum of 600, wi. ^ure of mild typhoid. All
beds. Tlrr'-i'iiii^iAfc"' "^'-- ^ — ... o^uDle J;he companies and trans-
'^eri-t ■ !6"lBase Hospitul 204 at Hursle^ where the diagnosis of ty-
phoic fever wns ^.-iiablished. The two companies were transferred
to Ca "^p StaAdon, at Hursley, for isolation.
Ab at the 20th of September the Olympic reached Southampton
loader with American soldiers and nurses, among whom was a severe
epidemic of influenza that blazed out during the last days of the
voyage. The troops could not be moved on to France, and suitable
quarters not being available for all the nurses, 66 members of nurses^
replacement gi'oup A. 20 telephone operators, and 4 members of"
psychiatric replacement unit were quartered in the unfinished wards
of the hospital. The epidemic did not diminish in severity, pneu-
monia becoming more prevalent. The nurses of replacement group
A were detailed for teuiporary duty at Base Hospital 204. at Hurs-
ley; American Red Cross 21, Paignton: Camp Hospital 36, South-
ampton ; and at this hospital. The epidemic spread to the rest camp
at Winchester, and this hospital then began to receive patients from
Winchester and Southampton rest camps.
A total of 433 cases were admitted during the month, of which 331
were influenza and 27 were acute bronchitis. There were 3 cases
of lobar pneumonia and 50 cases of broncho-pneumonia following
influenza. Also 1 cerebrospinal meningitis and 1 acute appendi-
citis, 1 endocarditis. 1 syphilis, and 1 nephrolitliiasis. The first
death in this hospital occurred on the last day of the month from
broncho-pneumonia following influenza.
In October a total of 305 cases were admitted to the hospital, of
which 180 were influenza. There were 28 cases of lobar pneumonia
and 52 cases of broncho-pneumonia due to influenza, of which 5 de-
veloped empyema. There were 31 deaths, of which 22 were due to
broncho-pneumonia, 6 to lobar pneumonia, 2 to influenza alone, and
1 to endocarditis.
Y. CAMP HOSPITAL NO. .■^5.
The history of Camp Hospital No. 35 begins at a period approxi-
mating the middle of December, 1917. By that time the Winchester
Camp had been taken over from the British as a rest camp for United
States Armv trooDS.
A. E. F. CAMP HOSPITALS. 2101
On January 19, 1918, the hospital was sutficientlv equipped to re-
ceive patients. It was known as United States hospital. American
rest camp, Winchester, England. As had been planned, the O. lines
section w^as for the treatment of contagious diseases oiil}-. while the
R. lines section was devoted to the care of surgical and other medical
cases. '^V .^,
Previous to January 19, cases of '^sequently discovered at the
lated in huts in the rest camp', -vhi^ ■^' surgeon. Base Section No. 3,
had been transferred to other ^ ■ -'''information to the chief surgeon,
to Magdalen Hospital. On t 'K for isolation of the carriers. Posi-
ferred from the rest camp t^ '"^Wt specialists.
an epidemic of measles and iiiuiiips. "jAuieGt^f'ts were immediately
tions from the chief surgeon in Er"rio-i .jj j;i^ \ ^:t, wt'he contacts
in British hospitals began etained for observation and treatment,
was severe overcrowding. -tained. carriers and contacts proceeded
tients to Magdalen Hospit^ x'e contacts had proceeded with the unit,
upon surgical cases, as R M- ff^'VcJiion uas not yet prei,*.:this fact
ceive patients. ' ' ' 'I '^^""^
By February 10 the available bed capacity for patients'^.^as ap-
proximately 203, of the 301 beds on hand, 98 were in use-V'ir per-
sonnel. It was then estimated that the hospital as it stoocjj would
accommodate 395 beds: that 75 of these would be reipiired f)r per-
sonnel, and that a total of 320 available l)eds for patients was possible.
On about February 22 a group of seven nurses arrived for duty at
this hospital.
On April 1 the Selfridge Convalescent Home was opened at High-
cliffe Castle, (liiistchurch. Hants. On April 5 this hospital received
the name of Camp Hospital No. 35, which it retained.
During the month of June the mess hall for patients and personnel
at R. lines was completed. Construction continued on the large
wards, of Avhich there were two at O. lines, on the site of former
horse shelters, and two at R. lines, north of the nurses' quarters.
Moreover, numerous latrines and additions to the existing wards, in
the nature of linen rooms, bathrooms, duty rooms, and isolation
rooms for sj)ecial cases were in course of construction.
On July 19 Camp Standon was opened, and from about August 1
was reserved for the isolation of men who had been in contact with
infectious diseases. These contacts had been quarantined previously
at the Winnall Downs section of the rest camp.
Previous to August 19. all construction had been done by the
British authorities. On this date, the 11th and 12th Construction
Companies, Air Service, arrived at the rest camp, and at once began
work upon the construction here, with the result that its completion
was considerably hastened.
During September the four large open-air wards and the new ad-
ministration building and officers' quarters were couipleted. Three
portable huts for contagious diseases at O. lines were erected and
occupied. The alterations in the kitchen at O. lines were com-
pleted. A new bath house and latrine for personnel at R. lines were-
begun. The delousing plant at Winnall Downs was fiuished. except
for the installation of the boiler, the shipment of which was de-
layed. One portable hut was erected for V. A. D. quarters at R. lines.
The completion of the new construction raised the capacity' of the
2102 REPORT OF THE SURGEON GENERAL OF THE ARMY.
hospital to 483 beds, normal, o29 bods, maximum. Tlie pmer<;enoy
capacity, including tentage, for 90 beds approximated G79 beds.
In the month of October a large number of cases (jf influenza were
admitted during the epidemic subsequent to the arrival of the ti'ans-
port Olympic at Southampton. From Septeuiber 27 to Octolier 24, 285
CA3es of influenza were admitted here, of which 153 were discharged,
58 died, 74 remaiiimg on Oh^ober 24; 9 of the enlisted personnel and
6 nurses contracted the disease^; 2 of the personnel died. All beds in
use for influenza patients were is.olated in cubicles formed by sheets
hung upon wires. Medical officers, n;iirses, and orderlies wore gowns
and face masks while on duty. On f Jctober 5, there were 663 patients
in hospital, which rei^rp^^witiV-^ine high- water mark in its history.
In the iiiy^Rtb of XoveniJber, two additional portable huts were
erected at O. lines, making a total of '•' huts in this section, and the
breeze block foundation of an eighth h ut was laid. This raised the
bed capacity to a maximum of 600, wieth an emergency total of 690
beds. Thfv-' lielousing plant was cinu^le ted and put into oj^eration.
X)Y\. November 30, all construction by United States Engineers ceased.
A marked diminution in the number of patients began about De-
cember 1, due to the cessation of troop movements through this camp.
On December 4, the E. lines wards were closed. By December 13,
only 9 wards in O. lines were in use, with a total of 106 patients. By
December 22 only four wards were in use containing 22 patients.
Milk was obtained originally from a dealer in Winchester. His
method of delivery was very insanitary, with the result that in the
snmmer time the milk often became sour within three hours of de-
livery. A sample count showed 1.200.000 bacteria. In Juh''a new
dairyman was found at Avington Park, with a clean, modern dairy.
The bacterial count of a sample of this milk was 50,000. To prevent
the souring of the milk, a small building was erected in R. lines for
the installation of a pasteurizing plant. This consisted of four
galvanized-iron tanks. 36 by 20 by 20 inches, two of which were sup-
plied with steam pipes and pipe for cold water, the other two being
fitted with pipes for continuous running water. The milk was ])laced
in sterilized quart bottles, and immersed in water heated to 140° F.
for 30 minutes, then placed in warm water, and then quickly cooled.
The count after the process showed 1,500 bacteria. The milk re-
mained sweet for three or four days, its taste unaltered.
Contacts were held for the following periods : Smallpox, 12 days,
or innnediate vaccination and transfer to France; scarlet fever, 8
days: measles, 14 days: mumps. 21 days; chicken pox, 14 days;
typhoid fever, 21 days; diphtheria, 7 days; cerebrospinal meningitis,
28 days (contacts of these last two were sent forward after two con-
secutive negative throat cultures: all carriers were sent to hospital
for treatment, correction nasopharyngeal defects, etc.) ; plague, 8
days; cholera, 10 days; typhus fever, 8 days; recurrent fever, 14
days; whooping cough, 14 days; paratyphoid, 21 days. In the case
of scarlet fever, measles, mumps, and chicken pox. contacts who had
previously had these diseases were not quarantined.
This system of quarantining contacts resulted in the retention at
times of 2,000 to 3,000 troops at Camp Standon.
In order to avoid unnecessary retention of troops, instructions
were issued from the office of the chief surgeon. Base Section No. 3,
on September 16, 1918. for the following procedure: All cases of
A. E. F. CAMP HOSPITALS. 2103
infeitious diseases were immediately isolated and transferred to
hospital. Close contacts were isolated within their organization,
confined en route to separate train compartments, and grouped sepa-
rately in the transports. In the rest camps they were billeted sepa-
rately. While in the rest camps special measures were provided as
regards dijihtheria: carriers discovered before organization left were
quarantined for treatment: carriers subsequently discovered at the
laboratory were reported to the chief surgeon, Base Section No. 3,
by wire : he in turn forwarded the information to the chief surgeon,
.American Expeditionary Forces, for isolation of the carriers. Posi-
tive carriers were treated by throat specialists.
As regards cerebrospinal meningitis, contacts were immediately
isolated, swabbed, and cultured. If over '20 per cent of the contacts
were positive, carriers were retained for observation and treatment.
If under 20 per cent were obtained, carriers and contacts proceeded
with the organization. If the contacts had proceeded with the unit,
and the cari-ier rate was later found to be over "20 per cent, this fact
with the names of the carriers Avas reported to the chief surgeon,
Base Section Xo. 3, by wire, and by him rei)orted to the chief surgeon,
American Expeditionary Forces.
The fundamental principle of these new instructions was that con-
tacts were not to be retained pending laboratory reports, but were
sent on with their organizations, and isolated later if necessary.
The contacts with measles, nuunps. scarlet fever, whooping cough,
etc., were in no cases detained under the new procedure.
3. CAMP HOSPITAL NO. 36.
This hospital was located on the connnon at Southampton, which
in previous years had been the pasture for the cattle belonging to
the inhabitants inside the walled toAvn. Construction began June 22,
1018, and stopped November 29, 1018, and at that time the buildings
were about 50 per cent completed. The total cost would probably
have been about £40.000 when finished.
It was found necessary during the serious influenza epidemic to
make use of the Millbrook Isolation Hospital, at Shirley, and be-
sides this, many of the tents in the camp on the common were used
for additional hospital space.
Al. CAMP HOSPITAL >'0. 37.
In establishing hospitalization for the Services of Supply. Camp
Hospital No. 37 was opened at Romorantin. Loir et Cher, France, to
provide medical atteiKlance for camps in adjacent vicinity, and served
with few exceptions Air Service Production Center No. 2, located
aproxiumtely 3 miles from Romorantin.
Romorantin. a small towu. antebellum population 8.000, is sitiuited
in a valley in central Fi-ance. where there is nuu-h huuiidity and rain-
fall, not esi)ecially conducive to good health.
The scarcity of suitable buildings in toAvn made it necessary that a
building be remodeled and fitted to meet the requireuients of a hos-
pital. A convent on the Rue Beauvais, used as a school for young
girls, not modern and in an insanitary condition, was obtained.
2104 REPORT OF THE SURGEO:^ GENERAL OF THE ARMY.
1
The three-story building of brick and cement, having four wings
and a crossbar forming the letter " H," faces east. The wings are
approximately 25 by 60 feet, the crossbar 30 by 75 feet. The two
southern wings were retained for use by the French school, leaving
the two northern wings and the part corresponding to the crossbar
for hospital use.
Tlie second floor consisted of three medical wards, isolation ward,
and officers' quarters.
The space on the third floor was utilized for four medical wards, a
property room, and enlisted men's quarters.
An abundant quantity of potable water was furnished by the town
filtration plant, located about 1 mile outside of Romorantin, which
obtained its supply from the Sauldre River.
The small amount of electric and gas lighting in the building was
entirely insufficient and unclependable.
There was no provision for heating and no water supply except on
the first floor.
The toilet system consisted of but one antiquated water-closet on
the first floor.
The sewerage system was a simple pipe drain into the Sauldre
River.
The first patients were admitted on April 5, 1918. Tentative pro-
vision was made for accommodation of 150 patients.
The post progressively grew larger at the rate of about 1,000 per
month, necessitating the enlargement and improvement of the hos-
pital and its reorganization.
During June there was a mild epidemic of influenza without any
serious complications or deaths occurring.
In August a severe epidemic of dysentery, bacillary type, cause
unknown, resulted in one death.
An epidemic of influenza, with double pneumonia of a severe
hemolytic type as a complication, occurred in October, being brought
into A. S. P. C. No. 2 b}' the 309th Motor Transport Corps, en route
from Havre, with 79 cases occurring within 21 hours. This type
prevailed all through the American Expeditionary Forces, and was
associated with a high mortality rate.
Bl. CAMP HOSPITAL NO. 38.
History of Camp Hospital No. 38, Chatillon sur Seine, March 31,
1918.
Source. — This hospital was organized in Chatillon sur Seine,
France, and officially opened May 7, 1918.
The enlisted personnel on May 10, 1918, consisted of 10 men.
Since that time casual detachments have been added, and at the
present date the enlisted personnel consists of 76 members.
Two nurses reported for duty October 10, 1918. Since that time
this number has been increased to 14, the number fluctuating. At
present there are nine nurses on duty here.
There have been epidemics on a small scale of influenza and Vin-
cent's angina (trench mouth). The latter until recently was treated
by methylene blue locally and salvarsan intravenously. Recently
salvarsan in glycerin has been used locally. The latter seems to
give better results.
A. E. F, CAMP HOSPITALS. 2105
Recently pneumonia has been treated according to modern
nethods, plus one addition, after the scheme tried at Base Hospital
sTo. 15. Formaline was given intravenously with very encouraging
•esults, the per cent of deaths from pneumonia being reduced more
han half since this method of treatment was given.
Cl. CAMP HOSPITAL NO. 3 9.
Camp Hospital No. 39 is located in and around the old stone build-
ngs known as Chateau Perigny at a distance of about 2^ miles from
jH Rochelle.
The sewerage system for the main building and the smaller Avards
md bathhouse is handled by a septic tank, as is also the larger
vards, the tank in the latter case being somewhat larger and more
efficient. The first tank was constructed bj' the 25th Engineers, while
he latter was erected bj' prisoners of war under the direction of the
)ase engineer. At present the water analj^sis laboratory of the base
s installing a chlorinator to purify the effluent from the larger tank.
The water supply was at first a part of the water system of La
Rochelle, but was changed about the Tth of December to a system of
oumj), well, and water tower on the hospital grounds with a better
^rade of water, free from the salty taste common to the majority of
ources of water in this locality, it being necessary, however, to
hlorinate it.
Camp Hospital No. 39 functions as a base hospital for the base
section and furnished hospitalization as such for the entire base,
Ira wing the majority of its cases from La Pallice and La Rochelle,
he hospital first receiving patients on the 29th of July, 1918. The
:wo diseases which have been the most prevalent are mumps and in-
fluenza.
The former disease has generally kept one ward filled most of the
'ime, breaking out afresh in the district now and then, at which
'Ames the number of cases has totaled nearly 100. The first epidemic
started with the arrival in the base of the 518th Engineers.
The first epidemic of influenza occurred during the middle of
September, 1918, 50 men from the 338th Labor Battalion being re-
ceived on the 16th. This epidemic continued through to the latter
part of October, and during this period the capacity of the hospital
svas sorely taxed, it being necessary to put up as wards 10 large
storage tents and four pyramidal tents. The majority of the in-
fluenza cases treated were of the respiratory type, and those that
were complicated by pneumonia presented for the most part a lobar
pneumonia of great virulency in the treatment of which the serums
aad no apparent effect.
Another epidemic of a less virulency manifested itself during the
month of November, and there are a number of cases in the hospital
at present, this being the third quite sharply marked outbreak since
the hospital has been in operation.
D. CAMP HOSPITAL NO. 4 0, HOSPITAL UNIT " W\"
Camp Hospital No. 40, embarkation camp. Knotty Ash, Liverpool,
April 28, 1919.
Historv of Camp Hospital No. 40, January 1, 1919, to April 28,
1919.
1
2106 REPORT OF THE SURGEON GENERAL OF THE ARMY.
The work of tliis hospital in the early part of 1019. consisted in
evacuatinof the patients of the hospitals in England to the United
States. Aside from the small Red Cross military hospital, at Lan-
caster Gate. London, we are the only American hos]:)ital in England,
at present open.
The first of the year found the medical section on the smaller sec-
tion of the hospital due to the influx of battle casualties from the
other hospitals: hence the burden of the work fell on the surgical
section.
These cases arrived in groups ranging from 10 to 300. Some were
medical, most of them were surgical. Some were ambulatory, others
litter cases. They came from France and Russia, from English hos-
pitals, and American hospitals in England. The greater part of the
surgical cases were battle casualties and as such they presented almost
every conceival)le type of injury. Some were alread}' convalescent!
with healthy granulations: others were in the active stages of sup-'
puration.
As a routine, on all wounds a per cent phenol solution was ap-
j)lied either as a wash or an irrigation. The wound was then painted
with compound tincture of benzoin. This worked exceptionally well
in surface wounds but did not yield satisfactory results on the deeper
injuries. Owing to the fact that our surgical wards were then newly
opened we were unable to institute a series of Carel-Dakin irrigators.
It was deemed advisable to then use a solution of dichloramine-T.
This soon reduced all discharges.
B}' dissolving the dichloramine-T in tincture of benzoin compound
we procured a dressing that worked even more effectively than the
dichloramine-T. Only the ones with fistulous tracts resisted treat-
ment occasionally.
HISTORY OF HOSPITAL VSIT " W."
In May. 1917, permission was asked from the American Red Cross
to organize and equip a base hospital for service overseas. We were
informed that no more base hospitals were to be organized, but per-
mission would be granted to foi-m a smaller hospital unit. This
was the last hospital unit to be organized under the Red Cross. It
was to consist of 12 ofhcers. 21 Red Cross nurses, and ah enlisted per-
sonnel of 50 men.
On the 22d day of January. 1918, orders were receiA^ed for the
officers to mobilize at Fort ^IcPherson, Ga., and the enlisted men
mobilize at the arsenal in Springfield, 111., proceeding one week later
to Fort McPherson.
We received orders to proceed to the embarkation camp at Camp
Merritt, IS". J., on May 1, 1918. We arrived at this camp on May 5.
1918, and left the United States on May 11, 1918. We arrived in
Liverpool. England, on May 27 and proceeded to Southampton. On
June 1 orders were received to proceed to Efford Camp. Plymouth.
England, to establish a base hospital at that point. This order was
revoked two or three days later by another order sending us to
Liverpool for duty at the camp hospital.
On the 0th day of June, 1918. the organization then known as hos-
pital unit W reported at the American rest camp at Knotty Ash,
Liverpool, for duty. The local camp hospital, then in its infancy,
i A. E. F. CAMP HOSPITALS. 2107
poiisisted of a series of marquee tents in Springfield Park. Some of
ithese were already equipped and were being used as hospital wards.
Still others had been erected, but were not at this time fitted out.
Tlie capacity of the hospital was slightly over 100 beds.
In July a set of plans for the permanent hospital were drawn iq).
These were souiewhat uiodified and then approved of. On August
10. lOLS. the contract was let and work almost immediately started
in the permanent brick and concrete buildings.
On the grounds when we came were a group of Royal Ami}- Medi-
al Corps men, about 30 in all, under the supervision of a sergeant
najor. These uien served in the capacity of Avard orderlies and were
means of educating our own American personnel in this line of
vork. On the whole, they were good workers and were essential, to
lie progi-ess of the hospital, since we had in our own personnel but
iS men. Shortly after our arrival (July 21) 15 new ^Nledical Corps
men were added to our organization, but even these were not suffi-
cient, since each convoy that came to the port brought new contagious
cases.
A request was made for additional personnel, and 30 more Ameri-
cans were attached. AVith the services of these at our disposal, we
found that the English personnel were mostly men of " C "' class, and
were not as efficient as before: in fact, their work was rapidly de-
teriorating day by day, and they decreased rather than increased
our own efficiency. True, they were not working in an American in-
stitution, but felt that they were responsible to their next immediate
English officer rather than to the American camp hospital commander.
Noticing the loss of time in their efforts, we requested that they be
relieved from further duties at this camp. The request was almost
immediateh' complied with.
According to plan, the new institution was to consist of two sepa-
rate divisions — a general and a contagious section. They were to be
so constructed aslo be used as a whole, but, should occasion so de-
mand, either might be run in<lependently of the other.
Xearing the end of October, 60 per cent of the new hospital was
completed.
The next four weeks saw 15 per cent more of total Avork accom-
plished ; general offices now ready for occupation.
On December 1 the new administration building was occupied. On
December 10 the new surgical ward received its first occupants. On
December 20, 1918, the operating room was ready for use. On De-
cember 25 the new recreation hall appeared. On this same day gen-
eral wards were ready for use, so also new kitchen and contagious
wards were at our disposal.
There have been two epideuiics of influenza in camp since con-
struction. One in ^lay. when 48 men on the small permanent per-
sonnel had influenza, mild form. Men were treated in hospital with
no death rate. One in October, which has been described in hospital
histoiy.
Inasmuch as Camp Hospital No. 40 was intended as a contagious
hospital, the great bulk of the work would naturally fall on the
medical side. "We soon found, however, that here and there in the
medical wai'ds would be seen a case of surgery arising sometimes as
a complication to the infectious diseases, sometimes as a concurrent
2108 REPORT OF THE SURGEON GENERAL OF THE ARMY.
i-ondition. The only means then at our disposal was to let sucl:
cases outlive their period of ((uarantine and then have them trana
ferred to a general hospital for the needed attention. Often thes(
cases had not suffei-ed any great loss in waiting until the (juarantim
limit had heen reached. Then again there were times, in enipyem
cases, acute appendices, and the liUe, wlien it was not to the best in-
terests of the individual to wait. Then came the realization that somi
sort of an operating room should be improvised.
We had no huts; tents alone were at our disposal, so it was a
lent that we first fitted out for operating purposes. The t-ented surgi-
cal ward was fitted parallel to this with a canopied corridor con-
necting the two. Tlien came the work of equipping the surgical tent.
That part of the equipment such as tables, instruments, which was not
at that time on the grounds, was procured from the medical supply
depot. There were no lights at that time in any of the tents, so most
of our emergency cases Avere ojierated by day oi- in the light of a
lantern by night.
One question alone seemed to be raised again and again. That was
just hoAv efficient was our linen sterilizer. A stitch infection or two
made us realize that this sterilizer was not so good as we at first
thought, so we began a 24-hour sterilization after this. Our stitch
infections ceased. A tented operating room in such a climate as this
is not an ideal place in which to open chests or abdomens. Despite
this fact our results were unexpectedly good.
About October 10. 1918, since the iniiuenza was raging, our operat-
ing tent was closed. The engineers were busy on the construction
of the new hospital, and since the}' needed space our patients were
moved over to the newly erected huts in the adjoining rest camp. Our
operating equipment was likewise moved at this time and an operat-
ing hut was fitted out.
When hospital unit " W '" took charge of Camp Hospital 40. on
June G. 1918. there was a row of triple marquee tents, six in number,
along Prescot Road. Of these, three were occupied. " A " and " B "
contained mumps. " C '' contained measles and was under suspicion
because a questionable case of scarlet fever had been removed from
there but two days previous. Wards " D,"' '* E,'" and " F '' were va-
cant.
Beyond these was another row of triple marquee tents. Ward
*' G " was vacant. Ward " H " was given to general medicine. Ward
" I " was given to such surgical cases that came up among the in-
fectious patients and the personnel. Ward " J " was filled with a
class of cases laiown as exhaustion cases. These cases Avere men
that had been picked up on the line of march from the landing stage
to the camp.
Over on the site of the present first infectious ward were four
tents capable of holding six patients each. One tent was given to
cases of itch, one to diphtheria, one to scarlet fever, and one for
observation cases. There was no receiving ward, no dispensary, and
as for Army paper, especially Form 55, such was not to be had.
There was a fair supply of drugs on hand, and these were stored
in an old stable some distance from the field of activities. An open
cement kitchen, planted in the center of a group of tents, furnished
the necessar}' food for the officers, men, and patients. In a far corner
A. E. F, CAMP HOSPITALS. 2109
of the grounds next to a bowling green there were two sectional
huts slowly nearing completion. The morning report showed 132
ipatients iii the hospital. Such was Camp Hospital No. 40 at that
time.
On the 12th the receiving ward moved into Hut No. 1, where it
was to remain until about December 1. wlien it was moved to its
present location in the administration building. Before the end
of the month the dispensary was established in the rear end of Hut
No. 2 and the drug room was established in Hut No. 1.
Large convoys were arriving at the rate of two a week. Some
would bring us but few patients, other would bring many. From
unit Q we heard of the horrible time when one convoy brought 54
patients. Well, we remember the "wildcat" division, with its 108
cases. Then the convoy, 12 days later, that brought us 148 cases in
one day. It was toward the end of June that we received our first
cases of true influenza. Ten cases were sent down one evening from
an aviation camp. The influenza bacillus was discovered in all these
cases. One case developed pneumonia, followed by enipyema, but all
recovered. At this time ward H became the surgical ward and
ward I was divided in the center, one end for influenza, the other
for lobar pneumonia.
The increasing number of patients received from the convoys, due
to the increasing number of short-service men, together with the
long period of isolation required by British law for mumps and
measles, resulted in a bed capacity of 500 being authorized about the
middle of July. Whenever a convoy came in they would report so
many measles, so many mumps, etc., but 12 of the mumps are
contacts with measles. 3 with meningitis: 7 of the measles are con-
tacts with mumps, 4 with meningitis. Then the skirmish for tents
and for space for these tents would commence. One day we carried
on the morning report 198 cases of mumps. We reached nearly 100
cases of measles at one time. An occasional case of influenza was
beginning to come in. Early we adopted a scheme of cubicling
ward I % means of screens. A case of cerebrospinal meningitis
appeared in one of the measles wards, and was removed to a British
hospital, where the patient died. Culturing of the patients in this
ward revealed eight carriers, all in direct contact with the case.
Cross infections of mumps and measles would appear. They would
immediately be isolated in bell tents. But it was only when an
iron fence was placed around the mumps and the measles and they
were separated by a space of about 10 feet from the civilian popula-
tion that would come up to the fence on Prescot Road that any
headway was made on cross infections.
The third hut of the officers' quarters was nearing completion
when that ever-remembered convoy of September 29 arrived. It
brouglit its expected quota of mumps and measles, and besides
brought a large number of cases of influenza-pneumonia. In these
cases the influenza bacillus was a rare finding, while the pneumo-
coccus was present in all. One boat of the convoy, the Lajjland^
brought 210 cases. The hospital was taxed to its capacity and the
commanding officer of the rest camp turned over to us what huts as
were completed in Camps 5 and 11 to house the sick. Sick they were,
iind speedy death was the result in many of them. From the pallid,
2110 REPORT OF THE SURGEOJs^ GENERAL OF THE ARMY.
prostrated cases we called influenza to the cyanotic, septic cases w3
called infiuenza-pneunionia was frequently but a matter of a fe-v^
hours. Those (ases that were called pneumonia were moyed into Cami
5, the new officers' quarters, to Ward I, and to Hut 3. The mornim
report on the 30th showed patients in hospital, 859; deaths. 10-
Deaths occurred daily. An oyerworked personnel was attackecl?
Another conyoy brought the same thinsf. Many of the cases of pneu-
monia were moyed into other hospitals. Then the epidemic beffan
to subside. ^
Number of cases of influenza 49Q
Number of cases of influenza-pneumonia ~_l~ 127
Number of deaths from influenza-pneumonia I" ~ I 52
Numl)er of personnel to develop influenza r_II__Z 32
Number of personnel to develop influenza-pneumonia I_ Q.
Number of personnel to die from influenza-pneumonia I__I 2
Shortly after the signing of the armistice the work began to take
on a different character. Xo convoys came in and we began to em-
spections are but part
of the measures used to prevent disorders appearing on the trans-
ports.
On December 11 smallpox appeared in a patient that had been ad-
mitted five days previously, to be followed by another case on the
13th. This resulted in the entire hospital and the entire rest camp
being vaccinated. Both of these cases had been discharged from the
same ward in a neighboring hospital but a few days previously, but
strict search failed to find the source of infection.
E. CA3IP HOSPITAL NO. 41.
American Expeditionary Forces Camp Ilosiiital Xo 41, A. P. O.
No. 712.
Z(9c«//wk— Camp Williams. A. P. O. Xo. 712. Is-sur-Tille, France.
Camp Hospital Xo. 11, American Expeditionary Forces, opened
for the admission of patients March 11, 1918.
April 1. 1918, began to operate as Camp Hospital Xo. 41. There is
no record of the authority for this change of status.
In addition to furnishing hospital treatment for all troops, Span-
ish and Chinese labor organizations and prisoners of war stationed
at Camp Williams, A. P. O. Xo. 712, the hospital cared for all the
sick taken from the trains passing through the regulating station at
Is-sur-Tille, France. On some days as many as 50 patients were
admitted to the hospital from the trains. Most of the patients that
were eyacuated from Camp Hospital Xo. 41. were sent to Base Hos-
pital Xo. 17 at Dijon, a distance of about 18 miles; some we sent to
hospital center at Langi-es, and some to Camp Hospital Xo. 10. Sick
call for oyer half of the troops stationed at Camp Williams was held
at the hospital until December 20, 1918, when the sick call for the
entire camp was held away from the hospital.
From the opening of the hospital, March 11, 1918, to March 31,.
1919. there were 12,270 patients admitted to the hosp.ital. During
the same period there were 208 deaths.
A. E, F. CAMP HOSPITALS. 2111
Xiimber of influenza cases admitted to Camp Hospital No. 41 dur-
inir the year ending March 31, 1919, was as follows :
April, 1918 67
Ma.v, 1918 53
June, 1918 195
July. 1918 134
Aii},'ust. 1918 172
September. 1918 632
October, 1918 649
November, 1918 790
December, 1918 824
January. 1918 497
February. 1918 440
March; 1918 344
Total 4, 797
All cases of contagious disease except scarlet fever and diphtheria
were isolated in tents until October. 1918, when a ward was erected
for contagious diseases ; scarlet fever and diphtheria cases were trans-
ferred to Base Hospital Xo. 17 for treatment.
All cases of venereal diseases from the troops stationed at Camp
Williams requiring hospital treatment were admitted to Camp Hos-
pital Xo. 41, and all cases that were able to do duty were sent to the
hospital twice daily for treatment until November 1, 1918, when a
segregation camp was established, where all cases were confined and
treated until cured. The segregation camp is under the charge of the
post surgeon.
Most of the laboratory work for Camp Hospital Xo. 41 was done at
tlie central laboratories at Dijon. On January 1, 1919, a medical
officer from the central laboratories was sent to Camp Hospital Xo. 41
to take charge of the laboratory work.
F. CAMP HOSPITAL NO. 4 2.
Historical report Cam}) Hospital Xo. 42. Bar-sur-Aube. Aube,
France, A. P. O. 913.
It is impossible to compile any history from the date hospital
opened to June 5. 1918, as no records of any description were left by
former organization. On June 5, 1918, Ambulance Company Xo. 42,
witli a personnel of 5 officers and 122 enlisted men. took charge of
the hospital under verbal orders, general headquarters. American
Expeditionary Forces.
Tlie hospital is located in the 13th Training Area and has taken
care of the sick of the organizations located or coming into this area.
The following organiziitions liave been located here since the estab-
lishment of the hosjjital : Artillery headquarters of the Army. 5th
and 3Gth Divisions, various labor battalions, and Services of Supply
troops, and headquarters of the First Army.
When the 5th Division turned over the hospital to Ambulance Com-
pany Xo. 42 they left 73 patients behind, but with no records.
Beginning Avitli July, tlie first epidemic of the three-day fever, a
mild type of influenza was obserA'ed. nearly the whole of headquarters
troops. Army Artillery, being infected. We found that, regardless
of the method of tieatment. it would take from three to five days for
the patient to recover. With this first epidemic there were practi-
cally no complications or sequelhv.
211*2 REPORT OF THE SURGEON GENER.VL OF THE ARMY..
The 36th Division entered this area and was stationed here from
Auo-ust 6, 1918, to Septenilier 27. 191S. ()n the 10th of August the
first case of pneumonia was achnitted to the hospital, coming: from,
the 14'2d Keginient, stationed at BHgny. During August and Sep-
temher the entire area was infected with an epidemic of influenza
which was of a different character than the mild epidemic of the
preceding month. In this infection it was noticed that the disease-
exhibited a marked inclination toward developing into a broncho-
pneumonia : in fact, many of the cases developed pneumonia after
having been convalescent from influenza from a period of one to
two Aveeks.
The hospital group consists of 19 wooden, sectional barracks, lo-
cated just east of the village of Bar-sur-Aube.
When Ambulance Companj' Xo. 12 arrived to take charge of the-
hospital they found only a number of empty barracks without floors^
partitions, or any of the buildings completed. There were no roads
through the camp, no hospital equipment, and very few improve-
ments. During the month of June. 1918. most of the time was spent
in nuiking the hospital habitable for seriously sick soldiers. For
latrine purposes, the engineers had been satisfied with a very insani-
tary shallow straddle trench, and so about the first thing accom-
plished by the Ambulance Company was a pit latrine with a modi-
fied Harvard box, which was made as near fly proof as possible and
has lieen burned out on an average of once a week and new pits con-
structed when necessary.
The cases of pneumonia which became so prevalent at this time-
showed, upon microscopical examination, that the streptococci hsemo-
lyticus was responsible for nearly To per cent of the cases. The 36th:
Division had had a previous epidemic of this form of pneumonia at
Camp Bowie, Tex., when they lost a large percentage of cases. It is
fair to presume that there were still carriers of this same infection
in the companies. The majority of soldiers succumbing to this dis-
ease were those recentlj" drafted and who had practically no training^
before reaching France.
The 36th Division left this area September 27, 1918, going up to-
the front. When they left the hospital was filled, having as a total
478 patients.
During the period of August and September the 114th Field Hos-
pital erected two ward tents and a laboratory tent wherein they
treated the venereal cases of the various regiments of the 36th Divi-
sion, the hospital cooperating in every way possible.
After the 36th Division left there were no other divisions or large-
bodies of troops located in this area until November when the Heacl-
quarters of the First Army established itself here. During this
period the only patients received were those from the railhead, sales-
commissary, labor battalions, and small detachments of' Engineers
Corps and signal battalions who came here from time to time. We
also receiA'ed a few wounded men from the front who had been;
dropped from a French hospital train at Brienne le Chateau. These
were evacuated to a base hospital as quickly as possible.
During the occupancy of the 13th Area by First Army headquar-
ters the number of patients had steadily decreased both by reason of
less sickness among the men and also because of the departure of
many for the United States.
A. E. F. CAMP HOSPITALS. 2113
I
Up to Septeiiiljer Camp Hospital No. 42 had iio nurses, but when
the hospital became filled with the influenza and pnenmonia patients,
[the commanding- officer requested that nurses be sent. Six nurses
reported for dut}' within three chiys and later on they were augmented
by three others. Since then this hospital has not been without nurses
at any time.
It has been rather remarkable that during the entire period of
this hospital's existence very few cases of gastrointestinal diseases
have l)een received or treated, this being largeh' due to the fact
^that all water used for drinking or cooking has been thoroughly
chlorinated as it is drawn from the well by the use of chlorine gas.
On November 1, 1918, the Red Cross were supposed to have taken
aver the work of the Y. M. C. A. in the hospital, but for some reason
no Red Cross representatives have ever been in the hospital. Aside
from a Red Cross hut for officers which has been erected in Bar sur
Aube, since the establishment of the First Army headquarters, na
Red Cross activities have been apparent around here.
(;. CAMP HOSPITAL NO. 4 3.
In xA.ugust, 1917, a detachment of the loth Engineers arrived at
Gievres from Vierzon, bringing with them one officer of the Medical
Reserve Corps and a few enlisted personnel of the Medical Depart-
Iment.
' During September and October, 1917, the number of troops at the
(Vievres project was considerably augmented; each organization
brought with them one or more medical officers and enlisted per-
sonnel of the Medical Department. Up to the end of October, 1917,.
no systematic arrangements or centralized hospitalization facilities
jwere provided, the seriously sick and surgical cases being transferred
to Base Hospital No. 9 at Chateauroux.
From the regimental infirmary, loth Engineers, Camp Hospital
No. 43, and Medical Department, general intermediate storage depot
had its origin. This infirmary was located in the Engineers' sub-
post and consisted at first of two type A hospital buildings erected'
in the form of a T.
Only a few troops arrived in December, 1917, and the sickness
among the entire command was slight.
Early in the year 1918 various labor organizations and Chinese
laborers arrived in camp. These troops and civilian laborers brought
the usual number of mumps and sickness.
In April, 1918, post hospital was designated Camp Hospital No..
43, and construction was commenced on the present camp hospital.
Six type A hospital buildings and one Adrian barracks were erected.
By July, 1918, the strength of the command had increased to such
an extent that it became necessary to erect 12 additional hospital
buildings, which included operating pavilion, wards, storeroom, and
officers' quarters.
With the almost daily arrival of fresh troops from America dur-
ing August and September, 1918, the work at Camp Hospital No. 43
increased to such an extent that two additional buildings had to be
constructed.
2114 KKPORT OK THE Sl'RGEOX (JENERAL OF THE ARMY.
By the end of September, 1918, the hospital consisted of ^-l build-
ings, 12 used as wards, the remainder used as receiving ward, operat-
ing room, sterilizing room, laboratory, offices, officers' and enlistedj
men's quarters, kitchens, and mess.
On February 10, 1919. Base Hospital Xo. 94, operating at Pruniers,!
ceased to functionate as a base hospital and became part of Campj
Hospital Xo. 43. Base 94 consisted of 50 buildings. On taking
over this hospital the old Camp Hospital Xo. 43 was designated as
a contagious-disease hospital and used for contagious, skin, and
venereal diseases.
Xaturally with so varied a command as general intermediate supply
depot, including not only Americans, both white and colored, but
Chinese and Spanish laborers, as well as German prisoners of war,
the medical service comprises a large variety of diseases. Aside from
the ordinary sickness developing in a command of approximately
20,000 the medical pereonnel at general intermediate supplj^ depot has
had to combat two distinct epidemics of influenza, the first appearing
early in June, 1918, among the Chinese laborers. Developing at this
season of the year among an Oriental race who are subject to tropical
and other diseases not common to this section of Europe and present-
ing two distinct symptom syndromes, namely, sudden onset of gastro-
intestinal and bronchial disturbances common to tropical diseases,
the possibility of dysentery, cholera, a pneumonic type of plague were
thought of. Where a tentative diagnosis of influenza, bronchial and
gastrointestinal type, was made the services of a medical consultant
were requested. The medical consultant went over the cases both in
hospital and those isolated at the Chinese camp and after a thorough
examination and laboratory report confirmed the diagnosis of influ-'
enza. This disease ran its course among the Chinese and, notwith
standing strict quarantine and all sanitary measures, spread among
all troops of the command.
The gastrointestinal type predominated throughout this epidemic.
While the disease was severe, it was of short duration, lasting on an
average of four days. Xo deaths were attributed to this epidemic.
The second epidemic of influenza appeared at general intermediate
supply dei)ot late in October, 1918.
Contrary to the epidemic of June, the bronchial type predominated.
The disease at first presented the typical symptoms of the ordinary
influenza, but as it developed it gained in virulency, many cases reach-
ing the hospital cyanosed. the great majority developing bronchial
pneumonia of the purulent type. Pneumonia resulting from influ-
enza was fatal in many cases, this being especially true among the
colored races, streptococci proving to be the causative organism in the
majority of cases. The disease was of an especially severe type, last-
ing on an average of 14 days, convalescence being slow and tedious.
Diphtheria, scarlet fever, measles, and meningitis have appeared
from time to time, but with prompt isolation of all contacts and dis-
infection of barracks and sterilization of clothing and bedding these
diseases have never assmued an epidemic form. Only one case of
t3T)hoid fever has occurred. The diagnosis in this case was confirmed
by laboratory finding at central laboratory, Dijon.
During the early days of organization Tery little attention was paid
to sanitation. Open latrine pits were dug, with a view of nearness to
A. E. F. CAMP HOSPITALS. 2115
troops, regardless to location of kitchens and mess halls. Solid gar-
bage was in part removed by the French farmers, the remainder and
liquids being disposed of in open garbage pits.
After several months' delay a small open incinerator was built at
the Engineers' subpost. This never was satisfactory and never should
have been used for other than the incineration of wastes and garbage.
With the increase in size of conuiiand this incinerator had to be aban-
doned and excreta disposed of by burial.
In July, 1918, three sites for the burial of excreta and incineration
of dry garbage were selected, these sites located at points distant
from where troops were quartered. These burial grounds have been
cared for by a detail of prisoners and have proven satisfactory, no
odor having been detected and always kept fly proof.
Kitchens and mess halls were not screened, tliough several recom-
mendations were made by the surgeon. Contrary to the general
opinion, as expressed by several P^ngineer officers, flies were numerous
at the general intermediate supply dejiot and vicinity and. it is be-
lieved, contributed in no small degree to the .spread of intestinal dis-
eases occurring during the summer: breeding places were confined
largely to stables and pigpens cm French farms. Efforts were made
to have these farmers I'emoved or their stables and pigj^eus ])oliced,
but the French law so protected the farmer in his pri\ilege to live in
filth and dirt tliat the commanding officer, general intermediate supply
depot. v\as powerless to correct insanitary conditions existing on
French farms.
All organizations arrived in camp were placed in quarantine for a
period of two weeks. At Camp Hospital Xo. 43 separate weirds are
set apart for each contagious disease. This has taxed the capacity
of the hospital to such an extent that an average of 350 patients have
had to be quartered in tents. Mumps, measles, chicken pox. whoop-
ing cough, diphtheria, scarlet fever, influenza, lobar and broncho-
pneumonia, and scabies have required separate wards. AVhenever a
contagious disease is reported in an organization a memorandum is
sent from the surgeon's office to the commanding officer, general inter-
mediate supply depot, requesting an order placing the oiganization in
quarantine. This order prevents the men from visiting Y. M. C. A.
huts, other organizations, or receiving visitors from other organiza-
tions. In addition to quarantine each man in an organization having
contagious disease is re(iuired to gargle throat twice a day. and all
contacts have nose and throat sprayed once a day: all mess kits are
washed first in boiling soapsuds and then in clear boiling water; cloth-
ing and bedding sterilized l)y steam: bunks and floors sprayed with 10
per cent cresol-sodique solution.
The troops stationed at general intermediate supply depot have not
been infected with pediculosis to any great extent. Nearly all cases
found have been in men who have been out of the camj) on convoy
dutv.
Those cases which have been fdund have been promptly deloused :
all clothes sterilized 1)V steam at group infirmnries in Serbian l»arrels;
straw in bedticks burned: bedticks and blankets sterilized in steam
sterilizer at Camp Hospital No. 43: bunks washed with 10 pei- cent
cresol solution. Each man given a hot bath and issued a complete set
of clean clothing.
142367— 19— VOL 2 72
2116 REPORT t»l-' THE SURGEON GENERAL OF THE ARMY.
At Camp Hospital No. -13 all cases of contagious diseases ar
promi)tly isolated: cubicle isolation has l)cen carried out in all wards,
regardless of class of disease. This has greatly reduced the chance of
cross infections.
Medical officers, nurses, and attendants all wear masks and gowns
while attending the sick, and patients suffering from respiratory or
other contagious diseases are required to Avear masks upon leaving
their cubicle. Free ventilation of wards is maintained at all times;
all linen disinfected before leaving ward; mattresses and blankets
sterilized by steam ; mess kits boiled ; sputum, urine, and excreta dis-
infected before being removed from wards.
H. CAMP HOSPITAL NO. 4.5.
In February, 1918, the United States Army established a leave-
area center in Aix-les-Bains, Savoie, France. This proved such a
success that soon other parts of the Savoie, Haute Savoie, and
Dauphine Pi'ovinces were secured and turned into an Alpine play-
ground for the American Expeditionary Forces, with centers in
Chambcry, Annecy, Chamonix. St. Gervais, Challes-les-Eaux, Alle-
vard, Grenoble. Uriage. etc.
Toward midsunnner of 1918 the number of permissionaires had
so increased that it became necessary to provide more elaborately for
their ailments. Heretofore tliose who became realty ill were cared
for in local French hospitals or hotels. The surgeon of the area
had been negotiating with the French authorities and on Juh?^ 8, 1918,'
the Leon Blanc hospital, built on the outskirts of Aix-les-Bains and
presented to the municipality in 1912, was officially transferred to
the American Expeditionary Forces as Camp Hospital No. 45.
During the sununer months most of the patients were men wh
had become victims of bicycle accidents or mountain climbs or other
wise injured in strenuous outdoor sports. With the coming of win
ter influenza and pneumonia, etc., swelled the " sick book " and called
for rapid expansion of the then existing acconnnodations. To meet
this emergency two wooden barracks were erected and a nurse's home
and a personnel's " villa " procured.
The signing of the armistice and flooding of leave areas with
tired-out and overcrowded men caused a large increase in hospital
admissions from all sorts of causes. i
All the surrounding playgrounds sent their injured and sick tq
the Hospital Americane d'Aix, and Camp Hospital No. 45 became
well known to men from all over the American Expeditionary
Forces, who came for a few days to this Alpine wonderland.
The real purpose of a leave area is to give health and happiness
to the Army and so increase the vigor and efficiency of the whole
American Expeditionary Forces. In this work the hospital plan's
a very important role, not only in caring for those already ill, but
also by establishing dispensaries and inaugurating methods of sani-
tation for the prevention of disease.
A number of very ugly appendix cases and emypemas came in
from various distances, some in ver}' bad condition, and usually at
night, so that this part of the hospital became regular night
operators.
1
A. E. F. CAMP HOSPITALS. 2117
The three large porches accommodated the pneumonias and were
doubtless responsible to a large degree for the low death rate here,
which averaged about 17.5 per cent. It was noticed that most of
the fatal cases were of a peculiarly rapid and virulent mixed in-
fection, resulting in a very massive form of pneumonia.
Although all wards were large and airy and all beds in the hos-
pital individually screened and cubicled, a certain number of in-
fluenza cases inevitably developed broncho-pneumonia, which often,
however, ran a mild course. Xo deatli resulted from influenza with-
out a complicating pneumonia.
Among other things of interest to the sanatarian in these areas
is the control of the hotels and living and eating of the men on
leave and of those stationed locally. Much has been done to relieve
undesirable situations and to improve the conditions and tone of
things generally.
Now that this part of France is officially the recreation center of
the Army of Occupation in Germany, the hospital will doubtless
continue to functionate as a definite and important entity in this
mother of leave areas. Aix-les-Bains.
I. CATMP IIOSPrrAL NO. 4;t.
Camp Hospital No. 49 was organized at Laignes, Cote-d'Or. where
it o]:)erated throughout its existence. The hospital was still under
construction when the Medical Department troops were assigned to
it for duty. It was constructed for the purpose of caring for the
sick of the fifteenth divisional area. The hospital was originally
intended to be a 300-bed institution. Its capacity was. however, ex-
panded to 87.") beds.
The first patients were admitted on September 22, 1918. They were
from the 7th Division, which occupied the fifteenth divisional area.
A lack of medical facilities made it difficult to care for these patients.
With the aid of the Eed Cross patients were made comfoi'table until
sup])lies arri\ed.
The 7th Division left the di\ isional area duj'ing the last week of
September, relieving Field Hospital No. 22 from duty here. Work
was light until the arrival of the 80th Division in the area, there being
an average of 00 jKitients for treatment in the hospital during the
months of Octol)er and November. During the first of December the
80th Division moved into the fifteenth area. From this time on the
hospital Avas filled to capacity almost continuously until the division's
departure.
The numl)er of admissions to hospital per month were as follows:
Patipnts.
8o|»teial)t"i-. 1018 . 81
October. 1918 20
November. 1918 60
December, 1918 803
.Tanuary, 1919 656
February, 1919 469
March. 1919 _ 548
April, 1919 21
Total number of admissions 2. 658
2118 REPORT OF THE ST'RGEOX GENERAL OF THE ARMY.
Xiimber of deaths in hospital per month were as foHows:
September. 1918 i9
October, 1918 ZZ"l~ 9
Xovoinbei-. 1918 7
Deceniber, 1918 Z__Z__IZ on
January. 1919 ""
February. 1919 ~ .t
March. 1919 ;
April. 1919 irizizizriizr' .s
Total number of deaths ^5^
The hospital was officially closed on April 11, 1910, all patient
remaining m hospital cm that date being evacuated to Base Hospital
No. 103 at Dijon. ^
J. CAMP IICSPITAL XO. r,o.
Camp Hospital Xo. :>() is situated on the Tonnerre-iNIoslomes Road
about one-half kilometer from the former town, on the gradually
rising slope of the north l)ank of the Armancon River. Tlie site is
well chosen, botli fi-om the standpoint of facilities for .supplies and
evacuation and from the characteristics of the terrain. The station
of Tonnerre is on the main line from Paris to Dijon.
Camp Hospital Xo. .50 was not organized and called into active
service as a separate intact unit.
In general, it was the duty of Camp Hospital Xo. 50 to serve
troops m the sixteenth training area of the advance section, Services
of Supply. From the date of opening until the end of September,
1918, the 81.st Division occupied the sixteenth training area and the
sick of that division were hospitalized at Camp Hospital X^o. 50.
After the departure of the division for the front activities of the
hospital were somewhat diminished until the beginning of December
when the First Army Corps, the 3Gth Division, and the 80th Divi-'
sion occupied the sixteenth training area. The ho.spital was servj
Tiig in all a1)Out 30.000 troops. In addition the personnel of suc¥
Services of Supply units as were stationed in the vicinitv were care3
for. as the 34r5th Field Bakery. Sales Commissarv Unit X^o. 37, Motoi
Transport Corps 26. 4th Railway Division, 13th Grand Divisioii
Transport Corps, 15th Grand Division, Transport Corps, 328th Lai
bor Battalion 333d Labor Battalion, 514th Engineers, 502d Engi!
neers. and the 532d Engineers.
1918
1919
Total.
.'■'et)-
tember.
Octo-
ber.
Vovem-
ber.
Decem-
ber.
Janu-
ary.
Febru-
ary.
March.
April.
Admittod
400
299
99
2
0
90
44
13
94
I
26
135
56
13
2
0
90
701
425
120
5
0
241
643
357
265
11
0
251
835
450
314
21
3
298
787
371
.548
10
1
1.55
485
233
3.53
2
0
52
:l
Discharged to duty
Transferred
Died
Deserted
Remaining in hospital
When the 81.st Division was in the area there was a marked epi
demic of mumps : with the arrival of the 36th Division there begai
an epidemi • of influenza, lol)ar and broncho-pneumonia, which con.
A. E. F. CAMP HOSPITALS. 2119
inued imreiiiittiiigly until the division left the area. These troops
eenied especially susceptible to respiratory diseases. About 201
3ases of lo'bar and broncho-pneumonia were treated, with a death
ate of about 19 per cent. In the case of meningitis, about 20 cases
m all were treated, with a death rate of 'S'di per cent.
Kl. CAMP HOSPITAL XO. R2. '
August 0, 1918, to January 1, 1919: Camp Hospital No. 52, Le
Mans (Sarthe), France, was organized from casuals. The nucleus
3f the hospital was taken from the 308th Sanitary Train, 83d Divi-
sion, Chiefly Field Hospital Xo. 330. which has been functioning as a
60-bed hospital at Chanzy Barracks, Le Mans, known as the classifi-
jation camp, 83d Division (second depot). Four Red Cross nurses
were assigned per verbal orders of the division surgeon, 83d Division.
As the hospital grew, casual officers. Army Xurse Corps nurses, and
casual Medical Department enlisted men were added.
The permanent personnel of the hospital on the first day was 1
officer and 10 enlisted men, with 10 officers and about 60 enlisted men
on temporary duty. September 1, 1918, it had increased to 19 officer'-
and 130 enlisted men. During the winter of 1918-19 the personnel
was approximatel}' 60 officers. 85 to 90 nurses, and 650 enlisted men.
The hospital is located in the old Abby St. Vincent (Seminaire St.
Vincent) corner of Rue St. Vincent and Rue Germain Pilon. The
main building had been occupied by the French Complementary Hos-
pital Xo. 49 (State building) and was transferred on July 30, 1918,
by order of the sous-secretaire d'etat du service de sante militaire.
The hospital was first equipped to care for 300 patients, using only
the west half of the building. This mark was reached September 1,
1918.
September 19, 1918, two schools, each accommodating about 200
patients, were transferred by letter Xo. 22.208B.1/T of September 7,
1918, from the sous-secretaire d'etat du service de sante militaire.
Possession of these was taken September 9, 1918.
The hospital w^as opened for the reception of patients August 6,
1918, per verbal order of the division surgeon, 83d Division (second
depot). Before this date the American soldiers requiring hospital
treatment were taken care of in the French hospitals, chiefly Mixte
Hospital, Le Mans. These cases, about 50 in all, were transferred
to Camp Hospital No. 52.
The hospital served the second depot area as the only hospital
from its beginning until November 15, 1918, when Camp Hospital
No. 10 was opened at Camp d'Auvours. Since December 15, 1918, it
has been the largest camp hospital in the American embarkation
center. Its capacity is 1,700.
During the month of November the hospital was taxed to its
capacity, and it was necessary to evacuate about 500 patients by hos-
pital train.
On August 27, 1918, the first cases of true influenza occurred in
the division, and from early September until the end of October
these predominated over all other diseases. The incidence of com-
plicating pneumonia did not seem unusually large, but was none
the less extremely severe. In November the influenza epidemic had
2120 REPORT OF THE SURGEON GENERAL OF THE ARMY.
practically subsided. On the other hand, admissions of mumps cases
(1,891 during the month) and of measles with its usual severe com-
plications, had reached their height.
The hospital proved all too small and there were many cross in-
fections. In Xovember the medical service was reorganized accord-
ing to the following principles : An observation ward was established,
where cases were properly sorted and which received all medical ad-
missions other than outspoken exanthemata ; beds were cubicled ; the
exanthouiata wards were completely isolated from the remainder oi
the hospital, and a mumps annex of 750 beds was established with
officers and personnel solely for these diseases. Such measures had
an immediate effect in checking cross infections and in obtaining con-
trol of admissions.
Measles cases decreased in December, and during this month respi-
ratory infections, acute bronchitis, tonsillitis, sinusitis, etc., prevailed.
It is noteworthy that the returning troops, seasoned men, introduced
so few of the exanthematous diseases compared to the earlier recruits.
Pneumonia has accounted for over 80 per cent of the total deaths
in this hospital. As a complication of influenza it proved excep-
tionally severe. Most of the cases were broncho-pneumonia, although
in many cases it was impossible to distinguish these from the lobar
variety. The latter were chiefly Type II. whereas hemolytic strep-
tococci were isolated from the lungs of broncho-pneumonia in most
instances. Empyema proved a frequent complication, but its inci-
dence was far less than that encountered in many southern canton-
ments one year ago.
In proportion to the number of troops in this area the number of
cases of meningitis is unusually small. The high mortality is at-
tributed to two factors — many cases are received in a critical condi-
tion, frequently undiagnosed: and there has been a constant lack of
suitable sera. But one variety was furnished at a time, first Mul-
fords, then Lederlies, the date of much of the latter had expired.
Mumps. — Over 4,500 cases of mumps were admitted; these were
treated for the most part in tents. Excepting orchitis, complications
were notably few. Otitis media occurred very seldom, and the inci-
dence of pneumonia was actually less than among health}' troops not
out of doors. A few instances of presumable pancreatitis were noted.
Ll. CAMP HOSPITAL NO. 53.
Camp Hospital No. 53, American Expeditionary Force, Army
Post Office 752, Marseille, France.
The last section of France to be opened for the activities of the
American Expeditionary Forces was that area lying along the i
Mediterranean Sea, extending from Italy to Spain, and known as
" Base Section Xo. 6." The area prepared for the friendly American
invasion in the summer of 1918, included within its limits the city
of Marseille, the second largest port in France, with diversified ship-
ping interests from every quarter of the globe. The enormous busi-
ness of supph'ing the Allies with food, shelter, raiment, and
munitions found Uncle Sam meeting the emergency by opening the
port of Marseille for wartime cargoes so immense as to stagger
belief. To properly care for the health of employees and to furnish
A. E. F. CAMP HOSPITALS. 2121
officers and soldiers with the necessar}- medical attention Camp Hos-
jpital No. 53 sprun<r into existence, and was opened for the reception
bf patients on September 25, 1918.
I The hospital is located on the principal residence street of Mar-
iseille, the Boulevard Prado, and occupies a large stone building
Iformerly used as a theological institution, more recently occupied
by a young ladies' seminary. It has a capacity of 300 beds. The first
patient admitted to the institution was a German prisoner of war,
who was seized with acute appendicitis while working at the near-by
American storage depot of Miramas.
Marseille became a port of embarkation for the American troops
in February, 1919. This further added to the responsibilities of
Camp Hospital Xo. 53. As the activities of the institution increased,
!so did its medical force, and so did its usefulness.
I The hospital was not manned by any unit or other definite organi-
jzation. It was officered by physicians gathered together from
[various sources, and added to as the development of the institution
demanded.
:mi. camp hospital no. oy.
I
I This hospital (Issoudun. Indre. France), formerly the French
Hospital Auxiliare, Xo. 23, was taken over from the French on
August 18, 1918.
First report of personnel was rendered on August 21, 1918.
The first patients were received on September 8. 1918.
The hospital was ordered closed by communication from chief sur-
geon, intermediate section, Service of Supplies, American Expedi-
tionar}- Forces, dated February 4, 1919.
Of the 1,406 patients admitted, 687 were because of disease and
719 because of injuries.
All remaining jjatients were transferred to Base Hospital No. 63,
Chateauroux, on February 18, 1919.
There were 27 deaths; 2 were the result of wounds received in
action and the remaining 25 were due to disease.
This hospital occupies the buildings of the Ecole Sacre Coeur, a
school for boj's. It is a large four-stor}' building and has a large
park on the eastern side, which is entered directly from the building.
AVe also have the use of a larger park Ij'ing in the rear, but. except
to convert an unused building into additional sleeping quarters for
enlisted men, we have made no use of it. AVhen we took over the
l)uildings the smaller park contained two Bessoneau hospital tents,
and later 10 marquee tents, each accommodating 18 patients, were
set up. The buildings form a letter E, the front court being in-
closecl on four sides, three of which make a cloister. The rear court
is opened on the outer side, offering access to the kitchens. The
French had used the building for about three years as a hospital,
with a capacity of 450 patients. When we took it over it Avas very
dirty and infected with vermin, necessitating the destruction of much
of the furniture and bedding.
Our maximum capacity was 600 patieiits. AAHien the number of
patients lessened, the small ward on the fourth floor was set aside as
a Red Cross recreation room, where the efforts of two Red Cross
2122 REPORT OF THE SURGEON GENERAL OF THE ARMY.
•nnelf
workers did iniicli to entertain the patients and enlisted personnel
and to counteract the demoralization of idleness and the bad influ-
ences in the town.
The first patients were received on September 8, 1918.
On Septeml)er 20 we had 162 patients and received 124 more. Of
the latter number, 112 came in on a hospital train from the St. Mihiel
sector. That evening there were 580 patients here, which was the
greatest number we had at anj^ one time. Our strength that day w^as
12 medical officers, 6 nurses (borrowed from Camp Hospital No. 14),
and 81 enlisted men. The same day Field Hospital, No. 15G, of the
114th Sanitary Train, 39th Division, came to our aid for temporary
duty. Six officers and 81 men from this organization remained one
month.
At first there was no water available above the second floor, which
made the care of patients, and of such inadequate sanitary appli-
ances as existed very difficult. Besides this, there w^ere no baths
of any kind for either patients or personnel. Illumination was an
uncertain gas suppl}', supplemented by candles and lamps or lan-
terns. Through the cooperation of the Engineer officer at the third
aviation instruction center an electric lighting plant, shower baths,
and improvements in the plumbing were installed.
Most of our patients were received from the advanced areas. Three
hospital trains were unloaded here : On September 20, 412 patients ;
on October 11, 289 patients; and on November 3, 298 patients were
received. In addition to these were cared for the sick and injured
from the St. Florent area during the first month of our existence,
and also at the close of Camp Hospital No. 70, situated at that place,
together with all the hospital cases from Camp Cheneviere, the Ord-
nance camp near by, as well as casuals. The total number of cases
treated at this hospital was 1,406.
The terrific mortality of cases of broncho-pneumonia is largely due
to the poor condition in which the patients were at the time of their
arrival here. The}^ were nearlv all moribund at the time, exhausted
by recent traveling, and insufticient food and shelter during their
journey from base ports in a period of unexpected cold, wet weather.
On Felu'uary 5, 1919, a letter was received from the chief surgeon,
intermediate section. Service of Supply, directing us to close the
hospital and j^repare to return it to the French authorities by March
1, 1919. To-day w^e are awaiting the arrival of the French in order
to complete the transfer.
On February 18 we transferred our remaining patients to Base
Hospital No. 63, at Chateauroux.
On March 4 orders were received from the commanding general
intermediate section. Service of Supply, to transfer the remaining
personnel to Camp Hospital No. 14 for duty.
W. CAMP HOSPITAL NO. 64.
Camp Hospital Ko. 64, Army Post Office No. 730, American Expe-
ditionary Forces.
Location. — Chatillon-sur-Seine, Cote d'Or, France; population,
4,500.
The town has quite a little historical interest and was of consid-
erable importance in the Middle Ages.
A. E. F. CAMP HOSPITALS. 2123
It was here in 1814 that a congress was l\eld to pronounce the
deposition of Xapoleon I.
During the early daj^s of the World War Marshal Joffre had his
headquarters in the Chateau Mormot, whence he issued his famous
order, which is inscribed on a tablet at the south entrance.
The hospital consists of 19 buildings of the standard camp hospital
type. lu addition, there is a Eed Cross hut of the same type and
two ward tents used as .-arpenter sliop and storehouse for patients'"
clothing.
The Mards normally accommodate 30 patients each, the total nor-
mal capacity being 300 beds. The wards are heated by standard
drum, stoves, which afforded ample comfort even during the coldest
weather.
Ol. CAMP HOSPrrAL NO. Co.
The history of Camp Hospital Xo. 65 practically begins coincident
with the arrival of the 78th Division in the twenty-first divisional
area, headquarters at Semur, Xovember 17, 1918. Prior to that date
this hospital received a few patients from the various labor and
casual organizations. From September 17, 1918. the hospital was in
charge of Sanitary Squads Xos. 69 and 70, formerly attached to the
88th Division. On October 10. 1918, a commanding officer was as-
signed to take charge of this hospital, and during the period from
Octol)er 10 to Xovember 1 the hospital was being equipped and per-
sonnel assigned. The two sanitary squads, theiefore, formed the
nucleus from which Unit No. 1, Camp Hospital No. 65, originated.
The hospital consists of 20 100- foot wooden barracks, 11 being used
as wards, 1 for nurse's quarters, and the balance for clinical and
administrative purposes. Total emergency capacity, 375 beds, with
an average floor space of 40 square feet per bed. Municipal water
IS piped into the camp; is adequate in quantity; is made potable and
jialatable by the use of chlorinate of lime in Lyster bags. There is
one shower bath of the French Army type h?ing nsed. which has
proved to be satisfactory.
The records from which the following statistics were obtained
show the respiratory diseases reached the maximum number during
late Januar}^ and early February; that as influenza and bronchitis
increased the pneumonias increased; that in the beginning of the
epidemic the pneumonias were diagnosed lobar in type. As the epi-
demic gained force the diagnosis of pneumonias accompanying in-
fluenza and bronchitis were diagnosed lobular. The X-ray and post-
mortem findings well sustain the clinical diagnosis.
Complications. — Pleural fluid was often a complication of lobular
pneumonia. Pericardial fluid was diagnosed in 9 cases; empyema
in 33 cases. The diagnosis of pericardial fluid by auscidtation and
})ercussion Avas extremely difficult. Our i-outine examination was as
follows: Diagnostic puncture to be repeated until fluid located.
Fluid sent to laboratory for diagnosis. X-ray fluoroscopic and film.
The presence of j:)leural fluid called for repeated therapeutic aspira-
tion. When pus was evidence: Rib resection by the surgical staff.
The bacteriology of the empyema was largely streptococcus hemoly-
ticus.
2124 REPORT OF THE SURGEON GENERAL OF THE ARMY.
All beds, whether m respiratory wards or not, were cubicled. The
pneumonia wards were in charge of officers whose training and expe-
nence had especially prepared them in the care of pulmonary dis-
eases.
PI. CAMP HOSPrrAL XO. 6 6.
The camp of St. Sulpice, Base Section Xo. 2, American Expedi-
tionar}^ Forces, was started January 4, 1918, by a detachment of 20
engineers, detailed from Company B, 18th Engineers Railway, sta-
tioned at Rest Camp Xo. 4, Base Section No. 2. The first work ac-
complished was the building of four barracks of the American type.
Sick call and dispensary were held in a small 9 by 12 room, parti-
tioned off in one of the company barracks. All cases needing hospital
treatment were transferred to Camp Hospital Xo. 5 by authorization
of the base surgeon.
The 313th Labor Company, 185 men, and Companies B and C of
the 506th Engineers, Stevedore Battalion, 500 men, who arrived Jan-
uary 17, 1918, February 4, 1918. and January 25, 1918, respectively,
composed the commancl.
At this time there were no sanitary appliances installed. The
latrines used were of the straddle trench type. These, however, were
replaced in a short time with closed latrines. The garbage and refuse
from the kitchens was taken away by the French civilians. The,
drinking water was hauled in trucks from an artesian well about one-
half mile distance from camp and was boiled before use. An epi-
demic of mumps broke out among the colored troops of Companies B
and C, 506th Engineers, and the 313th Labor Company in the latter
part of January and early part of February.
A detachment of 26th Engineers Water Supply arrived in camp
with a well-drill outfit and started operations to sink an artesian well
in the early part of February, 1918. Two months later, having gone
"to a depth of 800 feet, a 100-gallon-per-minute flow was obtained.
Although the quantit}', 100 gallons per minute, is hardly sufficient for
the present camp demand, analysis has proved the water to be excel-
lent in quality from a sanitary standpoint.
Work on the camp infirmary was started in the middle of Febru-
ary, and upon the completion of two ward buildings, March 12, 1918,
the dispensary was moved in a small room partitioned off in one of
them. The post hospital supplies consigned to us arrived March 14,
1918, and beds were set up in both wards immediately.
The 12Tth Infantry, National Guard, 1,021 men. accompanied by
3 medical officers and 1 dentist: Company F, 25th Engineers, 140
men, accompanied by 2 enlisted men of the medical department ; and
Company D, 505th Engineers, 225 men, arrived in camp in March.
An epidemic of mUmps broke out in the 127th Infantry shortly after
they arrived. Several cases of diphtheria suspects were also noticed
and transferred to Base Hospital No. 6. A case of smallpox in Com-
pany H of this regiment was detected, and upon authority of the base
surgeon the entire company was vaccinated and quarantined for two
weeks. The 127th Infantry, with the exception of Company H, under
quarantine, loft camp April 5, 1918. Company H followed as soon
as the quarantine period expired.
The infirmary was enlarged to the extent of five more buildings.
Truck Companies Nos. 448 and 451, 106 men; Companj' A, 38th En-
A. E. F. CAMP HOSPITALS. 2125
gineerinf^ Regiment, 80 men ; Companies A and D, 312tli Labor Bat-
talion, 477 men; 900 German prisoners of war; and 225 British
guards arrived in camp during the month of May.
In view of the present size of the camp recommendation for a 200-
bed hospital on another site was made on July 15, 1918.
Some diarrhea appeared during the month, the new cases running
from 6 to 15 daily and continuing to appear. All cases which were
anything more than slight were isolated in hospital and treated as
ontagious, Avith separate dishes, disinfection of stools, etc. A num-
ber of specimens of stools were sent to the base laboratory for bac-
teriological examination, and of these two were reported as positive
for B. dysentarice, Flexner type. One of these positive cases, how-
ever, showed no clinical symptoms of dysentery. All of the cases
have cleared up rapidly on cathartics and restricted diet. It is
believed that part of the cases at least can be attributed to improper
diet, as there has been shortage of fresh vegetables in the rations
lately. In looking into the cause of this diarrhea, it was found that
there was considerable laxness in the supplying of chlorinated drink-
ing water. Labor details working on the warehouse project at some
distance, from camp were getting water from any convenient well
and passing it about in buckets to the men without chlorination.
This was corrected and orders in regard to chlorination were more
strictly enforced. Three water points were established, with a man
in charge of each, whose duties were to keep on hand an ample supply
of chlorinated water and to prevent the use of carrying away of
other water. Two galvanized-iron cans were set on a stand at each
of these points. It has also been found difficult to prevent defecat-
ing on the ground in the warehouse district by the labor detail, which
were widely scattered. For cleaning up this district and for the
water points use has been made of the sanitary details authorized
by General Orders 41, Headquarters Base Section No. 2, American
Expeditionary Forces. Considerable effort has been made to get
screening for company kitchens and mess halls, but none were ob-
tainable.
A complete tabulation of all new venereal cases recorded since the
opening of this infirmary shows that out of 134 cases 97 failed to
take prophylaxis.
Sixty additional beds were obtained and set up in the ward and
pyramid tents erected on the hospital site. This hospital now com-
prises seven buildings — two ward tents and five pyramidal tents —
and has a capacity of 127 beds, of which at the end of the month 84
were occupied. The present capacity being over 100 beds, recom-
mendation was made to change the ,designation from infirmary.
An epidemic of a severe type of influenza, frequently complicated
by broncho-pneumonia, became prevalent during the latter part of the
month. Four of the eight organizations in camp were the most seri-
ously affected, and these were placed in quarantine in their quarters,
but continued their duties, being worked separately. The first case
was o])served in a prisoner-of-war company. Some 10 days later
Company A, 333d Labor Battalion, arriving from Brest, France, had
shortly a large number of cases. The company spent nine days at
Brest during a cold, rainy spell, camped in shelter tents, the men
having no bed sacks and only one blanket each. Six deaths from
broncho-pneumonia occurred in this organization. The four pris-
2126 REPOET OF THE SUEGEON GENERAL, OF THE ARMY.
I
oners-of-Avar companies arriving on September 24, 1918, were also
greatly a fleeted, and six deaths occurred among them. To enable
the hospitalization of cases exhibiting severe symptoms, it became
necessary to expand the present hospital to the extent of five more
ward tents with 80 additional beds, bringing the total capacity up
to 210 beds, of which at the end of the month 160 were occupied.
Precautions taken to prevent the spread of this disease were the
quarantine of all companies seriously affected, requiring the men
with mild symptoms to sleep in tents and mess separately, placing the
hospital cases in separate wards, and screening the pneumonias.
Some figures of interest have been tabulated by the office of tho
hospital on the epidemic of influenza tliat has been prevalent in this
camp. They are as follows : During tho month of from September
23 to October 31, 1918. inclusive. 508 cases of influenza were admitted
to the hospital ; of this number and during the same period 144, or
28.34 per cent, w^ere complicated by bioncho-pneumonia. The deaths
from this complication nunil)ered 42, wliich bears a ratio to the total
influenza cases of 8.26 per tent and to the pneumonia complication of
29.16 per cent. The epidemic has al)ated somewhat, although the-,
death rate is still high.
The transporting from the old hospital to the new camp hospital,
of 123 patients, of whom 25 were seriously sick with pneumonia, waS'
completed on November 3, 1918, two Ford ambulances and one truck
covered with a tarpaulin being used for the j)urpose. The new hos-
pital at the present time is complete, with the exception of the surgi-
cal service, which is delayed pending ihe delivery of equipment. The-
hospital group is composed of 28 buildings.
The epidemic of influenza, which reached its height in the latter
part of October. 1918, has subsided to such an extent that it is now
practically extinct. On the first of the month there were untler treat-
ment 53 influenza cases and 52 pneumonia cases, all complication ofj
influenza : on the 30th there were 24 influenza and 25 pneumonia cases-
in the hospital. Two hundred and .seventeen new cases of influenza,
developed in camp and were hosjiitalized during the month, as-]
against 508 cases admitted to hospital during the period of September
23 to October 31, 1918. The daily average of admittances was 7; the-
highest iiumber admitted in one day was 14 and the lowest 2. The-,
complication of pneumonia was observed and diagnosed in 26 influ-
enza patients, and 7 deaths due to this complication occurred during:,
the month.
A complete tabulation of the venereal prophylactic record of this
camp since its establishment was made as of Xovember 30, 1918. The-
figures arriA'ed at are as follows : Of 261 men who developed venereal
disease, 194 did not take the prophylactic treatment. The intervals
elapsing between the hour of exposure and the hour of treatment for
the 67 that took prophylaxis are: One hour or less, 26; one to two
hours, 11; two to three hours, 15; three to four hours, 6; and more
than four hours, 9.
Fl. CAMP HOSPITAL NO. 6 7.
Camp Hospital No. 67 was situated in the grounds of the Chateau-
de Guilbaudon, about 2 kilometers distant from Moneteau, Depart-
ment of Yonne, France, in the nineteenth area. American Fxpedi-
tionary Forces.
A. K. F. -CAMP HOSPITALS. 2127
The hospital whs lunised in standard wooden barracks, and the per-
sonnel was occupied up to December 23. 1918. completing: the bar-
tucks, installin<i- equipment, etc.
On December 1-2, 11)18, Field IIos])it:il Xo. 42. reported with (om-
plcte personnel and e(iuii)ment of a iicld hospital and was attached
Imi- duty.
The first patients were admitted Dei ember 23. 1918. but at no time
w as the hospital utilized to any extent, due to the fact that very few
t loops remained in ihe area. The maximum numl)er of ))atients at
;iiiy one time was 21.
As the hospital was needed in the area, the patients remaining
March 25. 1919. were evacuated to Camp Hospital No. 50 at Tonnerre,
and the hospital records closed on March 31, 1919. The ]n-oi)erty
was turned into supply depots and the remaining personnel re-
assigned or ordered to the United States.
HI. CAMP HOSPITAL NO. 6.s.
Camp Hosi)ital No. 08 is situated in a portion of the College de
.It'imes Filles. No. 10 Rue Littre. Bourges. Department of Cher. The
portion u.sed by the Americans is located at the rear of the court —
3 .-tory stone building, with roomy basement and a spacious, well-
ventilated attic. In this building is located the hospital proper.
The basement contains a large kitchen, and a still larger room
which is used as a mess hall for tlie enlisted personnel and convales-
cent })atients who are able to walk to and from their meals. The
ground floor is divided into four rooms, which are used as supply
i-ooms. receiving room, pharmacy, operating room, and a surgical
ward of 28 beds. The second floor is divided as follows: One me-
dium-sized roouL which serves as a Laboratory and X-ray room;
one large room, which has previously been divided into cubical
sections with 21 beds; and a smaller room not divided containing nine
beds. From this room a hallway extends the balance of the length
of the building, and leads to three smaller rooms, each accommo-
dating four beds. These rooms are used for female patients and
commissioned officers, for cases of seriouslv ill American and Eng-
lish (which included the W. A. A. C, the Red Cross, and the Y. M.
C. A., and others) in this district. Along the entire front of this
floor runs a comfortable balcony, where patients may be taken on
sunny days for an airing
Tliis hospital was established with a one thought ever foremost,
i. e.. not to make it the largest in the American Expeditionaiy
Forces, but to nuike it the best. To have the lowest death rate and
the least suffering was the constant aim of every man and woman.
The building was formallv turned over to the Americans on Octo-
ber 1.
On December 1 the hospital was averaging about 150 patients, and
every increase in bed capacity only met the demands. The necessity
for increased room made it necessary to procure and erect five' tents in
the courtyard, In'inging the total number of beds to 180.
Tt was evident that our hospital was entirely too snuill. Many
atemi)ts were made to have the French authorities give up the re-
maining part of the building which we were in. but to no avail.
Negotiations were opened with the French authorities, and tliey
;agreed to evacuate their buildings. At this time there was quite an
2128 REPORT OF THE SURGEON GENERAL OF THE ARMY.
epidemic of influenza. AVe were taxed to our capacity, all surgica
work was abandoned, the surgical ward, and every other availabh
ward convert<Hl into influenza wards, but still thej- came.
On February 10. the new buildino; on Court Jacquin was openec
with 100 beds, with a capacity of 150 if necessary. The eye, ear, nose
antl throat clinic was removed to this annex, and the convalesceni
patients (three throat and four influenza patients) were transferrec
here.
The new hospital building, which is officially termed the "Annea
to Camp Hospital Xo. 68,'' is located at No. 5 Impasse Des Jacobin
off the Kue Moyne and opposite the Xouvelle Postes. It is a three^
story building, surrounded by three 1-story buildings, with a largi
courtyard in the center. A long 1-story building at the south enc
of the court is divided into 6 wards with 10 beds to the ward. On
the second floor there are two large wards accommodating 12 an(
16 beds, respectively; a long inclosed hallway with a capacity of 1(
beds: eight small rooms with 3 and 4 beds to the room. With thes(
additional buildings. Camp Ho-pital Xo. 68 can now accommodat
350 ])atients and possibl}' 400 in an emergency.
SI. CAMP HOSPITAL NO. C!).
Camji Hospital Xo. 60. while located in the Province of Charente-
Inferieure. was in what was known as the Saintes Pons area, having
the 87th Division, and not under our jurisdiction. Had a bed ca-
pacity of 175 beds. Operated about two months only. Surgical
ca.ses were sent to Camp Hospital Xo. 39. La Eochelle.
Tl. CAMP HOSPITAL NO. 7 0.
On December 12. 1918, the following personnel reported to the-
connnanding officer Camp Hosi:)ital Xo. 70 for duty, per paragraph
50, Special Orders 340. Headquarters First Depot Division, Ameri-
can Expeditionary Forces, dated December 9, 1918.
On January 18, 1919, in compliance with orders (telephonic) from,
the chief surgeon intermediate section, preparations for the evacua-
tion of the hospital were begun. In accordance with the above order,,
all class C and D men were evacuated to Base Hospital Xo. 63 on
January 21. 1919. On January 25, 1919, the remaining patients were'
evacuated to Canqj Hospital Xo. 59. On January 22, 1919, the six
nurses, who had up until this time been attached for duty to Camp
Hospital Xo. 70, proceeded to Base Hospital Xo. 63, per orders chief
surgeon intermediate section.
On Februaiy 8, 1919, all post medical •and camp hospital property
shipped to intermediate medical supply, depot, Giovres, per tele-
graphic instructions from chief surgeon, intermediate section. On
February 8. 1919. Camp Hospital Xo. 70 Avas officially closed, per
telegraphic instruction chief surgeon intermediate section, dated
February 7. 1919.
Ul. CAMP HOSPITAL NO. 7 2.
The history of Camp Hospital Xo. 72, located at Chateau du Loir
(Sarthe), France, is one of steady growth in ecjuipment, personnel,,
and importance. From a personnel of 1 officer and 5 enlisted meit
A. K. F. CAMP HOSPITALS. 2129
and practically no equipment it has grown to a well-equipped camp
hospital of 300 heds and a personnel of 15 officers, 11 nurses, and 88
enlisted men.
On Septeml'er 8, 1918. the first Medical Corps officer "arrived at
Camp Clayton, the quartermaster depot at Chateau du Loir, for the
purpose oiF starting a hospital; three days later came one sergeant
and four }n-ivates. lentil September 28 these men. the nucleus of
the present hospital, were stationed in the College Ancien of Chateau
du Loir with the 323d Supph' Company, Quartermaster Corps. Dur-
this period several minor cases were treated, such as measles, influ-
enza, and bronchitis. It was necessary' September 28 to move the
hospital fatalities nearer the quartermaster barracks of the new
camp in the Hotel de la Gar, where the hospital work was continued
in four rooms of the hotel.
With the growth of the Quartermaster Corps camp the number of
patients had gradually increased until it was necessary to move into
one of the Quartermaster Corps barracks. The treatment of the
patients was exceedingly difficult at this time, due to the lack of
proper food, supplies, and medications. The only medicines avail-
able were aspirin, urotropin, Devers powders, and oleum recini. The
first operation was performed October 6, 1918.
While the hospital was maintained in the Quartermaster Corps
camp 64 cases were treated, as follows: Influenza, 51 ; influenza com-
plicated with pneumonia, 5 : mumps. 3 ; and all others. 5. Of these,
23 were discharged to duty during the same period.
October 11 hospital was moved to the Ecole Primarie Suprieure de
Garcens, where it is located at the present. This modern three-story
building of 26 rooms is well adapted for use as a hospital. It is
located a short distance from the center of Chateau du Loir. Prepa-
rations were made immediately for a hospital of 300 beds.
The first death occurred at the hospital October 15. From October
15, 1918, to January 1, 1919, three more deaths occurred. During
this time approximately 400 patients were treated in the hospital, as
follows: Pneumonia, 11; influenza complicated with pneumonia, 22;
influenza, 162; measles, 10; mumps, 34; venereal, 12, surgical post
operatives, 18; all othei's, 131. In December the number of patients
increased to 150, rendering the work difficult because of the limited
personnel.
Until January 27 Camp Hospital Xo. 72 functioned under the
chief surgeon, intermediate section. Services of Supply, but on that
date it was transferred to the American embarkation center, Le
Mans (Sarthe), to receive patients from the organizations passing
through this area.
VI. CAMP HOSPITAL >;0. 7 6.
Camp Hospital No. 76 began its career as a small regimental in-
firmary about Mai'ch 1, 1918. It opened simultaneously with the
coming to Mehun of the 501st Engineers, and consisted at the tiine
of one Adrian barrack. With the coming to the camp of ordnance
troops and the erection of the large ordnance repair shops here in
August and September the need for better facilities for the care of
the sick became apparent. Up to this time there was no hospitaliza-
2130 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
tion of patients at Mehuii. and all hospital cases were transferred
to Base Hospital Xo. 9 at Cliateauroiix. The influenza epidemic of
September and October emphasized greatly the need of a camp hos-
pital, for during this epidemic it had been necessary to utilize the
Y. M. C. A. building as a temporary hospital. During this epidemic
475 cases of influenza were treated and 75 of these resulted in a fatal
pneumonia as a complication. In the short space of one month the
hospital had grown from one small infirmary to a mcKlerately large
hospital communit}" capable of easily accommodating 150 patients,
and with the use of tents, which were erected from time to time in the
rear of the hospital, could expand to a capacity of 300 beds.
Iron frames for cubicles were placed at all beds, and all beds were
numbered. Shelves were placed for sputum cups, and bedside tables
were built and placed wherever necessary. The operating room was
located directly behind the surgical ward and Avas well equipped and
well lighted. It was ver}^ efficiently managed by a male surgical
nurse, who served many years as an orderly at the Boston City Hos-
pital. As the hospital increased in size it gradually developed into
the medical center of this entire area, and the medical administration
of same was directed from this hospital. It administered medically
to approximately 7.000 troops located not only at this camp but also
at Yierzon, Le Chapelle, Mehun, and Foecy. The hospital at present
consists of 11 buildings.
During the regime of the hospital it has rendered valuable assist-
ance to the French civilian population, and several serious accidents
to inhabitants of this community have been treated at this hospital.
Wl. CAMP HOSPITAL XO. 7 8.
Camp Hospital No. 54, established at Chateau La Roche, Dordogne,
for caring for the sick and injured of the 84th Division. Hospital
designation changed to Camp Hospital No. 78 per letter chief sur-
geon, American Expeditionarj' Forces, October 5, 1918. First pa-
tients received September 15, 1918.
Owing to the increased number of patients being received, six ward
tents, capacit}' of about 20 cots each, were set up on the chateau
grounds to be used as convalescent wards. Capacity of chateau, 140
beds.
Several severe cases of influenza developed among the personnel of
the hospital. Four of these cases developed pneumonia.
' Total number of patients admitted and treated for this period, 756 :
Influenza, 360: pneumonia, 49: measles, 137; mumps. 21; cerebro-
spinal meningitis, 2; bronchitis, 78; diarrhea, 2; dysentery, 4; syph-
ilis, 1; all other diseases, 98; injuries, 5; remaining in hospital at
midnight October 31, 1918, 167 patients. Highest total of patients
received in hospital for one day, October 10, 1918, 37.
XI. CAMP HOSPITAL XO. 82.
Camp Hospital No. 82, Base Section No. 4, Services of Supply,
American Expeditionary Forces, Le Havre, France, occupies a large
building composed of three wings, inclosing a large court or garden.
The main wing is four stories high and faces the sea, and two
lateral wings are three stories high.
A. E. F. CAMP HOSPITALS. 2131
In peace times this building was used as a first-class hotel, but at
the beginning of the war, in 1914. it was requisitioned b}' the French
Government for use as a hospital, and was occupied by them until
October, 1918, when it was taken over bj- the United States Govern-
jnent.
The first floor of the main building is elegant in construction.
The floors are of small tile inlaid with mosaics. The large con'idors
and spacious rooms on this floor have most exquisite lighting effect —
jlarge chandeliers of crystals and beautiful crystal ceiling lamps.
The walls are inset with immense French plate mirrors.
The capacity of the hospital is 400 beds, with an emergency expan-
sion of 50 additional, and also includes quarters for the enlisted per-
sonnel and nurses. Original j^lans contemplated the construction of
barracks for the enlisted personnel and Red Cross hut for entertain-
ment and recreation, but owing to the early armistice all construc-
tion work was discontinued; hence it became necessary to use one
floor of one wing for quarters for the enlisted personnel.
After a careful inspection we felt that we had a monumental task
before us. The building was insanitary and reeking with filth, the
accumulation of four years, but we could see splendid possibilities.
It is quite interesting to note that of 96 of the enlisted men who
were assigned, 90 of them had an intelligence rating of C and below.
A great majority of them had been coal miners, teamsters, and farm-
ers, and had had no hospital training whatever, and few of them had
liccn in the service over two months. However, after two weeks of
long hours and very hard work we reported, on November 14. " Open
and ready to receive patients." About this time there was an epi-
demic of influenza, and the hospital was quite rapidly filled.
Influenza has been the most prevalent disease, and quite frequently
'omplicated with pneumonia. Of the 321 cases of influenza ad-
mitted, 32 cases developed pneumonia, from which 8 died, or a rate
of 25 per cent. The death rate from all pneumonia was 25.5 per
cent.
The cubicle system was used in all contagious and infectious wards,
and all nurses and attendants in these wards were required to wear
masks. Convalescents who leave these wards were also required to
wear masks. Dishes and utensils were boiled and kept separate and
apart from others. Lyster bags with water treated with calcium
liypochlorate were used throughout the hospital.
In January. 1919, there was a notable decrease in the number of
influenza cases admitted : the form was milder and fewer complica-
tions resulted. In the severe cases prostration was very profound-
headache, cough, pain in the back, and a burning sensation in the
eyes. Throat cultures and blood examinations were made in all
severe cases, with the following average result : Throat cultures
showed the presence of micrococcus catarrhalis and staphylococcus
purogenes aurius. In a few cases streptococcus and pneumococcus
were found. The Pfeiffer bacillus was not found in any case.
The routine treatment adopted is as follows: During the first 24
hours calomel, followed by magnesium sulphate, is given at once;
aspirin, 648 mgm. every 3 hours: and water from 2 to 3 quarts daily.
Nose and throat sprayed three times daily with argyrol solution, 15
per cent, and 5 per cent solution of the same dropped in the eyes three
142367— 19— VOL 2 73
2132 REPORT OF THE SURGEON GENERAL OF THE ARMY.
times daily. Liquid diet. During the second 24 hours the dosage
of aspirin is dropped to 324 mgm. every 3 hours. During the third
24 hours the aspirin is discontinued and diet increased to li^ht. In-
hahitions are given three times daily. For giving the inhalations
the inhaler recommended in Bulletin of Disease No. 24, Office of the
Chief Surgeon. American Expeditionary Forces, September 23. 1918.
The prescription used in the inhaler contains menthol, thymol, en-
colyptol, camphor, and tincture benzoin camphor. As soon as the
temperature becomes normal forced feeding is advised, giving small
quantities frequently. The inhalation and sprays are continued until
the case is discharged. For observation it is believed that parox-
ysm of coughing is caused by a large congested uvulu. This condi-
tion is controlled b}' swabbing with equal parts of tincture ferric
chloride and glycerine. .
April 12, 1919, the telegraphic instructions were received to clost
Camp Hospital Xo. 82 by the 30th of April, and steps were imme-;
diately taken to dissolve this institution.
The building occupied by Camp Hospital No. 82 was thoroughly
cleansed and renovated, and on May 1 was inspected by base inspec-
tor. The same da}' this building was turned over to the rents, requi
sition, and claims. Havre, France.
Yl. CAMP HOSPITAL NO. 85.
In compliance with Circular No. 30, Office of the Chief Surgeon.
American Expeditionary- Forces, dated February' 27, 1919, the fol-
lowing historical report is herewith submitted for Camp Hospital
No. 85. district of Montoir:
Montoir district, covering an area of about 20 square miles, com-
prises Camps Dodge and Gron, with a capacity of 4,000 troops;
Camp Montoir, with a capacity of 20,000 ; the Reserve Embarkation
Camp, with 10,000 capacity; Camp Donge, with a capacity of 2,000;
Wilgast 3'ards and warehouse section, with a capacity of 1,000.
The present camp of Montoir is located on a slightly elevated
plateau overlooking the River Loire, midway between Savenay and
St. Nazaire. It was orginally built to accommodate 5,000 engineer
and quartermaster labor troops, who were working on the construe
tion of the extensive warehouse system.
The medical administration was centralized at Montoir and £
branch infirmary established in Wilgast yards, but the rapid influx
of troops necessitated the establishment of additional infirmaries
in the outlying district. At present writing there are in Montoir
area 12 infirmaries, 12 prophylactic stations, and 3 first-aid stations,
in addition to Camp Hospital No. 85, with a normal bed capacity
of 400 and an emergency capacity of 500 patients.
The predisposing factors to disease on this area were (1) climate,
(2) the fact that many unseasoned troops were rushed into this area
during the emergency at the front. (3) the type of work required
that the men be constantly exposed to the elements during working
hours, (4) 35 per cent of our troops were colored draftees from the
Southern States, who seemed to possess a lowered resistance to
disease.
From May until October, 1918, sick men were held in the infirmary
for three days only. All surgical cases were evacuated to Base Hos-
A. E. F. CAMP HOSPITALS. 2133
pital Xo. 101. All contagious and infectious diseases were evacuated
to Camp Hospital No. 11, Camp Xo. 1, St. Xazaire. All mental and
tuberculosis cases to Base Hospital Xo. 8, Savenay,
On October 8, 1918, the infirmary expanded overnight from 25 beds
to a 140-bed institution, to accommodate patients arriving at this post
on a convoy heavily laden with influenza.
November 8, 1918, authority was granted to erect a 400-bed camp
hospital about the infirmary unit already established, and on Decem-
ber 4, 1918, we were in a position to accommodate that number of
patients.
Camp Hospital Xo. 85 is constructed entirely of standard-size bar-
racks, floored and lined with lumber. There are 28 of this type of
barracks.
Total number of cases treated in hospital from August, 1918, to
February, 1919, 2.5-40; total number of deaths in hospital from
August, 1918. to February, 1919, 60.
Zl. CAMP HOSPITAL XO. 86.
The hospital contemplated by the chief surgeon to serve the
American troops in the District of Angers, Army Post Office 733, was
originally' designated as Camp Hospital Xo. 86 and located in an un-
occupied chateau, some 12 kilometers southeast of the city of Angers,
near the stations of Brain-sur-Anthion on the Paris & Orleans Rail-
The conclusion was reached that the site selected for the hospital
was unsatisfactory in numerous respects, and verbal authority secured
for the transfer of the organization to a centrally located site, which
had formerly been placed at the disposal of the American Army by
the French authorities for hospital use. This site was locally known
as the Ecole Xormale and consisted of a large building of masonry
construction and adequate surounding ground space, located in the
city of Angers. The transfer of the organization was effected and
the new site occupied Xovember 3, 1918.
Camp Hospital Xo. 86 never functioned as a hospital, no patients
having been received up to the time of its abandonment and the
transfer of the organization to the newly designated Camp Hospital
Xo. 96.
A2, CAMP HOSPITAL NO. 91.
Camp Hospital Xo. 91. in Base Section Xo. 1. was opened for the
reception of patients on October 26. 1918, and is located at La Baule.
Loire. Inferieure. France, a place admirably suited to this purpose.
La Baule is a seaside summer resort of the best type, situated at
the southwestern extremity of Brittany. It looks out upon a bowl-
shaped bay of beautiful contour, with long shallow sand beaches.
This bay faces south and is bounded on the eastern side of a low ly-
ing sandy point where rests the village of Pornichet, while the west-
ern side of the bowl is formed by a rockv promontory occupied by
the picturesque fishing village of Le Pouliguen.
The climate, except for a month or two of rain in Xovember and
December, is delightful. There is no snow, and ice rarely forms, even
at night. The water supply is adequate in quantity and of good
2134 KEPOKT OF THE SURGEON GENERAL, OF THE ARMY.
quality. The soil is sancl}^ and well drained, and the roads are ex-
cellent in construction, and kept in good repair.
There are no industries in La Baule, it being essentially a pleasure
and health resort, having a summer season from July to September.
During August and September. 1918, certain buildings were pro-
cured through the rental, requisition, and claim department, for use
as a convalescent hospital. In order of importance they are: The
Hotel Eoyal; a large modern hotel building of stone, situated near
the center of the esplanade. It has ample bathing facilities, running
water in all the rooms, a central heating plant, and a large dining
room and kitchen accommodations, for which reason all the officers
and nurses have messed there. This hotel w^as also used as a central
hospital unit. The capacity of this building as arranged for the
hospital is 357. Hotel De La Baule, the second in size and import-
ance is located at the eastern extremity of the esplanade. It is com-
posed of a main building, and annex is of brick construction, and
well plumbed, but has no central heating. The larger rooms, how-
ever, have fireplaces. Its capacity as arranged for the hospital is
164. Associated with it is an annex skating rink and garage. The
annex has been used to quarter the colored convalescents. Its ca-
pacity as arranged for the hospital is 94. Hotel Splendid is next in
size and is situated on the esplanade about halfway between the La
Baule and the Royal Hotels. It is a stone building, has good plumb-
ing, pleasant sun parlors, but no central heating plant. The capacity
as arranged for the hospital is 110. Manoir La Cotiere is the smallevSt
of the hotels comprising this hospital and is a stone building, well
plumbed, and has a furnace and several fireplaces, and has been used
for administration offices, and quarters for those officers actively as-
sociated with the conduct of the hospital. Two concrete garages were
also secured for use as storage rooms, which completes the total of
the buildings.
There have been no epidemic diseases, an occasional sporadic case
of influenza or mumps. The discipline has been good, very few
court-martials has been held and these for minor offences. The pres-
ent strength of the detachment is 1 hospital sergeant, 1 sergeant
(first class) , 8 sergeants, 7 corporals, 7 cooks, 12 privates (first class) .
89 privates, and 7 privates. Quartermaster Corps.
The convalescent patients admitted to this hospital have come from
base and camp hospitals in Base Section No. 1.
About January 1, 1919, it became necessary for the base surgeon's
office to send to Camp Hospital No. 91, for concentration and later
distribution, a large number of casual officers of the Medical Corps.
The hospital has further functioned as a rest and concentration camp
for nurses waiting transportation to the United States. The first de-
tachment arrived on January 2, 1919.
Camp Hospital No. 91, La Baule, France, has since January 2,
1919, functioned as a centralization point for the Army Nurse Corps,
under orders to return to the United States, and at times the full
capacity of the four hotels have been taxed by the many units report-
ing near the same time. The usual length of stay for the units at this
place was from 10 to 1.5 days, as it required much time to complete
the records and make arrangements for their journey overseas. The
larger number of nurses were sent to Brest for embarkation, but many
were sent through St. Nazaire and Bordeaux.
A. E. F. CAMP HOSPITALS. 2135
B2. CAMP HOSPITAL 'SO. 94.
In the fall of 1918 the 35th Engineers, who were then located in
the new station at La Rochelle. were contemplating the moving of
their car plant to Aytre. When the armistice was signed on November
11 they had practically completed four buildings. Three of these
buildings are now occupied by detachments of Engineers. The fourth
is knoAvn as Camp Hospital No. 94. This building is 50 feet long and
:^0 feet wide, two stories high. It is equipped with plumbing system.
One room of this hospital is set aside as an infirmary where from
25 to 50 men report each morning on " sick call." In the prophylaxis
station we are able to accommodate the needs of the men of the 35th
Engineers. Upon our arrival we were furnished with two Ford
ambulances, one of which was later transferred to Camp Aigrefuille.
December 21 we received our first patients, who were sent here from
the 338th Labor Battalion at La Ballice. From that time on to the
, present we have treated 204 bed patients, mumps, influenza carriers
of meningitis. All of the more serious cases requiring special atten-
tion are transferred to Camp Hospital No. 39 where they are equipped
to take care of special cases. At this date we have discharged prac-
tically all of our patients and are awaiting the arrival of 60 venereal
patients.
C2. CAMP HOSPITAL NO. 9 5.
Camp Hospital located at Verneuil, Province of Nievre, France,
' began functioning Septemper 5, 1918. At the beginning three of the
standard type barrack buildings Mere available for hospital use, two
of these buildings used for wards and one for administrative purposes,
i allowing a bed capacity of 80. The kitchen and quarters for corps
' men consisted of tents, no buildings being available. The facilities
, at first were very limited, and medical cases only were kept in hospital,
all surgical cases being transferred to hospital center at Mars, a dis-
tance of approximately 30 kilometers.
During the period from September 15, 1918, to November 1, 1918,
the capacity of the hospital was taxed by the epidemic of influenza
so prevalent throughout France at the time.
On January 2, 1919, the hospital was moved to the opposite side of
the camp nearer the road where seven barracks had been erected.
Three of these buildings were used for ward purposes, giving a bed
capacit}' of 108 beds for ordinary diseases, the remaining buildings
being used for kitchen and mess hall, quarters for men, administrative
purposes, etc.
With the added personnel and increased facilities which wore ob-
tained at this time the scope of the work was widened. Surgical cases,
except where Roentgen ray work was required, were taken care of,
and few cases transferred except those for evacuation to the United
States. Upon completion of new buildings, which are now under way,
the hospital will have a capacity of 200 beds, a laboratory, and com-
plete dental laboratory where practically any class of dental work
may bo done. Quarters for 20 nurses are at present under construction
and will be completed soon at which time nurses will take over the
care of the sick in hospitals.
2136 REPORT OF THE SURGEOX GENERAL OF THE AEMY.
D2. CAMP HOSPITAL NO. 96.
I
Camp Hospital Xo. 96 was created Xoveinber 4, 1918. in the Eeole
Normale, No. 7 Rue D'Acier, Angers, a three-story building of
masonry construction, well adapted without alteration to hospital
use and capable of accommodating from 250 to 300 beds. The site
included grounds approximately 100 yards square, well parked, and
surrounded by a stone wall. The hospital was established for the
purpose of serving directly the troops stationed in the district of
Angers, the latter functioning as a training area, chiefly for heavy
artillerj^ troops. The district, including the billeting area surround-
ing the city, contained approximately 20,000 troops.
With the cessation of hostilities through the signing of the armis-
tice, three days after the admission of the first patient to hospital,
the necessity for such a function ceased to exist. The hospital was
therefore closed January 12, 1919, after approximately 10 weeks of
operation.
In the city of Angers was also located Base Hospital No. 27, includ-
ing its annex and convalescent camp, and constituting the hospital
center of Angers. The latter was provided with ample surgical facili-
ties. Because of this fact it was not deemed necessary or advisable
to install surgical facilities at Camp Hospital No. 96. Its activities
were therefore confined to medical cases.
During the period of its operation the hospital cared for 457
medical cases. A large proportion of these were contagious in char-
acter, rather extensive epidemics of measles, mumps, and influenza
prevailing at that time in the Angers district.
E2. CAMP HOSPITAL NO. 9 7.
Camp Hospital No. 97, American Expeditionary Forces, St. Dizier,
France, located at Camp Moseley, was a development of the American
regulating station infirmary, which had been functioning for the
personnel of the regulating station quartered in the detachment camp
(Camp Moseley) since November 1, 1918.
The site, barracks, and personnel for the infirmary were supplied
by the regulating officer, as prescribed by G-i, General Headquarters,
and the work directed by an officer of the Medical Corps.
On November 1 one barrack was available. This provided an ad-
mission and waiting room for sick call, a dispensary and drug room,
examining room, office, storeroom, and officers' and sergeants' quar-
ters. On November 15 ward No. 2, with a capacity of 30 beds, was ready
to receive patients, and hospitalization was commenced for the first
time. Ward No. 1 was completed during the following week, making
a total of 56 beds, including 6 isolated beds for officers. The con-
struction of two more wards, Nos. 3 and 4, was begim, and on De-
cember 10 patients were admitted to ward No. 3. This increased the
available bed space to 86, with an additional 20 beds in ward No. 4
for contagious cases, making a total of 106 beds.
F2. CAMP HOSPITAL XO. 100.
The personnel of Evacuation Hospital No. 28 arrived at Belfort,
France, November 25, 1918, and proceeded to caserne, Rethenans de
Belfort, where Camp Hospital No. 100 was located, took over the in-
A. E. F. CAMP HOSPITALS. 2137
stitution, and immediately began functioning as United States Army
Camp Hospital No. 100. The physical property consisted of a group
of practically new buildings, constituting barracks and admmistra-
tive and officers' quarters, formerly used by a French artillery regi-
ment. It included 30 large buildings with a total capacity of 2,000
patients. The group coyered approximately 12 acres and was sur-
rounded by a high stonewall.
At the time of taking oyer the hospital, the roster showed 62 pa-
tients. The commanding officer inspected all French hospitals m the
area, and transferred to Camp Hospital 100 a number of American
patients left in these French institutions by their organizations when
leaying this section.
The seriously ill patients were eyacuated to the base hospital cen-
ter at Dijon by rail in hospital cars. As this hospital was the only
American Expeditionary Force organization in this area, casuals
moying through were furnished with food and shelter, and an ayer-
age of 20 casuals were cared for daily.
This hospital receiyed and cared for ex-prisoners of war, both
American and British, picking them up at the rail end and transport-
ing them in the 15 trucks and ambulances attached to the hospital.
Here they were bathed, fed. deloused. and furnished with all needed
clothing. As the only clothing ayailable was the United States Army
regulation uniform, it was necessary to equip the British with Ameri-
can uniforms to replace their worn-out garments. These men were
all examined and all needing medical treatment receiyed it. They
were then eyacuated to Channel ports by train under the direction of
a British lieutenant attached to the hospital for this purpose. As a
rule these men were in fairly good physical condition except the
group receiyed from Freibourg, who were poorly nourished and in
poor condition.
The records show that 955 medical patients were treated, approxi-
mately half being influenza convalescents, with nearly 100 pneumo-
nias, both lobar and broncho. There were a number of mumps and
^arlet-feyer cases.
The surgical service at Rethenans was very light; there were no
iiajor operations performed. Such surgical cases as we had had
already received surgical attention and were given proper attention
and nursing with a view to evacuate to a base as soon as possible,
strict attention being given to proper splinting and dressings. There
ucre ()57 patients admitted: of these 136 were American ex-prisoners
and battle casualties, the latter being gathered in from French hos-
pitals in the area. There were 521 British ex-prisoners — almost all
of which were medical cases.
It was noticed that most of the British ex-prisoners were pot-bel-
lied and presented a general lack of muscle tone. A proportion of
them suffered with chronic-leg ulcers which readily cleared up under
proper surgical treatment and wholesome diet. The facilities with
which these cases cleared up with proper diet led us to believe that
the condition was due rather to dietic than mechanical causes.
On January 2 the hospital ceased functioning, all patients having
been transferred, the property Avas turned over to the French au-
thorities, and the hospital personnel proceeded with all United States
Army property by rail and motor transport to Nantes for duty.
LI.
I
2138 REPORT OF THE SURGEON GENERAL, OF THE ARMY.
G2. CAMP HOSPITAL NO. 10 2.
On December 18, 1918, Camp Hospital No. 102 was established i
Chateau Virelade, an unoccupied chateau, Avhich had been vacan
about 20 years, situated about one-half mile from the village o
A^irelade, in the Department of Gironde, and about 1 mile from the
Garronne River, and 25 miles southeast of Bordeaux, on the Rue
Nationale. The chateau is located in a park comprising 75 acres of
open and wooded, well-kept grounds, and is traversed by a small,
stream.
The main chateau consists of some 23 rooms; 17 are available fo
hospital purposes. The servants' quarters, adjoining the main build
ing, has 20 rooms, 11 of which can be used for hospital purposes.
There are 3 large, connected stables used for wards, and 2 large lofts
which are used for billeting personnel and convalescents, and also 3
smaller rooms used for storerooms, bathhouse, and electric-lighting
plant.
At the time of establishment, December 18, 34 convalescent patients
were admitted, the sick left by the 34th Division. At present there
are 144 patients being treated. These patients came from the 40th
Division mainly and four regiments of Coast Artillery Corps who are
billeted in the La Brede billeting area.
The La Brede area extends approximately parallel with the
Garonne River, and is about 17 miles long by 4 wide. At present
the area is billeting nearly 14,000 soldiers, and this hospital is
handling all sick and injured originating in this area.
Camp Hospital No. 102, Virelade, Gironde, started the month of
February with 139 patients remaining from the previous month.
During the month 208 patients were admitted for treatment and 214
returned to duty with their organizations, 24 patients were trans-
ferred to other hospitals, 23 of which were transferred to Base Hos-
pital No. 208 at Talence (Gironde). Two deaths occurred in the
hospital during the month.
The month of March opened with 112 patients in the hospital, the
majority of which Mere from the 82d Division. The average num-
ber of patients in the hospital for the month was 102 ; the total number
of admittances for the month was 186 ; the total number of discharges
to duty was 175 ; the total number of transfers to other hospitals was
28, all of the latter to Base Hospital No. 208, Talence (Gironde).
Four deaths occurred during the month.
Camp Hospital No. 102 started the month of April, 1919, with 84
patients in hospital. During the month 231 patients were admitted
to the hospital, 198 patients were discharged to duty, and 80 patients
were transferred to other hospitals ; all of the latter to Base Hospital
No. 208, Talence (Gironde). The total treated during the month
being 315.
The end of the month finds the La Brede billeting area practically
deserted, a total of 104 officers and 1,787 enlisted men, but as the
advance part of the 78th (Lightning) Division has already arrived,
it is expected that the 2d of May will find the area again fully
occupied.
H2. CAMP HOSPITAL NO. 103.
Camp Hospital No. 103, United States embarkation camp, Pauil-
lac (Gironde), American Expeditionary Forces, France.
A. E. F. CAMP HOSPITALS. 2139
On January 14, 1919, the Navy sick bay was taken over for Army
patients. The sick bay consisted of three barrack-type buildings,
two of which were connected. In the latter were the offices, phar-
macy, venereal treatment and prophylaxis room, surgical dressing
room, eye, ear, nose, and throat room, and one 20-bed ward. The
separate building was used as a ward only. An adjoining building
used as a barracks by the Navy was temporarily used as a storeroom
later to be fitted up as a ward.
At the same time five stone buildings of the Lazaret Marie Therese.
a French quarantine station, were being put into shape. The build-
ings were old but in good condition. Tlu*ee of them were fitted up
as four ward pavilions with capacity of 19 patients each. One of the
smaller ones was used as a surgical pavilion, having an operating
room and a 12-bed ward.
The medical service was concerned in the treatment of the acute
respiratory diseases for the most part. Influenza was just begin-
ning to appear in the first troops that came in. Separate wards were
used for each of the following classes: Acute throat (except diph-
theria) : meningitis; pharyngitis: bronchitis, acute; influenza;
mumps and other medical cases. One case of scarlet fever was
isolated. All medical wards were cubicled.
No new cases of meningitis developed in any of the organizations
from which the five cases were found. All contacts were quaran-
tined and inspected daily. No deaths occurred among the five cases
in hospital.
Influenza began a steady increase from February 1. and kept up
until the last of the month, where it began to remain steady and
showed a tendency to decrease. The camp Young Men's Christian
Association and theater were closed. All colds were regarded as
cases needing medical care, and all cases of pharyngitis and bron-
chitis were admitted to hospital to prevent their being in quarters.
There were 28 cases of mumps during the month. Contacts were
isolated in working quarantine and inspected daily.
12. CAMP HOSPITAL NO. 104,
Pursuant to Special Order, No. 29, paragraph So, Headquarters,
Base Section No. 2, Service of Supply, American Expeditionary
Forces, January 29, 1919, an officer proceeded, February 5, 1919, to
Chateau Terrain to establish a camp hospital at that chateau to care
for the sick in the Libourne (Gironde) billeting area on the abandon-
ment of Base Hospital No. 71. Monpont (Dordogne).
The next few days were spent in studying the building and gi"Ounds
with the view of determining the most practical methods of organiz-
ing tlie hospital ; also to cleaning the building, making requisitions
for supplies and rations, getting stoves set up and fuel delivered, and
the great amount of preliminary work necessary for the establish-
ment of a camp hospital in a chateau.
Chateau Terrain was a partially occupied chateau situated about
1 kilometer north of the village of Lussac (Gironde). Because of its
central location in relation to the Libourne area and to its situation
on the crest of a gentle slope and to its general floor plan and posi-
tion of outbuildings made a very desirable location for a camp hos-
pital.
2140 REPORT OF THE SURGEON GENERAL OF THE ARMY.
4
The chateau i:»roper faces south and contains 30 rooms, two inside
flush-type toilets with drains leading into cesspools; a large tank on
the third floor, with plumbing in fair state of usefulness, furnishes
the chateau with water. The chateau is entered through a glass^
inclosed pergola into a large wide hall extending through the widf
ot the building which opens by double doors into a courtyard in th
rear. To the right as one enters, opening into the hall, is the origin^
dining hall which was made into ward 1 (eight beds), an influen:^
ward. Directly opposite and to the left was a large light and air"
room Avhich was made into ward 2 (eiirht beds), a pneumonia ward-
openmg into this Avard and also into a short hall is a smaller ward
(seven beds), also light and airy, which is used for other respiratory
diseases.
Ascending the spiral staircase the second floor is reached approxi
mately m the center of the building.
Directly opposite the landing of the staircase on the second floor is
a large room used as a general medical ward, 5 (10 beds) . To the right
.of the staircase two connecting rooms are reached through glass
doors; the front one, ward 6 (7 beds), is a surgical ward, and a back
one, ward 7 (7 beds), is a general medical ward. Opening from ward
7 is a small room suitable for three or four beds which is used as an
omcers ward.
Continuing up tlie spiral staircase the third floor is reached; this
IS unfinished, but one large room has been converted into ward 10 (18
beds) iind used at present for mumps. Other space might be con-
verted into wards under emergency, but has not been necessary up to
date. ■
At the west end of the chateau, across a small driveway leading
to the stables directly in the rear, is a large room with full o-lass
front. Avhich was converted by putting in a floor, tables, and a stove
into a patient's lounging room and mess hall. This room faces south
and makes an admirable recreation room which, besides, can be con-
verted into a large ward should it be necessary.
Four large hospital ward tents are placed in the courtyard conven-
ient to chateau proper, kitchen, and latrines. These have o-ood
wooden floors and, as sides are not boarded, can be raised when
weather permits. Each tent is provided with stove and makes in
all very pleasant and comfortable wards.
The total normal capacity of the hospital is 200 beds. At present
there are set up in use or ready for use 80 beds in the chateau proper
This can be increased in emergency to 110. Beds in two tents are set
up and ready for use and every bed is cubicled.
The hospital draws patients from surrounding area of about 16
miles square, and the area billets over 15,000 troops.
On March 1, 1919, 20 patients had been received and at present
writing 41 patients receiving treatment, with admissions averaging
from 3 to 6 daily and discharges averaging 3 daily. Character
of cases are those acute cases generally received in camp hospi-
tals in billeting areas, such as acute bronchitis, influenza, pneumonia,
mumps meningitis, and other general medical conditions, and acute
surgical conditions, such as fractures, sprains, abscesses, acute appen-
dicitis, etc.
All ward attendants in contagious wards wear masks, and all at-
tendants wear slippers while on duty.
A. E. F. CAMP HOSPITALS. 2141
On April 28, 1919, verbal orders were received from the office of
Dase surgeon, Headquarters Base Section No. 2, Services of Supply,
A^merican Expeditionar}^ Forces, France (later confirmed by para-
graph 47, Special Order No. 120, Headquarters Base Section ^o. 2,
A.pr. 30, 1919), to evacuate this hospital as soon as possible and pre-
pare to abandon same. All patients except one of cerebrospinal
meningitis were immediately transferred to Base Hospital ^o. 208,
Bordeaux.
J 2. CAMP HOSPITAL. NO. 105.
Headquarters Camp Hospital No. 105, Salle Boeuf, Gironde, Army
Post Office 705, March 8, 1919. . o ni t> i.
January 29, 1919: Arrived at Chateau St. Kegis, Salle Boeut
(Gironde), as per Special Order No. 24, paragraph 55, Headquarters
Base Section No. 2, Services of Supply, dated January 24, 1919, and
found chateau occupied bv Headquarters 336th Field Artillery.
This hospital is to be constructed on the grounds of and in the
chateau, and to be conducted as a camp hospital to supply the needed
medical and surgical attention for troops invalided during their so-
journ in this area, while awaiting orders of embarkation.
February 11 : Hospital formally opened for receiving and caring
for patients. Continued construction of wards.
February 15 : Received surgical equipment and completed arrange-
ment of operating room.
March 28: Reduced number of beds in each ward tent from 20 to
15. Installed X-ray apparatus in pyramidal tent midway between
chateau and first tent ward.
April 28 : Received orders to evacuate and close this hospital im-
mediately, per authority General Order No. 33, paragraph 1, Head-
quarters Base Section No. 2, Services of Supply, April 28, 1919, as
this billeting area is not to be used as a billeting area any longer.
April 29: Began the evacuation of patients and tearing down
ward tents and the assembling of equipment in preparation for clos-
ing. All patients who were not ready to be sent to duty were trans-
ferred to Base Hospital No. 208. Bordeaux.
K2. CAMP HOSPITAL NO. lOG.
Camp Hospital No. 106, Base Section No. 2, Services of Supply,
Army Post Office, No. 705, March 1, 1919.
Hospital established February 4, 1919, per order chief surgeon,
Headquarters Base Section No. 2, Services of Supply, at Blaye,
Gironde No. 35, Cours de Republic.
L2. CAMP HOSPITAL NO. 111.
Camp Hospital No. Ill came into existence on the 1st day of
March, 1919, when the personnel of Field Hospital No. 123, 106th
Sanitary Train, 31st Division, moved from Laval, Mayenne, France,
to Solesmes, Sarthe,"to take over bed space for 200 patients in French
Temporaire Hospital No. 38 at that place. At this time the French
were caring for all American patients.
2142 REPORT OF THE SURGEON GENERAL OF THE ARMY.
i
'V^^len the personnel of Field Hospital Xo. 123, arrived they
found that the American patients were scattered all over the hospi-
tal, many of them suffering from Spanish influenza and pneumonia
and no effort was being made to segregate the various classes of
maladies. For example on the day tliat the change occurred therc^
were 221 American soldiers sick in the hospital of which numbei^
148 had influenza and 14 pneumonia, with the bronchial type pre-
dominating. Of these 14, 9 were being reported as seriously ill and
of these 9, 7 died shortly after the change took place. Indeed, 4
died on the very first day of the new administration.
Immediately after the new personnel '' took over ■' all patients
were grouped, and the respiratory cases were separated from all
others. All pneumonias were carried to the " Salle Juigne " which
was on the top of the building and formed an ideal pneumonia
ward as it w^is extremely well ventilated, lighted, and heated by
radiation. All respiratory cases were then screened and the cubical
system installed. Following these changes very few pneumonias
died. A total of 46 pneumonias were treated during the months of
March and April with 13 deaths. Seven of these deaths were of
soldiers who were practically moribund when the American occupa-
tion began.
On March 23, 1919, Field Hospital No. 123 was skeletonized, along
with other units of the 106th Sanitary Train and the personnel of
Ambulance Company No. 123 and Field Hospital No. 123 were com-
bined into the personnel of Camp Hospital No. 111.
After the 77th Division left the area the hospital had little to do
as very few troops were left to draw from. Consequently from April
15 to the date of closing, May 15, there were practically no patients.
On May 15 the few remaining patients were evacuated to Camp
Hospital No. 52 at Le Mans and the hospital officially closecl.
X. REPORT OF ORGANIZATION AND OPERATION OF THE INSTRTTC
TION AND ASSEMBLY PARK FOR MOBILE UNITS.
During the latter part of August, 1918, an officer was instructed
by the chief surgeon's office to find a suitable location for assembling
mobile hospitals, the place to be suitable for assembling equipment,
mobilizing, and giving preliminary training to the personnel, and to
haA'e sufficient space for setting up two or more mobile hospitals at
one time.
Previous to this Mobile Hospitals 1, 2, and 3 had been equipped in
the polo field near Paris. This was accomplished by the personnel
being ordered to Paris, and the equipment obtained by the command-
ing officer as it became available from the French, and from our
quartermaster and medical supply divisions. At that time Mobile
Hospital No. 4 was being equipped at the polo field, and the per-
sonnel of No. 5 was there awaiting their equipment.
An ideal place was found at the Pare de Princess, Port St. Cloude,
just outside the city wall of Paris, 5 miles from Fort De Vavnes,
and three-quarters of a mile from the Gare Grinelle freight yards.
It had barracks and kitchen facilities for a personnel of 400, auto-
mobile sheds covering approximately 48,000 square feet, storehouses,
with 25,000 square feet of floor space.
^^ E. F. DIVISIONAL, TEAINING AEEAS. 2143
All the available time was concentrated in familiarizing the per-
,onnel with the technical equipment of a mobile hospital, where it
liffered from that of a base hospital. This turned out to have been
I very serious mistake, and one that was not realized until ]ust before
■he armistice was signed. It has since been learned that the ma]ority
3f these organizations could erect their hospitals, operate the laun-
iries, sterilizing apparatus, and X-ray equipment, but were prac-
:ically helpless when it came to administering a hospital, obtaining
supplies, or having their organization function as an organization.
The question of standardizing the equipment of mobile hospitals
was one of the difficult problems. Before attempting to standardize
Ihe equipment the mobile hospitals that were in operation at the front
were visited and the opinion of commanding officers who had had the
most active experience obtained as to what articles of equipment
could be dispensed with and as to what additional articles they re-
quired. After obtaining this information a list was made up and
this standard list of equipments was given to Mobile Hospitals No.
10, and those that followed it. This equipment could be moved with
20' three-ton trucks, not including the personnel, as compared with
anywhere from 35 to 60 trucks required by the previous organiza-
tion. .
The equipment of Mobile Operating Unit No. 1 was received trom
the United States during. October and this equipment was overhauled
at the park, the intention being to send the equipment when com-
pleted to the Medical Department concentration area. Joinville
(Haute-Mame) where the personnel was to be mobilized. Two of
the five sections of this unit were ready for transfer on November
10 and the other three the following week, but owing to the signing
of the armistice this transfer was not made.
In December instructions were received that mobile hospitals that
were to be demobilized would be demobilized at Joinville and the
equipment turned in to the supply officer at the instruction and
assembly park. These instructions' have been carried out with the
following organizations: Mobile Hospital Nos. 1, 2, 4. 5, 6, and 8.
In most instances the equipment of the above organizations was
found to be in very poor condition. This was especially true of the
tentage and bedding. However, this equipment is being placed in as
good condition as possible, and then stored at the park awaiting in-
structions as to its future disposition.
XI. DIVISIONAL TRAINING AREAS.
The plan of establishing training areas for American troops was
formulated soon after the entrance of the United States into the war.
A similar system had l)een in operation in the British service, although
in that service the training areas were in reality reserve areas, which,
in the event of great activity, particularly of an advance of several
miles by the enemy, such training areas might, and occasionally did,
become active sectors.
Each divisional training area was leased from the French Govern-
ment, and included a sufficient number of towns to accommodate a full
combat division. The troops were billeted in houses, bams, and out-
buildings, and in barracks erected for this purpose.
214-4 REPORT OF THE SURGEON GENERAL OF THE ARMY.
For administrative piuposes a zone major and three or four as'
sistant zone majors were assigned to each training area. These officers
represented the rents, requisitions, and claims department of the
American Expeditionary Forces, and were under the direction of the
chief billeting officer of the advance section, Services of Supply. In
each town occupied by American troops a town major was appointed
by the commanding officer of the unit, who supervised the distribution
of troops and arranged the settlement of all claims for damages.
The billeting of troops in the towns was arranged for on a basis
of 1 linear foot per man in standard Adrian barracks, and 2 square
meters for each bunk in billets. Every eti'ort was made to increase
the average floor space per man to 40 square feet, allowing 20 per cent
of the billeting accommodation for each town to be reserved for
refugees, extra crops, etc.
In each diA'isional area a railhead was established, usually in the
central part of the area and readily accessible bv road from the most
distant billeting town. A camp hospital of 300 beds, fully equipped
with surgical and medical supplies, was erected near the railhead.
This hospital received patients from all units within the area, and
either kept them under treatment until recovery was complete or
evacuated the most serious cases to the nearest basehospital for special
treatment. The advantage of this system was that minor cases, i. e.,
those Avhose recovery might be expected within a week or two, could
receive proper hospital treatment and be returned to their organiza-
tions promptly. Another advantage was that it obviated the necessity
of establishing field hospitals in the area except for uncomplicated
venereals, scabies, and mumps.
To assist the town majors, and also to keep the zone major and as-
sistant zone majors informed regarding sanitary conditions in the
different towns, 1 sanitary squad of 26 enlisted men of the Medical
Department, and 1 Medical or Sanitary Corps officer was stationed in
each area. The commanding officers of squads so stationed acted as
area sanitary inspectors, supervising the work of the enlisted men,
and compiling all data which might be of value to division sanitary
inspectors and imit medical officers. The necessity for close check on
sanitary conditions left by units on vacating a town was obvious.
During the time that divisions actually occupied the area the sani-
tary squads were placed at the disposal of the division sanitary in-
spectors to assist them in placarding water points, investigating epi-
demics of communicable disease, supervising sanitary details in
towns, etc.
In spite of numerous discomforts and incoveniences attending the
billeting of troops in barns and outbuildings, the general health of
the troops was exceptionally good. Even during the severe epidemic
of influenza and pneumonia the mortality rate was much lower than
that of troops in cantonments in the United States. Every effort
was made to provide stoves for all billets during the winter months,
and one shower bath was authorized for each town in which the bil-
leting capacity was sufficient for 1,000 soldiers.
During the early months of the occupation of the areas by United
States troops there were few epidemics of communicable disease.
In the winter and spring of 1918. owing to the fact that the trans-
portation facilities from base ports were limited and the organiza- I
A. E. F. — DIVISIONAL TRAINING AREAS. 2145
ion of the supply service had not been completed, the troops suffered
ntensely from the cold, and a considerable number of cases of
pneumonia was reported. It was stated by one division surgeon that
t was not uncommon for a company commander to find half of his
command missing at reveille, and upon investigation to discover
he absentees burrowed deep into holes in haystacks to keep warm.
[n spite of these hardships, the general health of the troops was
very good.
By t> 3 early part of the summer of 1918 most of the Regiilar
A.rmy .md National Guard divisions had moved into the battle line,
md the training areas were rapidly filled with National Army divi-
sions. As the weather conditions were by this time greatly im-
proved, there were few epidemics.. In October, however, the 36th
Division suffered from a severe outbreak of influenza and pneu-
monia, which was traced very clearly to overfatigue in marching,
followed by prolonged exposure to cold and rain and overcrowding
in billets. This epidemic was brought under control as soon as spe-
cial sanitary measures were carried out.
Another severe epidemic of influenza broke out in colored troops
of the 322d Labor Battalion at Jonchery. A labor battalion at Viller
St. Marcelin, in the eleventh area, also suffered very heavily, but in
both instances the severity of the epidemics was found to bear a
direct relationship to insanitary conditions. One interesting fea-
ture of these epidemics of influenza was the fact that the disease
spread with great rapidity in a barrack. This seemed to demon-
strate the probability of it being primarily a dust-borne and direct-
contact infection.
The measures which proved of most value in the stamping out of
influenza epidemics were:
1. Avoidance of overcrowding, allowing 40 square feet per man
wherever possible.
2. Prevention of spray infection by separation of men by shelter
halves or other partitions between bunks.
3. Sterilizing of mess kits by provision of boiling water before
and after meals. The plunging of mess kits in boiling water before
meals tended to eliminate the danger of contamination of otherwise
clean mess kits by dust from an infected barrack.
4. Rigid enforcement of rules against spitting in and around the
doors of barracks.
5. Daily inspection of troops and segregation of respiratory cases
without fever and prompt hospitalization of all fever cases.
6. Avoidance of overfatigue, cold, and wet wherever possible.
7. Avoidance of congregation of troops in cafes during epidemics.
Soon after the signing of the armistice a number of typhoid-fever
cases were reported from combat organizations returning from the
battle areas to the training areas. Later a few cases developed in
post of service of supply troops, notably Liffol-le-Grand and Gon-
drecourt. Careful investigation of these epidemics showed that the
causation factors were:
1. CareleSvSness in chlorination of water and drinking of water
from unauthorized sources.
2. Incomplete inoculation against typhoid and paratyphoid.
3. Carriers.
2146 REPORT OF THE SURGEON GENERAL. OF THE ARMY.
Many factors, such as the eating of unsealed salads at cafes, may
also have been responsible for some cases reported. Again the factor
of lowered resistance by long marches and drills, coupled with an
overwhelming infection from a polluted water source or a carrier
may have caused some of the outbreaks. The establishment of cen-
tral chlorinating plants in towns did much to cut down the number
of intestinal-disease cases, and a careful check on the chlorination
of water in the Lyster bags was made by trained men of sanitary
squads or representatives from the laboratories. In this connection
it is interesting to note the fact that undue zeal on the part of medi-
cal officers in the matter of chlorination sometimes proved a stum-
bling block. Soldiers frequently complained of the chlorine taste
of water in the Lyster bags, thus making the water unpalatable. In
order to prevent such mistakes an effort was made in most areas to
determine the exact amount of hypochlorite necessary for steriliza-
tion. When there was found a small amount of organic matter pres-
ent in the water it was found that one-half, or even one-quarter, of
a tube was necessary to render the water perfectly safe.
XII. CONVALESCENT CAMPS.
1. Convalescent Camp, Paris.
This convalescent camp is located in a small French village called
Tremblay, on the south bank of the Marne. It is just across the river
fi'om Xegent-sur-Marne and not far from Champigny. The location
is an excellent one, the camp being only about 6 miles from Paris.
The latter can be reached within three-quarters of an hour, either by
a tramway, which runs right past the camp, or by train from the
Xegent-le-Perreux station, just across the Marne. Tremblay is con-
nected with the town of Negent-sur-Marne by an arched bridge,
which is within a few steps of the camp.
The site of the camp is a practically new, turf race-track course,
built not very long before the war. It is an ideal site for a camp,
inasmuch as the grounds are large and level and of a good combina-
tion of sand and gravel, contrary to the usual mud in other localities
brought about by the continual rains in this country.
An excellent water system, which supplies the camp with water
fi'om water works in Negent-sur-Marne, was installed, thus providing
a plentiful supply of good, potable water. A fine system of drainage
and sewerage was also installed.
When the first detachment of 50 Medical Department men arrived
on the 1st day of November, 1918, the work of cleaning up the camp
began immediately.
On the 26th of November, the first convalescents arrived, number-
ing 105. Due to the signing of the armistice and of the cessation of
hostilities, no additional convalescents were sent to this camp. Those
who had been sent here were examined and reclassified, some of them
being returned to duty with their organizations and others sent to the
United States.
On December 30, 1918, orders were issued from the chief surgeon's
office in Tours to abandon the camp, and the work of removing sup- '
plies commenced the first week in January. In about two weeks'
time all of the equipment was removed, and convalescent camp was
reported as abandoned on Wednesday, January 22^ 19X9,
A. E. F. — CONVALESCENT CAMPS. 2147
2. CONVALESCENT CAMP, MARS.
Rouglily speaking, this camp occupies an area one-half mile square
and comprises 100 tent units, with 300 tents, 38 wooden buildings,
4 wooden latrine groups, 3 sheds for salvage, 1 for coal, 1 for tool
storage, and 4 feces destructors built before the advent of the per-
manent apparatus. All tent units, buildings, roads, and walks have
double ditches. The Engineers built 1,925 feet of road, while our
own men constructed 14,450 feet of walks and rebuilt over 2,000 feet
of the same, using large and small stones as well as discarded cement.
On January 16 the first tents were struck. Already 14 complete
units are clown and packed, and the side walls and doors of 36 other
units are in storage. Weather permitting, one-half the tentage of
this camp will be down within five days' time.
Patients statistics. — Patients admitted to this camp from the
Mars hospital center, Vichy hospital center. Chatel Guy on, and
Chaumont. On August 18 there were 130 patients in this camp. On
October 1, 1918, there were 1.796 patients here. This number steadily
increased to its maximum of 4,565 on December 5, 1918, which, plus
117 of the personnel, etc., made a maximum number to house of 4,682.
The greatest number received on any day — on October 23. 1918 — was
435. The largest evacuation — on December 18, 1918 — was 1,336.
This evacuation was accomplished in 45 minutes from the time the
details from each of the 10 companies left this camp to the minute
that they boarded the train. The Field Musci, as usual, was em-
ployed to speed them on. There have been no admissions since De-
cember 14, 1918, when 128 men came in. The registrar's report
shows that up to January 1, 1919. 11.497 men had been received in
this camp since its opening; 9,638 have been discharged. Since
January 1 a few more have been evacuated, leaving 1.293, mostly
duty status men.
Industrial training. — Next to military discipline and drill there
was nothing that contributed so much to the physical and mental
welfare of convalescent as agreeable work. While at one time this
camp had over 900 of its members on detached or detailed duty,
working outside the camp limits and contributing largely to the
])uilding of the hospital center, it is not of their endeavors that we
particularly speak, but rather of the 600 men who at one time or
another have been employed in the three wooden buildings devoted
to our shops. Most of these men were untrained and had to be
taught in a crude way by the few that knew the trades. While it
was the evident intention of the Government to equip such shops,
nothing was ever done in this respect except to furnish two tool
chests. At no time were Government funds forthcoming for the
purchase of tools or equipment. Another officer and niyself supplied
the necessary funds to buy the initial equipment, and the Red Cross
kindly undertook to furnish more. Eventually all these loans were
repaid from the profits from, the tailor, cobbler, and barber shops,
which were more than sufficient to finance further shop endeavors.
In all, 10 shops were established. Two tailer shops, which did a
large amount of work for the entire center; two barber sliops, with
six chairs in constant use; one electrical repair shop; one cobbler
shop, which repaired over 200 pairs of shoes; one cot-repair shop,
which received 2,214 broken cots, returning 2.034 as good as new;
142367— 19— VOL 2 lA
2148 REPORT OF THE SURGEON GENERAL OF THE ARMY.
one bench carpenter shop, the evidences of whose activities may be
seen in every part of our camp as well as in the quarters of other
units; one disinfecting shop, which frequently had to use a day and
a night shift; and one sign-painting shop, which produced over
500 signs, some of real artistic merit. Akin to these activities is a
splendidly arranged post office, with our chaplain in charge and
seven assistants, all former postal employees, and the canteen, which
in the past few montlis has had a turnover of 213,000 francs.
Sickness. — The health of this camp has been remarkable. No cases
of the exanthomata, diphtheria, paratyphoid, typhoid, or meningitis
have developed. An outbreak of mumps, totaling 27 cases, occurred
from December 13 to December 19, but was promptly stamped out.
Not more than 20 cases of pneumonia developed, and only 6 of these
of the lobar type.
Inasmuch as we were notified by the commanding officer of this
center on January 23, 1919. that the camp would be officially closed
on January 31, 1919, the last reported bed capacity was given as
2,000 on the morning of January 24. Thereafter only the number
of beds actually occupied was reported.
On January 31, 1919, the commanding officer advised the chief
surgeon at Tours that " convalescent camp at this center will be
closed February 1, 1919. Personnel available for duty elsewhere or
return to the States." On February 5 word was received from the
chief surgeon that it was desired to return the personnel of the
convalescent camp to the United States, and that orders would be
issued for this return when all the required records were completed.
3. CONVALESCENT CAMP, LIMOGES.
Convalescent camp, hospital center, Army Post Office 753, France,
arrived at its destination the morning of August 23, 1918, and re-
ported to commanding officer, this center, for duty. The camp per-
sonnel consisted of 7 officers and 45 enlisted men. The camp was
temporarily stationed for one week at Base Hospital No. 28, Limoges,
France, at the end of which time it was moved to a permanent loca-
tion, situated at Rue Montmailler and Rue New York.
The first patients for the camp, 23 in number, arrived September
21, 1918, coming from Base Hospital No. 24, Limoges, France.
The initial capacity of the camp was 1,000 beds, but the circum-
stances soon demanded an increase over that capacity. On November
1, 1918, the Caserne Beau-Pay was rented from the French Govern-
ment, and thereby the capacity of the camp was increased by about
700 beds.
Within a few days the number of patients had reached the capacity
of the camp, and the Belgian refugee barracks, situated about three-
fourths of a mile from the main camp, were obtained for the use of
convalescent patients, thus increasing the emergency capacity of this
camp to about 2,200 beds.
After November 20, 1918, we received no more patients, but con-
tinued to evacuate those in camp, thereby relieving the camp of the
need for increased capacity. The Belgian refugee barracks were
evacuated on or about November 30, 1918. On December 5, 1918,
442 class B patients were evacuated, being sent to Beau -Desert Hos-
pital, France.
December 28, 1918, the Caserne Beau-Pay was evacuated and im-
mediately returned to the French.
A. E. F. — CONVALESCENT CAMPS. 2149
The largest number of patients cared for at any one time was
2,165.
During the operation of this camp, 3,077 patients were cared for
and made as comfortable as conditions would permit, no deaths
occurring during the entire period.
On January 2, 1918, the commanding officer, hospital center, re-
ceiA-ed authority from the chief surgeon, American Expeditionary
Forces, to close "the camp, and per his order the 650 remaining casuals
were evacuated to Base Hospitals Nos. 24 and 28, hospital center,
Limoges, France.
4. CONVALESCENT CAMP, SAVENAY.
In the first part of May, 1918, one ward of 50 beds was set apart
for patients suffering from effort syndrome in Base Hospital No. 8.
The idea at that time was to collect the heart cases in the hospital
and put them under physicians who had experience in heart diseases.
This ward of 50 beds was soon filled with cases suffering from gas,
overstrain, and effort syndrome.
On August 21 orders were received from the chief surgeon's office
to establish a convalescent camp as a unit separate from the hospital.
In compliance with this a site was selected where the parade ground
measured something like 1,800 feet by 1,600 feet. Fifty pyramidal
tents were put up and 300 French beds placed in the tents for use
of the men. This change from hospital to convalescent camp was
made in one day, the patients being transferred from hospital to
camp and returns made from the camp as a separate organization.
Under Circular 11-A, chief surgeon's office, all patients m con-
valescent camps were placed on a duty status and consequently re-
ports returned were those of line organizations. This was changed
after a few weeks and patients were again put on a hospital basis,
necessitating again a change in forms.
An instance of the spirit which was shown by the enlisted men m
the camp is that within two days the camp was increased from 300
men to about 1,400 men.
It is not generally realized what an important function a con-
valescent camp may play with regard to the return of soldiers from
the hospitals to duty. And the function is not only that of returning
men to duty, but primarily is concerned with the revitalizing of
troops. "Wliere it is necessary for troops to go through the battle
line over and over again this becomes a highly important point
with fighting units. Consequently the more completely that soldiers
are allowed to rest their minds from the worries incident to battle,
the keener the spirit they will manifest upon being thrown into
battle the second time. This mental rest is best accomplished by
light duties, entertainment, and interesting occupations. Vocational
training is one of the best methods to bring men back to then-
standard of mental confidence, and it is also one of the greatest
advantages to be gained while in service.
M. W. Ireland,
Surgeon General, U. S. Army,
Major General, U. S. Army.
Washington, D. C. October 10, 1919.
INDEX VOLUME II.
KEY FOR INDEX.
Key for letters used as suffix to page number in index:
"X " — United States, reports of various acti\dtie8.
"Y" — Europe, reports of various activities, armies, hospitals, etc.
SUBJECTS, WITH PAGE NtJMBERS.
Page.
A.ccommodations and equipment on ships il^'vlvN
\ir Service, medical-research laboratories ^oQ^/v^
Auir Service, otological service i qq^vN
A.ir Ser\ice, physical directors J^cq^vI
.\isne-Mame campaign I 'io/v\
,A.isne-Marne offensive, casualties • ■ j^^^^^l
L\isne-Marne offensive, evacuation-hospital reports Iby6-lb9b( Y )
Allorey, Saone et Loire, hospital center j4?Q/v^
Ambulance Service, recommendation for n f oo/v\
^Ambulance Service, United States Army, demobohzation of i T";)-Cr<
Ambulance Service, United States Armv, field service ) v^
Ambulance Service, United States Armv, march to Germany ^'^^^)-G^I
Ambulance Service, United States Armv, with the French Army ■^'*"^)-C-l
Ambulances }5q2 ?
Ambulances, pooling system of 1 4q7^v\
Ambulances, shortage of 1 1 1 Lv\
American Ambulance Corps, strength by rank i li o/ y\
American Ambulance Corps, strength by weeks -.- - - - 1119(X)
American divisions with French, north of Chaisons-sur-Mame, medical
review of • ' v ^ /
American evacuation, United States Army, Ambulance Service -^^-^^(vl
American Red Cross, activities of , ift^/v\
American Red Cross convalescent homes, development of i r /vl
American Red Cross hospitals onoI/v\
American Red Cross Hospital No. 1 ofto-^v\
American Red Cross Hospital No. 2 onoQ/v\
American Red Cross Hospital No. 4 onoo/v\
American Red Cross Hospital No. 5 oaqi /vl
American Red Cross Hospital No. 6 onQ{^v^
American Red Cross Hospital No. 9 omo/v\
American Red ("ross Hospital No. 21 ibiq/v\
American Red Cross hospital center oaqo/v\
American Red Cross Hospital, Pado\ a, Italy T^c7)v\
American Red Cross militar>' hospitals, development of T dcI/v\
Amnesias .- - • }?qq v
Amputations, advanced hospitals inc-}v\
Anesthesia i^ooSvi
Auesthetics, advanced hospitals 9nnn^v^
Angina, camp hospital i 9qq)v^
Animal admission rates i <wq
Animal death rate |^^^
Animal deaths, cause of j^^^
Animal deaths, general tables j^^°
Animal incidence of special diseases at large camps 1^4U
Animal morbidity and mortality j^^^
Animal noneffective rates j^^^
Animal noneffective rates, general tables |^4»
Animal rates, American Expeditionary Forces i^^o
Animal rates, Siberia ^^^^
2151
2152 INDEX VOLUME II.
Pagi
Animal strength 123
Animals, admissions, general tables 124
Animals returned to duty 123
Anthrax 104
Anthrax. Veterinar\^ 8er\'ice 123
Antiseptics, use of, in advanced hospitals 179
Antitoxine 104j
Appropriations, securing of. Hospital Division 1141(X
Argonne-Meuse offensive, base hospital 1951(Y
Argonno-Meuse offensive, divisional reports 1550, 1562(Y
Argonno -^feuse offensive, evacuation hospitals 1696, 1720(Y
Argonne-Meuse offensive, First Army 1519(Y
"Army dumps " (medical) establishment of 1494(Y
Army Medical Museum 1062(X
Department of Pathologj^ and accessions 1062(X
Mo\dng picture 1064(X
Still photography 1065(X^
Wax modeling 1066(X
Anatomical art 1066(X'
Entomology 1066(X'
Special exhibits 1066(X'
Section with the American Expeditionary Forces 1067(X
Conclusions 1067(X
Recommendations 1068(X'
Army Medical School 1251(X*
Orthopedic section 1251(XJ
Pathology section 1253(X;
Prophylactic vaccines 1253(XJ
Chemical work 1254(X]
X-ray and photography 1254(X)
Physical examinations 1255(X)
Mimeographing." 1255(X^
Wasserman tests 1256(X;
Civilian personnel 1256(X)
Recommendations 1257(X]
Army Nurse Corps, discussion of 1122(X)
Army Niirse Corps, distribution of 1122(X)
Army Nurse Corps, number of 1122(X)
Army sanitary officer, relation to sanitary inspectors of divisions 1430(Y)
Arsphenamine, manufactiKe of 1047(X)
Artificial limbs 1105(X)
Assembly parks for mobile units 2142(Y)
Attending surgeon's division, embarkation service 1271(X)
Auditing and recording of hospital funds 1352(Y)
Automatic supply schemes 1490(Y)
Automatic supply table 1189(X)
Auxiliary embrakation depots 1204(X)
Auxiliarj^ remount depots 1204(X)
Aviators, classification of in relation to altitude 1392(X)
Awards and citations, Medical Department personnel 1120
Bacteriological department, hospital center 1869(Y)
Bacteriological service 1327(Y)
Bacteriological work, base hospital 1773(Y)
Barrack hospitals, location 1337(Y)
Base hospital allowances, General Staff 1453(Y)
Base hospital, demobilization of 1159(X)
Base hospitals, capacity of 1342(Y)
Base hospitals, census of patients in 1169(X)
Base hospitals, number of 1342(X)
Base Hospital No. 1, provisional 1864(Y)
Base Hospital No. 3 1876(Y)
Base Hospital No. 3, provisional 1843(Y)
Base Hospital No. 5 1878(Y)
Base Hospital No. 6 1880(Y)
Base Hospital No. 7 1883(Y)
Base Hospital No. 8 1884(Y)
Base Hospital No. 8, provisional 1844(Y)
INDEX VOLUME II. 2153
Base Hospital No. 9 1886(Y)
Base Hospital No. 11 1887 (Y)
Base Hospital No. 13
Base Hospital No. 20 1890(Y)
Base Hospital No. 22 1858, 1892(Y)
Base Hospital No. 24 1842. 1894(Y)
Base Hospital No. 28 1895(Y)
Base Hospital No. 29 1896(Y)
Base Hospital No. 30 1896(Y)
Base Hospital No. 31 1759(Y), 1901(Y))
Base Hospital No. 32 1798(Y)
Base Hospital No. 33 1911(Y)
Base Hospital No. 34 1914(Y)
Base Hospital No. 35 1920(Y)
Base Hospital No. 37 1924(Y)
Base Hospital No. 38 1926(Y)
Base Hospital No. 40 1936(Y)
Base Hospital No. 41 1937(Y)
Base Hospital No. 42 1942(Y)
Base Hospital No. 43 1943(Y)
Base Hospital No. 44 1946(Y)
Base Hospital No. 46 1948(Y)
Base Hospital No. 47 1953(Y)
Base Hospital No. 48 1955(Y)
Base Hospital No. 50 1842, 1956(Y)
Base Hospital No. 51 1957(Y)
Base Hospital No. 52 1960(Y)
Base Hospital No. 53 1961(Y)
Base Hospital No. 54 1842(Y), 1964(Y)
Base Hospital No. 55 1966(Y)
Base Hospital No. 58 1861(Y), 1967(Y)
Base Hospital No. 59 1968(Y)
Base Hospital No. 60 1970(Y)
Base Hospital No. 61 1972(Y)
Base Hospital No. 62 1974fY)
Base Hospital No. 63 1975(Y)
Base Hospital No. 64 1976(Y)
Ba.se Hospital No. 65 1979(Y)
Base Hospital No. 67 1981(Y)
Base Hospital No. 68 1982(Y)
Base Hospital No. 69 1983(Y)
Base Hospital No. 70 1827(Y)
Base Hospital No. 70-A 1829(Y)
Base Hospital No. 71 1984(Y)
Base Hospital No. 72 1844(Y)
Base Hospital No. 76 1865(Y)
Base Hospital No. 77 1985(Y)
Base Hospital No. 78 1986(Y)
Base Hospital No. 80 1987(Y)
Base Ho3])ital No. 81 1989rY)
Base Hospital No. 82 1990(Y)
Base Hospital No. 83 1991(Y)
Base Hospital No. 84 1992(Y)
Base Hospital No. 86 1842(Y), 1993(Y)
Base Hospital No. 87 1994(Y)
Base Hospital No. 88 1996(Y)
Base Hospital No. 89 1843CY)
Base Hospital No. 90 1997(Y)
Base Hospital No. 91 1998(Y)
Base Hospital No. 92 1999(Y)
Base Hospital No. 94 1999(Y)
Base Hospital No. 95 2001(Y)
Base Hospital No. 96 2001(Y)
Base Hospital No. 97 1829(Y)
Base Hospital No. 98 .... ; 2002(Y)
Base Hospital No. 100 2003(Y)
Base Hospital No. 101 2004( Y)
2154 INDEX VOLUME H. ^^
Page,
Base Hospital No. 104 2005(Y'
Base Hospital No. 10.5 2006(Y"
Base Hospital No. 106 2007(Y'
Base Hospital No. 107 2009(Y
Base Hospital No. 108 1844(Y), 2010(Y'
Base Hospital No. 109 1865(Y;
Base Hospital No. 110 2012(Y"
Base Hospital No. Ill 2012(Y
Base Hospital No. 113 2012(Y'
Base Hospital No. 114 2013(Y'
Base Hospital No. 115 1864(T
Base Hospital No. 116 2013(1 '
Base Hospital No. 118 2014(Y
Base Hospital No. 119 2015(Y
Base Hospital No. 120 2015(Y'
Base Hospital No. 121 2016(Y'
Base Hospital No. 123 2016( Y'
Base Hospital No. 131 2017( Y'
Base Hospital No. 136 2019(Y'
Base Hospital No. 204 2020(Y'
Base Hospital No. 208 2021(Y'
Base Hospital No. 210 2022(Y"
Base Hospital No. 218 2022( Y'
Base Hospital No. 236 2023(Y"
Base Hospital No. 238 2023(Y:
Base laboratory, Vichy, hospital center 1866( Y"
Base laboratories 1319(Y"
Base sections 2033( Y"
Base Section No. 1 2033(Y"
Base Section No. 2 2035(Y"
Base Section No. 3 2039( Y'
Base Section No. 4 2042(Y'
Base Section No. 5 2043( Y'
Base Section No. 7 2055(Y"
Base Section No. 8 2057( Y*
Bathing 1399(Y^
Bathing and delousing plants, description of 1407(Y'
Bathing apparatus 1404(Y^
Bathing of troops at base ports 1406(Y_
Bathing, organizations of di^^.sions 1399(Y'
Bathrooms 1409(Y^
Battle casualties, hospital center 1841(Y,
Bazoilles hospital, acti\-ities at prior to July 1, 1918 1801(Y^
Bazoilles-sur-Meuse (Vosges) hospital center 1801(Y,
Beau Desert, hospital center 1855(Y'
Beauval area, di\dsional reports 1651(Y'
Belgium front, medical review of 1478(Y]
Billetting area, divisional reports 1667(Y]
Bois-Brule front, 26th Di^ision 1580(Y;
Brest, care of hospital cases 2048(Y]
Brest, early days at 2045(Y:
Brest, evacuation of patients to transports 2050(Y^
British Army, system of evacuation 1414(Y,
Bronchitis, base hospital 1781( Y)
Broncho-pneumonia, base hospital 1942( Y]l
Burial of the dead, divisional reports 1640(Y)
Camp hospitals, expenditure for alterations in 1149(X1
Camp Hospital No. 1 2062(Y:i
Camp Hospital No. 2 2063( Y]!
Camp Hospital No. 3 2064( Y]:
Camp Hospital No. 5 2064( Y)
Camp Hospital No. 7 2065( Y)
Camp Hospital No. 8 2066( Y^i
Camp Hospital No. 9 2067rY;i
Camp Hospital No. 10 2067( Y '
Camp Hospital No. 11 2070(Y i
Camp Hospital No. 12 2072(Y,'
INDEX VOLUME II. 2155
Page.
amp Hospital No. 13 ' 2078(Y)
'amp Hospital No. 14 2080(Y)
'amp Hospital No. 15 2081( Y)
'amp Hospital No. 19 2082( Y)
'amp Hospital No. 20 2083( Y)
,'amp Hospital No. 21 2083(Y)
;amp Hospital No. 22 2086(Y)
;amp Hospital No. 2.3 2086(Y)
3amp Hospital No. 24 2087(Y)
^amp Hospital No. 26 2092(Y)
^amp Hospital No. 28 2095(Y)
^amp Hospital No. 29 2096(Y)
^amp Hospital No. 31 2097(Y)
"amp Hospital No. 34 2098(Y)
"amp Hospital No. 35 2100(Y)
'amp Hospital No. 36 2103(Y)
"amp Hospital No. 37 2103(Y)
""amp Hospital No. 38 2104(Y)
:'amp Hospital No. 39 2105(Y)
"amp Hospital No. 40 2105(Y)
"amp Hospital No. 41 2110(Y)
amp Hospital No. 42 2111(Y)
amp Hospital No. 43 2113(Y)
"amp Hospital No. 45 2116(Y)
amp Hospital No. 49 2117(Y)
amp Hospital No. 50 - 2118( Y)
amp Hospital No. 52 2119(Y)
ramp Hospital No. 53 2120( Y)
Camp Hospital No. 59 2121(Y)
Camp Hospital No. 64 2122(Y)
Camp Hospital No. 65 2123(Y)
Camp Hospital No. 66 2124(Y)
Camp Hospital No. 67 2126(Y)
Camp Hospital No. 68 2127( Y)
Camp Hospital No. 69 2128( Y)
Camp Hospital No. 70 2128( Y)
Camp Hospital No. 72 2128(Y)
Camp Hospital No. 76 2129(Y)
Camp Hospital No. 78 2130(Y)
Camp Hospital No. 82 2130(Y)
Camp Hospital No. 85 2132fY)
Camp Hospital No. 86 2133(Y)
Camp Hospital No. 91 2133(Y)
Camp Hospital No. 94 2135(Y)
Camp Hospital No. 95 2135®
Camp Hospital No. 96 2136(Y)
Camp Hospital No. 97 2136(Y)
Camp Hospital No. 100 2136(Y)
Camp Hospital No. 102 2138(Y)
Camp Hospital No. 103 2138(Y)
Camp Hospital No. 104 2139(Y^
Camp Hospital No. 105 2141( Y)
Camp Hospital No. 106 2141( Y)
Camp Hospital No. Ill 2141(Y)
Camp sanitation, hospital center 1814( Y)
Canti^y , First Division loss 1509( Y)
Cantigny , operations at medical review of 1471( Y)
Cardiovascular diseases, base hospital 1782(Y)
Cardio. vaacular section... 1078(X), 1373(Y)
Care of wounded, evacuation hospital 1684(Y)
Casualties, enlisted men. Medical Department, number of 1119(X)
Casualties, medical officer, nominal list 1435( Y)
Central Department, health of troops in 1274(X)
Central Department, sanitary conditions 1274(X)
Champagne defensive, medical review of 1475( Y^
Chateau-Thierry 1509(Y)
2156 INDEX VOLUME II.
agll
, PasI
Chateaii-Thierrv, base hospitals 1891(Y), 1916(Y), 1951(^
Chateau-Thierry divisional reports 1583(Y), 1593 (Y)
Chateaii-Thierrv, evacuation hospitals 1695-1698(Y]
Chemical service 1328('y1
Chemical warfare service 1394(Yi
Chest case?, advanced hospital 1787(YJ
Chest cases, base hospital 1910(Y)
Chest cases on hospital train 1743(Y)
Chest surgery, advanced hospital 1791(Y)
Chief sureeon's advanced sections, Ser\dce of Supplies 1674(Y)
Chief surgeon's First Army, report of 1508(Y)
Chief surgeon's Second Army, report of 1525(Y)
Chief surgeon's ofhce 1290(Y
Coblenz, evacuation hospital ]697-1699(Y^
Communicable animal diseases 1375(Y
Comparative statistics, animal rates, British, French, and American 1236(X
Concentration areas, Medical Department 1467( Y
Constitutional psychopathic states 1384(Y)
Contagious diseases, base hospitals 1968(Y^
Contagious diseases, hospital centers 1822{ Y)
Contagious fevers, base hospital 1782( Y)
Control of communicable animal diseases 1220(X;
"Controlled stores," policy of, medical supplies 1497(Y;
Convalescent camp, Limoges 214S(Y;
Convalescent camp, Mars 2147(Y)
Convalescent camp, Paris 2146(Y|
Convalescent camp, Savaney 2149(Y)
Convalescent camp, hospital center, A. P. O. No. 714 1S07(Y)
Convalescent camps 2146(Y)
Convalescent Camp No. 9 1865(Y)
Convalescent camps, development of 1456(Y)
Convalescent camps, function of 1830( Y)
Convalescent depots 1468(Y)
Cooperation of the French medical authorities 1488(Y)
Current statistical section 1020(X)
Debarkation of troops, reorganization of 1262(X)
Debarkation ser\'ice, preparation for 1268(X)
Debridement, advanced hospital 1791(Y)
Debridement, base hospital 1909(Y)
Degassing stations motorized 1399( Y)
Deluusing 1399( Y)
Delousing, organization of divisional reports 1399(Y)
Delousing plant. Camp Ancona 1406(Y)
Delousing plants, plan of operation of 1408(Y)
Demobilization plans 1498( Y)
Dental boards 1308(Y)
Dental casualties 130S(Y)
Dental Corps, discussion of 11 20(X)
Dental Corps, strength, by rank 1115(X)
Dental Corps, strength, by weeks 1115(X)
Dental Corps, strength, .Tune 30, 1919 1115(X)
Dental division, embarkation service 1271(X)
Dental Ser\ice 1300(Y)
Dental Ser\ice, base hospitals 1762(Y)
Dental SerW^e, character rendered 130o( Y)
Dental Ser\ice, equipment and supplies 1302( Y)
Dental Service, organization 1300(Y)
Dental Ser\dce, personnel 1301(Y)
Dental Service, school of instruction 1307(Y)
Dental Service, Second Army 1531(Y)
Dental Service, summary report of 1305(Y)
Department laboratories 1049(X)
Dermatitis gangrenosa, Veterinary Service 1226(X)
Dermatology', section of . 1108(X)
Detraining of patients, hospital train 1747( Y)
Developmental battalions 1031(X)
Diarrhea, camp hospital 2125(Y)
INDEX VOLUME II. 2157
Page.
Diarrhea, epidemic 1310(Y)
Diarrhea, outbreak of, First Army 1513(Y)
Diphtheria 1312(Y)
Diphtheria, base hospital 2008(Y)
Disbursements during the fiscal year 1189(X)
Disbursing and auditing money vouchers 1351(Y)
Disease occurrence, Philippine Department 1285
Disinfectors, Canadian hot-air 1404(Y)
Disinfectors, different styles of 1403(Y)
Disinfectors, portable hot-air 1404( Y)
Disinfectors, Serbian barrels 1404(Y)
Dispensing of drugs, base hospitals 1762( Y)
Distributing depots, Medical Department. 1186(X)
District of Paris, hospitals, United States Army 1751( Y)
Divisional litter bearers, French Army 1413( Y)
Divisional training area 2143( Y)
Division surgeon's reports 1547(Y),
1554(Y;, 1566(Y), 1569(Y), 1576(Y), 1589(Y), 1592(Y), 1597(Y), 1602(Y), 1613(Y),
1630 (Y), 1635 (Y), 1645(Y), 1650(Y), i655(Y), 1657(Y), 1660(Y), 1665(Y), 1666(Y)
Dourine 1230(X)
Dressing of amputations on hospital trains 1743(Y)
Drivers, mechanics, school for . 1118(X)
Dysentery, base hospital . 1955(Y)
Dysentery', camp hospital 2125(Y)
Eastern Department, health of troops in 1275(X)
Eastern Department, sanitary conditions 1275(X)
Effort syndrome - 1313(Y), 1374(Y)
Embarkation hospitals, expenditure for alterations in 1151(X)
Embarkation service, resume of . . 1264(X)
Emergency anaesthetics, base hospital 1763(Y)
Empyema, operations for 2092(Y)
Empyema, surgical treatment of 1088(X)
Entraining of patients, hospital train 1747(Y)
Epidemic diseases, camp hospital 2073(Y)
Epidemic diseases, divisional reports. 1660(Y)
Epidemic diseases, hospital center 1820(Y)
Epi<lemics, Second Army 1541(Y)
Epidemiological Service, field army 1433(Y)
Epidemiological survey, base hospitals 1773( Y)
Epidemiology, section of 1049(X)
Epilepsy ■ 1883(Y)
Epizootic lymphangitis. Veterinary Service 1232
Equalization of stock, medical supplies 1497(Y)
Europe (see key) ^oci^rvl
Evacuation division, embarkation service iJb7( A;
Evacuation from bse hospital 1901(Y)
Evacuation hospitals 1465( Y)
Evacuation Hospital No. 1 1677(Y), 1907(Y)
Evacuation Hospital No. 2 1678(Y)
Evacuation Hospital No. 4 ^^^^^X^
Evacuation Hospital No. 6 1694(Y)
Evacuation Hospital No. 8 ^^^P^.X|
Evacuation Hospital No. 9 1703(Y)
Evacuation Hospital No. 10 "'^'^'^^vx
Evacuation Hospital No. 11 1708(Y)
Evacuation Hospital No. 12 1713(Y), 1716( Y)
Evacuation Hospital No. 13 ^' ^^/v\
Evacuation Hospital No. 14 1719(Y)
Evacuation Hospital No. 15 1720(Y)
Evacuation Hospital No. 16 1721(Y)
Evacuation Hospital No. 18 1722(Y)
Evacuation Hospital No. 19 1730(Y)
Evacuation Hospital No. 20 '^'^I'^SVs
Evacuation Hospital No. 21 ^^7^)Z-i
Evacuation Hospital No. 22 , o ;-v-^
Evacuation Hospital No. 23 1727(Y)
2168 INDEX VOLUME 11.
P »|Page.
Evacuation Hospital No. 24 1728(Y)
Evacuation Hospital No. 25 1730(Y), 1865(Y)
Evacuation Hospital No. 26 1730(Y)
Evacuation Hospital No. 27 1731(Y), 1844(Y)
Evacuation Hospital No. 29 1732(Y), 1845(Y)
Evacuation Hospital No. 30 1733(Y)
Evacuation Hospital No. 33 1734(Y), 1865(Y)
Evacuation Hospital No. 35 1735(Y)
Evacuation Hospital No. 36 1738(Y)
Evacuation Hospital No. 37 1739(Y)
Evacuation Hospital No. 49 1740(Y)
Evacuation of wounded, Second Army 1527(Y)
Evacuation of battle casualties from the front lines 1481(Y)
Evacuation of battle casualties in the open warfare 1482(Y)
Evacuation of battle casualties, French system 1579(Y)
Evacuation of sick and wounded, port of embarkation 1263(X)
Evacuation of the sick and wounded at Brest 2054(Y)
Evacuation of the wounded, di\isional reports 1641(Y), 1669(Y)
Evacuation of the wounded, diA^sional reports, Chateau-Thierry 1548(Y)
Expenditure for construction of new hospitals 1148(X)
Eye, ear, nose, and throat department, "base hospital 1923(Y)
Feeding of patients, base hospital 1764(Y), 1780(Y)
Feeding of patients, hospital trains 1743(Y), 1744(Y)
Field army, sanitation of 1426(Y)
Field hospitals, divisional reports of 1464(Y), 1607(Y)
Finance and accounting division 1348(Y)
Finance and accounting division, outline of organization 1349(Y)
Finance and accounting division, personnel 1349(Y)
Finance and accounting division, preparatory work 1348(Y)
Finance and accounting division, purpose of 1348(Y)
Finance and accounting di\ision, results accomplished 1351(Y)
Finance and supply, di\'i8ion of 1185(X)
Finance division, embarkation ser\ice 1270(X)
Finance division, general resume 1353(Y)
Finance di\dsion records, disposal of 1354(Y)
Financial statement 1190(X)
Fliers, education of, for health and efficiency 1392(Y)
Fliers, reexamination of 1391(Y)
Fliers, value of tests for physical examination 1392(Y)
Flight surgeons 1390(Y)
Fly control 1024(X)
Flying, nausea, vomiting, and vertigo following air service 1393(Y)
Food and nutrition, section of 1331(Y)
Food section 1025(X)
Fractures, surgical treatment of 1092(X)
French Army, system of evacuation 1413(Y)
French evacuation, United States Army, Ambulance Service 1412(Y)
French surgeons 1766(Y)
Gas attacks, divisional reports 1666(Y)
Gas cases, base hospitals . 1930(Y), 1944(Y), 1955(Y), 1973(Y), 2020(Y)
Gas cases, evacuation hospitals 1725(Y)
Gas cases; hospital centers 1817(Y), 1824(Y)
Gas cases, hospital trains 1743(Y)
Gas-contact cases, base hospitals 1977(Y)
Gas gangrene, advanced hospitals 1790( Y)
Gas gangrene, base hospitals 1945(Y)
Gas gangrene, evacuation hospitals 1715(Y)
Gas gangrene, hospital center 1818(Y)
Gas hospital, Justice Hospital group 1872(Y)
Gas inhalation cases, base hospital 1978(Y)
Gas intoxication, base hospital 1902(Y)
Gas officer, duties of, divisional rejjort 1397(Y)
Gasolene heat for delousing plants 1408(Y)
Gastrointestinal diseases, base hospital 1781(Y)
General hospital, census of patients in 1169(X)
General hospitals, continued in service 1159^X)
General hospitals demobilization of 1159(X)
INDEX VOLUME U. 2159
Page.
General hospitals, expenditure for alterations in 1150(X)
General hospitals, medical officers on duty at 1171(X)
General Staff, Medical Department acti\ities 1442^Y)
General Staff, supervision and hospitalization 1448(Y)
General Staff, supervision Medical Department 1443(Y)
Genito-urinary department, base hospital 1769(Y)
Genito-nrinary service, evacuation hospital 1718(Y)
Glanders 1221(X), 1224(X), 1366(Yj
Glanders, destruction of animals on account of 1223( X)
Glanders, occurrence of at various posts 1224(X )
Handling of patients, base hospital 1901( Y)
Head injuries, advanced hospital 1794( Y)
Heart department, hospital center 1869(Y)
Hoboken, chief surgeon's report 1258(X)
Horse-purchasing boards 1204(X)
Horseshoeing school 1215(X)
Hospital barges 1360(Y)
Hospital beds, number required 1337(Y)
Hospital boats 2053(Y)
Hospital buildings, transfer of Government property for 1148(X)
Hospital capacity, iwrt of New York, embarkation ser\'ice 1268(X)
Hospital centers 1340(Y), 1755(Y)
Hospital center, capacity of , 1340(Y)
Hospital centers, development of 1370(Y), 1455(Y)
Hospital centers, personnel 1340(Y)
Hospital centers, work accomplished 1862(Y)
Hospital Division 1140(X)
Hospital Division, administration section 1152(X)
Hospital Division, administration section, personnel of 1153(X)
Hospital Division, embarkation service 1265(X)
Hospital leases, cancellation of 1147(X)
Hospital leases, renewal of 1147(X)
Hospital organization. Seventh Division 1570(Y)
Hospital service, port of embarkation 1263(X)
Hospital trains 11.>KX), 1157(X), 1358(Y), 1480(Y), 1742(Y), 2053( Y)
Hospital trains, difficulty of feeding patients 1269(X)
Hospital trains, embarkation and debarkation servi.ce 1269(X)
Hospital trains, transportation of cases on 1157(X)
Hospital Train No. 14 1865(Y)
Hospital Train No. 53 1742(Y)
Hospital Tram No. 54 1743(Y)
Hospital Train No. 58 1744( Y)
Hospital Train No. 59 1745( Y;
Hospital Train No. 60 1745( Y)
Hospital Train No. 61 1746(Y)
Hospital Train No. 62 1747(Y)
Hospital Train No. 63 1748(Y)
Hospital Train No. 66 1750(Y)
Hospital Train No. 70 1751(Y)
Hospital Unit " W " 2106(Y)
Hospitals, capacity of 1341(Y)
Hospitals, construction of 1339(Y)
Hospitals, embarkation service 1272(X)
Hospitals, evolution of plans and specifications, General Staff 1454(Y)
Hospitals, location of 1338(X)
Hospitals transferred to Public Health Service 1160(X)
Hospitals, United States Army, district of Paris 1751(Y)
Hospitals, use of existing French buildings 1338(Y)
Hospitals, use of hotels 1339(Y)
Hospitalization 1336( Y)
Hospitalization, divisional reports 1673(Y)
Hospitalization, construction program. General Staff 1450(Y)
Hospitalization, history of, from General Staff 1448(Y)
Hospitalization in England 2039( Y)
Hospitalization of overseas patients 1163(X)
Hospitalization, Second Army 1526(Y)
Hospitalization, status of Nov. 11, 1918 1342(Y)
2160 INDEX VOLUME II.
Hot-air disinfecting chambers, delousing plants 1407(Y)|
Housine, evacuation hospitals 1707(Y)j
Infections, handling of at hospital centers 1819fY)j
Infectious diseases and laboratory, division of 1041CX)|
Infectious diseases arriving on transports 2051(Y)j
Infectious diseases, base hospitals 1975(Y)I
Infectious diseases camp hospitals 2108(;Y), 2114(Y). 2129f Y)]
Infectious diseases, di^ ision of 1314(Y)J
Infectious diseases, hospital center 1845(Y)|
Infectious diseases, section of 1329(^Y)|
Infectious diseases, special study of 1043fX) '
Infectious fe- ers, l)ase hospital 1782(Y)
Infirmaries, capacitv of 1341(Y)
Influenza '. 1312(Y). 2134(Y)
Influenza at Brest 2049(Y)
Influenza, base hospital 1781( YV 1796/ Y\ 1881( Y). 1885fY\
1903(Y). 1912rY). 1919(Y), 1940( YV 1952i'Y). 1954fY). 1987(Y),
1990( Y\ 1996(Y)-1997(Y\ 2004( Y), 2008fY), 2011(Y), 2021(Y)
Influenza, base sections 2034( Y). 2038fY). 2049fY)
Influenza, camp hospitals 2064fY), 2066rY), 2070rY). 2073fY). 2079(Y),
2081fY). 2082(Y), 2085rY). 2089fY). 2091( Y). 2094(Y). 2097(Y),
2099fY). 2102(Y), 2104(Y), 2108(Y),2112(Y), 2114(Y). 2120(Y),
2123rY), 2125(Y), 2129(Y), 2131(Y), 2137(Y), 2139(Y), 2142rY)
Influenza, central department 1278(X)
Influenza, divisional reports 1634(Y), 1662(Y). 1669(Y)
Influenza, Eastern Department 1278(X')
Influenza epidemic, 1918 1033(X)
Influenza epidemic on transports 2052(Y)
Influenza epidemic, port of embarkation 1259(X)
Influenza epidemic, 1918, recommendations for control of 1036(X)
Influenza, evacuation hospitals 1731(Y), 1739(Y). 1740(Y)
Influenza, hospital centers 1823fY)
Influenza investifration 2076!' Y)
Influenza, Panama Canal Department 1289
Influenza, Southeastern Department 1282fX)
Influenza, Southern Department 1276(X)
Influenza, Western Department 1283('X)
Internal medicine, division of 1069(X)
Intestinal parasites, base hospital 1783( Y)
Irritable heart action, base hospital 1771(Y)
Issuance of clearance certificates, finance department 1352(Y)
Italian front, medical review of 1478(Y)
.Toint cases, base hospital 1910rY)
Joint cases, care of in advanced hospitals 1786(Y)
Join-sdlle (Haute-Marne) concentration area 1870(Y)
Justice Hospital group 1836(Y)
Justice Hospital group, gas hospital 1872(Y)
Knee-joint wounds, care of in advanced hospital 1792(Y)
Laboratories, advanced hospitals 1786(Y)
Laboratories, base hospitals 1320(Y)
Laboratories, camp hospital 1321(Y)
Laboratories, evacuation hospitals 1321(Y)
Laboratories, mnljile hospitals., 1321(Y)
Laboratories, central : 1316(Y)
Laboratories, chemical work 1318(Y)
Laboratories, di\n.sional 1323(Y)
Laboratories. di\-isional, equipment and supplies 1325(Y)
Laboratories, diAosional. personnel of 1324(Y)
Laboratories, di\'isional, techincal ser\dce 1326(Y)
Laboratories, field armies 1322(Y)
Laboratories, pathological work 1318(Y)
I>aboratories, section of, November, 1917, to November, 1918 1315(Y)
Laboratories, serological work 1318(Y)
Laboratory and epidemiological service. Second .^rmy 1539(Y)
Laboratory and infectious diseases, di\dsion of 1041(X)
Laboratory bacteriological work 1318(Y)
INDEX VOLUME H. 2161
Page.
laboratory Base Hospitals Nos. 31 and 32, historical sketch 1794(Y
-Aboratory division 1314(Y
laboratory di%ision, organization and development 1314(Y
laboratory evacuation hospital, Coblenz 1706(Y
laboratory facilities, base hospital 1772('Y
laboratory research ser\'ice 1328(Y
laboratory, organization of, field army 1433(Y
>aboratory railroad car 1047(X
laboratory section. Base Hospital No. 1 1867(Y
:.aborator>' section. Base Hospital No. 19 1864(Y), 1868(Y
laboratory section. Base Hospital No. 115 1868(Y
Laboratory serA'ice, evacuation hospital 1687(Y
;>aboratory ser\dce, hospital center 1758(Y
Langres hospital center ISOS^Y
liaisons of medical serx-ice vrith that of Allies ]486(Y
^-.ibrary, Surgeon General's Office 1257(X
liice, methods of elimination 1402( Y
Light railways, medical use of 1499(Y
Ivimoges, hospital center 1847(Y
Loading of hospital trains 1742(Y
Louse infestations 1313(Y
flange 1229(X
Vlarbach sector, di\'ision surgeon's report 1658(Y
\Iar( heville-Riaville raid, 26th Division 1586(Y
Mars, hospital center 1849(Y
Material for construction, hospital center 1840(Y
Maxille-facial injuries from overseas, care of 1100(X
Measles 1312(X
Measles, camp hospitals 2120( Y
Meat and dair>' inspection service 1206(X
Medical and hospital supplies 118o(X), 1346(Y
jMedical Corps, strength, by rank 1114
Medical Corps, strength, by weeks 1114
Medical Department, evacuation hospital, Coblenz 1706(Y
Medical Department, personnel, awards and citations 1120
Medical Department, purchases in England 1355(Y"
NIedical Department, representative in London 1355(Y
Medical Department, transportation 1358(Y
Medical equipment sent overseas 1186(X
Medical examination room, delousing plants 1409(Y
Medical inspection 1425(Y
Medical observation, base hospitals 1776(Y
Medical officers, regular service Ill
jMedical officers, Reserve Corps 1114
Medical Officers' Training Camps, School of 1128(X
Anatomy 1134(X
Surgery 1135(X
Orthopedic surgerj- - - . 1135(X
Roentgenology 1136(X
Uroloev 1136(X
Ophthalmology 1136(X
Laryngology 1137(X
Plastic and oral surgery 1137(X
Neuro surgery 1137(X
Medicine 1138(X
Laboratory technique 1138(X
Hygiene and sanitation 1139(X
Epidemiology 1139(X
Medical personnel on ships '. 1260(X
Mcilical record section 1019(X
Mt>(li(al representation at regulation stations 1479(Y
Medical section. Air Service 1388(Y
Medical Service, base hospitals 1774(Y)
1828(Y), 1904(Y), 1923(Y), 1940(Y), 19o2(Y), 2005(Y
Medical Service, camp hospitals 2063(Y
Medical Service, evacuation hospitals 1686(Y
2162 INDEX VOLUME II.
I
PagOi
Medical Service, hospital centers 1846(Y"
Medical Sen-ice:
14l8t Infantty 1616(Y'
142d Infantry 1617(Y*
144th Infantry 1624(Y'
Medical Service, illth Sanitary Train 1625(Y*
Medical supplies, approximate" money value of, purchased in England 1357(Yi
Medical supply department, personnel of 1348(Y'
Medical supply department, Second Army 1532(YJ
Medical supply depots, cantonments '. 1187(Xi
Medical supply depots, establislunent of 1493(Y
Medical supply officers for divisions 1188(X'
Medical supply officers, school for 1187(X
Medical supply 8er\'ice, suggestions for 1501(Y
Medical supply service, summary' of 1500(Y
Medical supply, system of replenishment 1495(Y
Medical supplies, method of purchase in England 1356( Y
Medical supplies, purchase in Europe 1347(Y
Meningitis, camp hospitals 2085(Y
Mental age 1075(X
Mental age, classification, Negro inducted men 1076(X
Mental age, classification, officers, by rank 1077('X
Mental age, classification, white inducted men 1076(X
Mental age, classification, white officers 1076( X
Mental age, foreign-born recruits 1076(X
Mental cases, general hospitals for treatment of 1081(X
Mental cases, number of 1081(Y
Mental cases on hospital trains 1742(Y
Mental deficiency 1384(Y
Mess equipment, care of 1022(X
Mesves hospital center 1838(Y
Method of handling patients, base hospitals 1935(Y), 1953(Y
Meuse-Argonne offensive, division surgeons' report 1567(Y)
1590(Y), 1599(Y), 1608(Y), 1637(Y), 1658(Y), 1668(Y
Meuse-Argonne offensive hospitalization, division surgeons' reports 1596(Y
Military surgery at the front 1783(Y
Mobile Hospital Xo. 1 2058(Y
Mobile Hospital No. 3 2058(Y
Mobile Hospital No. 11 2059(Y
Mobile Hospital No. 12 2061(Y
Mobile hospitalization and evacuation, general review of 1469(Y
Mobile hospitals 1465(Y
Mobile hospitals, development of 1369(Y
Mobile sanitary formations 1464(Y
Mobile surgical units 1465(Y
Mobile units available in United States, not sent overseas 1183(X
Mosquito control 1024(X
Motor ambulance supply depots 1188(X
Motor transportation, hospital center 1812(Y
Mounted Service School, Fort Riley 1215(X
Mumps, base hospitals .' 1930(Y), 2008(Y
Mumps, camp hospitals 2120(Y
Mustard-gas cases, portable tunnels for 1398(Y
Mustard-gas inhalation, pathology of 1833(Y
Nancois area, division surgeon's report 1652(Y
Nantes, hospital center 1851(Y
Necropsies, hospital centers 1834(Y
Nephritis, base hospitals 1782(Y
Nerv^e disorders, organic 1385(Y
Neuro-psychiatric section 1079(Y), 1379(Y
Neuro-psychiatric ser^dce, evacuation hospitals 1717(Y), 1739(Y
Neuro-psychiatric service, hospital centers 1826(Y
Neuro-surgical laboratory 1097(Y
Northeastern Department, health of troops in 1276(X
Nurse Corps, civil school students 1125(X
Nurse Corps, cooperation of civil schools of nursing 1125(X
IKDEX VOLUME II. 2163
rage.
surse Corps, development of school units 1125(X)
\ur-e Corps, dietitian service 112o(X)
Jurse Corps, hospital assistants 1126(X)
s'urse Corps, proo;ram of expansion 1125(X )
■fiirse (jorps, statistical summan,- of 1124(X )
•fnrsing, Army school of 1124(X)
v'^ursing service 1297( Y)'
■f ursing service, base hospitals 1761( Y)
Cursing service, evacuation hospitals lf)88( Y), 1710(Y)
■Jursing service, hospital centers 1813( Y)
s'^utrition section 1025(X)
Operating teams, base hospitals. 1725(Y), 1766(Y), 1922(Y)
)perating teams, evacuation hospitals
Operations, evacuation hospitals 1682( Y j
)phthalraic lectures 1103(X)'
")phthalmogist, conferences of 1103(XV
Ophthalmogist training, school for 1103('X /
)phthalmological department, base hospital 1933(Y)
)phthalmological service, evacuation hospitals 1718(Y)
)ptical units 1103(X)
Orthopedic activities in general and base hospitals 1105(X)
Orthopedic camp activities 1105(X)
Orthopedic cases on hospital trains 1742(Y)
)rthopedic equipment 1104(X)
'Orthopedic, experimental appliance shop 1104fX>
Orthopedic instruction 1]04(X )
Orthopedic surgen,', section of 1104fX )
Otological service, evacuation hospitals 1718(Y)
[Overseas mobile hospitals sent abroad after July 1, 1918 1180(X)
[Overseas patients, distribution of lieKX), 1]63(X)
Overseas wounded 1088(X)
Panama Canal Department, health of troops 1289(X)
Parat\-phoid fever 1311( Y)
Pathological and anatomical service 1327( Y)
Pathological and clinical service 1327( Y)
'atliological department, hospital centers 1869(Y>
I'athological laboratory, Base Hospital No. 31, historj' of 1797(Y>
'atients, method of handling, base hospital 1774(Y). 1878(Y)
Patients, number treated in hospital centers 1342( Y)
['atients, transfer of 1162(X)
pau, Basses-Pyrenees hospital center 1851( Y)
Payment of hospital charges, allies' hospitals ] 353( Y)
^'erigueux, hospital center 1850(Y)
Peripheal nerve injuries 1095(X)
Peripheal nerve operations 1096(X)
Peripheal nerves, special study of 1097f X)
Personnel division '. lllOfX ), 1290( Y)
:'er8onnel division activities, Xov. 11, 1918, to May 31, 1919 1296(Y)
Personnel division, embarkation service 1265(X)
r*ersonnel division, lines of communication 1295(Y)
Personnel division, organization 1290(Y)
i'ersonnel, increase in strength llll(X)
'ersonnel required, Medical Department 1292(Y)
Philippine Department, health conditions 1285(X )
^hysical examinations 1032(X)
Physical reconstruction, division of 1171(X)
Physical reconstruction, general hospitals used 1171(X)
'hysical reconstruction, section of education 1176(X)
'hysical reconstruction, section of physiotherapy 1177(X)
'hysical reconstruction, section on convalescent centers 1178(Xy
'hyeical reconstruction, section on publicity 1178(X)
'hysiology section. Air Service 1388(Y)
Mcardy, battle of, medical rexiew of 1471( Y)
^lastic and oral surgery, course of instruction 1104(X)
'neumonia at Brest 2049(Y)
'neumonia, base hospitals 1781(Y), 1917(Y), 1952(Y), 1954(Y), 1990(Y), 2004(Y)
'neumonia, base sections 2034(Y), 2049(Y>
142367— 19— vor. 2 75
2164 INDEX VOLUME II.
Pag
Pneumonia, camp hospitals, . . 2069(Y), 2073(Y), 2091(Y), 2097(Y), 2099(Y), 2104(Y
2112(Y), 2120(Y), 2123(Y), 2125(Y), 2129(Y), 2131(Y), 2137(Y), 2142C
Pnemnonia epidemic, 1918 1033(]
Pneumonia epidemic on transports 2052(^
Pneumonia, evacuation hospitals 1705(Y), 1731(Y), 1739(^
Pneumonia, hospital centers 1820( Y ), 1823(1
Portable bathing and delousing units 1404("5i
Port of debarkation, division IGSl^S
Post-operative cases, advanced hospitals 1791( r
Post-operative cases, base hospitals 1771(Y
Preliminary work, base hospitals 1878( r
Preparation of plans for hospitals. ^i^^.^"^
Primary dressings, advanced hospitals 1786("S
Primary dressing, base hospital 1910( Y
Prisoners of war, repatriation of 1543( n
Procurement of hospitals by leases 1143(X
Procurement section, hospital division 114UX
Professional service, development 1367( Y
Professional serxdces - 1370(Y), 1487 (Y
Professional services, evacuation hospitals 1716(Y
Promotion, system of - 1293(Y
Property division, embarkation service 1271(X
Providence hospital 1258(X
Psychology, section of ^^'.'^''^
Psychology, section, Air Service 13880^
Psychoneuroses 1382(1
Pulmonary tuberculosis, divisional reports 1554(1
Pulmonary tuberculosis, hospital centers 1817 (^^
Purchase of land for hospital buildings 1147(X
Rat investigation 1329(Y
Receiving and evacuation service, hospital centers 1811(Y
ReceiAang wards, hospital centers 1821(Y
Recommendations, Chief Surgeon's Office, May 29, 1919, to the commanding
officer. Service of Supplies 1439( Y
Recommendations, evacuation hospitals 1690(Y
Recording civilian personnel, special department 1352(Y
Recording disbursements _..-.. ■'^'^^^(^
Red Cross organization, United States Army Ambulance Service 1411( Y
Remount depots i^ot/ v
Replacement divisions, problem of • 1^*2 '/^
Respiratory diseases, base hospitals 1777(Y), 1968(Y), 1979( i
Respiratory infections, base hospitals 1929(Y
Resuscitation, advanced hospitals 1788(_i
Rimaucourt, hospital center loco/v
Riviera, hospital center ii nsf^
Roentgenology, section of iIvq/^
Russian front, medical review of i r^i /\
Samer, diA-isional report T cEj /v
Sanitation Tooi/A
Sanitation, base hospitals onSi"!
Sanitation, base sections T^-Qn
:Sanitation, divisional report Vn^V/V^ WnlA
.■Sanitation, division of -^"^^^^^'jnyrk
Sanitation division, organization of iR9-n
Sanitation, hospital centers \d9({A
Sanitation of field army j^-^u
Sanitation, Second Army ^^•*"^*. :
Sanitarv Corps, strength, by rank :[ |
Sanitary Corps, strength, by weeks ^\
Sanitary inspectors. . ............ - - ... ■■•••••. \^^\)i,
Sanitary inspector's division, Embarkation Service i^b^L
Sanitary organization, divisional report joU3(^
Sanitary troop, organization of, division joub^
Sanitary sections. Second Army ^aoq)^
Sanitary squads. Second Army - - - - - ••■■••■••: t^fQ,
Sanitary squad units sections, ambulance service with the French Army. . 14U9( •
INDEX VOLUME II. 2165
Pa?e.
,. . . 1665(Y)
antiary trains, division? 1313( Y)
cables - li42(X)
chedule of hospital buildings 1525fY)
econd Army, area occupied • • - -. ■ ^ S26/ Y")
econd Army, chief surgeon 's office, organization of 1525^Y)
,econd Army, constituents of 1546(Y)
lecond Army, general health 1525(Y)
econd Army, Medical Department units 1596(Y)
econd Armv, professional consultants , :^2-j(y\
,econd Battle of the Mame, provisional reports 1473 Y>
iecond Battle of the Marne, medical review of 1477(Y)
second Corps, medical re\dew of 1522(Y)
?econd Corps with British - - - 1792(Y)
5econdarv hemorrhage, advanced hospitals 1818(Y)
Secondary hemorrhage, hospital centers 1021(X)
section of communicable diseases 1024(X)
section of sanitary engineering 1869(Y)
serological department, hospital centers 1328fY)
serological service - 1773(Y)
Serological work, base hospitals 1945CY)
Shell shock, base hospitals 1642(Y)
Shell shock, divisional reports 1711( Y)
Shock wards, evacuation hospitals - .- , 9q2/Y )
Shortage personnel. Medical Department, vanous units 663( Y>
Sick, treatment of, in billets, di\nsional reports. . . , 1343(Y>
Sick and wounded reports, division of 1699(Y)
Souillv offensive, evacuation hospitals. 1'>89('X)
Southeastern Department, health of troops m 198^(X)
Southeastern Department, sanitary conditions 1976(X>
Southern Department, health of troops m 1977(X>
Southern Department, sanitary conditions iTeSc X)
Statistical section, hospital division 1776(Y)
Statistics, base hospitals ^^-g/ y)
St. Die sector, di\nsional reports ■-■••. • 1476(Y)
St. Mihiel-Meuse-Argonne offensive, medical review of . . - - ■•-•■-■ ^VsV/y^ 1951 Y>
St. Mihiel offensive, divisional reports 1559(Y), 1585U , i^JM^;
St. Mihiel offensive, base hospitals i fiS3( Y^' 1799( Y>
St. Mihiel offensive, evacuation hospitals ^^°^^ ^ '• j5|4(Y)
St. Mihiel offensive. First Army 10'^9(X>
Students' Army Training Corps 1409(Y)
Supervisors of bathing and delousing, duties of 1493(Y)
Supplies, distribution of 1743(Y)
Supplies, ho.spital trains 1491(Y)
Supplies, purchase of in Europe 1347(Y)
Supply depots. 1490(Y)
Supply reserve, liuilding oi 1084(X)
Surgery, diN-ision of - ■ 1790(Y)
Surgery, general, advance hospital 1905( Y)
Surgical cases, handling of in base hospitals 1087(X>
Surgical conservation and reclamation 1086(X)
Surgical consultants • - - 1884(Y)
Surgical department, base hospitals 1644(Y)
Surgical department, divisional reports. . . 1705(Y)
Surgical department, evacuation hospital, Coblenz 1084(X>
Surgical efficiency, maintenance of 1085( X)
Surgical instruction 1085(X)
Surgical monthly reports 1102(X)
Surgical museum records 1086(X)
suSl-vl;-;?Si;o^itais;;-i^^^^^
Surgiral service, hospital centers 1084(X)
Surgical service, school for surgeons 1095( X)
Surgical surgery of end results 1702( Y)
Surgical teams V«'qV( y{ iVoVVY) 1947(Y)
Surgical teams, base hospitals Vsciv/v^ iQlfi Y ' 1951 Y)' 20O4(Y)
Surgical work, base hospitals 18fl7(\ ). 191(j( \ ». IH.^K i ). -w-m /
2166 INDEX VOLUME II.
Surgical work, camp hospitals 2091(Y), 2116(Y)
Surgical work, evacuation hospitals 1707(Y)
Technical work, base hospitals 1951( Y)
Tetanus, advanced hospitals 1791(Y)
"Three-day fever" 1581(Y)
Tonnage allotments 1492( Y)
Toul section, division surgeon's report 1657( Y)
Train triage, hospital center 1860(Y)
Training area, divisional report 1658(Y)
Training Medical Department personnel, divisional reports 1645(Y)
Transport division, embarkation service 1266(X)
Transport service, tv-pe of ships 1260(X)
Transfusion, base hospitals 1906( Y)
Transfusions, advanced hospitals 1793(Y)
Transportation division, embarkation service 1267(X)
Transportation, hospital centers 1839( Y)
Transportation overseas, divisional reports 1665( Y)
Transportation, Second Army 1528(Y)
Transports, condition of troops upon arrival 1311( Y)
Transports, sanitary condition on, divisional reports 1650(Y)
Trench feet 1578(Y)
Trench fever, base hospitals 1782(Y), 1904(Y)
Triage 1786( Y)
Triage, base hospital reports 1909( Y)
Triage, divisional reports , 1570(Y), 1573(Y)
Triage operating teams, evacuation hospital reports 1710( Y)
Triage, stations 1701( Y )
Tribute to the medical man from civil life 1488( Y)
Tuberculosis, base hospitals 1930(Y)
Tuberculosis section 1370( Y)
Tuberculosis, section of 1069(X)
Type of service. United States Army Ambulance Service 1412(Y)
Typhoid bac illus carriers ". 1046(X)
Typhoid fever 1311( Y)
Typhoid fever, base hospitals 1904(Y), 1955(Y). 1964( Y)
Typhoid fever, camp hospitals 2095(Y)
Typhoid fever, divisional reports 1633(Y)
T>-phoid fever, mobile hospitals 2060(Y)
Ulcerative h-mphangitis, veterinary service 1231(X)
United States (see Key) 2151
United States Ambulance Service, history of 1484(Y)
United States Ambulance Service, organization of 1484(Y)
United States Army Ambulance Service, Battle of the Argonne 1414(Y]
Unloading of hospital trains 1743(Y)
Urological department. Sec ond Army 1544( Y)
Urologl' al service, base hospitals. 1914(Y)
Urological servic e. base sections 2037(Y)
Urology, setion of 1108(X)
Yenereal diseases 1312(Y)
Venereal diseases, divisional reports 1634( Y)
Yenereal diseases, section for combating 1058(X)
History of 1059(X)
Per-sonnel • 1060(X)
Equipment 1062(X)
Vermin disinfestation 1030(X)
Vermin infestation 1030(X)
Verdun offensive, divisional reports 1587( Y)
Verdun offensive, evacuation hospitals 1705(Y)
Veterinary Corps 13fi2( Y)
Veterinary Corps, disojssion of comptroller relative to 1202(X]
Veterinary Corps, enlisted personnel 1203(X]
Veterinary Corps, laboratory service 1210(X)
\'eterinary Corps, strength, by rank 11 18
Veterinary Corps, strength, by weeks 1118
Veterinary divisions 1200(X)
A'eterinary division, personnel ]200(X)
INDEX VOLUME II. 2167
t^ Page.
. inaiy field hospital units. : lojcl v
rinary hospital construction n olo/' v^
1 inarj- hospitalization i oi o/ y\
rinary instruction and training o /vl
rinary sanitation ^ oin
rinary service, American Expeditionary Forces I'^IO
rinary service at camps ■'^onft^Yl
rinary service at military posts. -^ _(^|
rinary service, instruction in operative surgery 1215(X)
rinarj- service, overseas departments 1206(X )
rinary service, ports of embarkation depots 1205(X)
,\ eterinary service, Siberia 1213(X)
Veterinary supplies ^^^"(^^
Veterinary training school, Camp Greenleaf 1214(X)
Veterinary training school, Camp Lee 1215(X)
Veterinary training school. Fort Riley 1214(X)
V'^eterinary transport service 1205(X)
Vichey, hospital center ^^^?^X^
Vittel hospital center 1755( Y)
War psychoses 1381(Y)
Water supply, hospital train 1744(Y)
Water supply, section of 1334(1 )
Water supply service. Second Army 1538( Y)
Weekly bed reports 1162(X)
Wounded, care of. divisional .- 1555(Y)
Wounds, treatment of, base hospitals 1906(Y)
'X" (see key) 2150
X-ray department, base hospitals 1933(Y)
X-ray units, development of 1189(X)
X-ray work, advanced hospitals 1786(Y)
X-ray work, base hospitals 1910( Y)
•' Y" (see key) ; 2151
Yale Army Laboratory School 1052(X)
Course of instruction 1G55(X)
Bacteriology 1055(X)
Pathology 1056(X)
Miscroscipy, clinical 1056(X)
Chemistry 1056(X
Conclusion 1057(X)
o
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